PMID- 28960543
OWN - NLM
STAT- In-Data-Review
LR  - 20180113
IS  - 1531-8257 (Electronic)
IS  - 0885-3185 (Linking)
VI  - 33
IP  - 1
DP  - 2018 Jan
TI  - Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A
      clinical review.
PG  - 10-20
LID - 10.1002/mds.27098 [doi]
AB  - Pedunculopontine nucleus region deep brain stimulation (DBS) is a promising but
      experimental therapy for axial motor deficits in Parkinson's disease (PD),
      particularly gait freezing and falls. Here, we summarise the clinical application
      and outcomes reported during the past 10 years. The published dataset is limited,
      comprising fewer than 100 cases. Furthermore, there is great variability in
      clinical methodology between and within surgical centers. The most common
      indication has been severe medication refractory gait freezing (often associated 
      with postural instability). Some patients received lone pedunculopontine nucleus 
      DBS (unilateral or bilateral) and some received costimulation of the subthalamic 
      nucleus or internal pallidum. Both rostral and caudal pedunculopontine nucleus
      subregions have been targeted. However, the spread of stimulation and variance in
      targeting means that neighboring brain stem regions may be implicated in any
      response. Low stimulation frequencies are typically employed (20-80 Hertz). The
      fluctuating nature of gait freezing can confound programming and outcome
      assessments. Although firm conclusions cannot be drawn on therapeutic efficacy,
      the literature suggests that medication refractory gait freezing and falls can
      improve. The impact on postural instability is unclear. Most groups report a lack
      of benefit on gait or limb akinesia or dopaminergic medication requirements. The 
      key question is whether pedunculopontine nucleus DBS can improve quality of life 
      in PD. So far, the evidence supporting such an effect is minimal. Development of 
      pedunculopontine nucleus DBS to become a reliable, established therapy would
      likely require a collaborative effort between experienced centres to clarify
      biomarkers predictive of response and the optimal clinical methodology. (c) 2017 
      International Parkinson and Movement Disorder Society.
CI  - (c) 2017 International Parkinson and Movement Disorder Society.
FAU - Thevathasan, Wesley
AU  - Thevathasan W
AD  - Department of Medicine, Royal Melbourne Hospital, University of Melbourne,
      Australia and the Bionics Institute of Australia, Melbourne, Australia.
FAU - Debu, Bettina
AU  - Debu B
AD  - Movement Disorders Center, Division of Neurology, Centre Hospitalier
      Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble, France.
FAU - Aziz, Tipu
AU  - Aziz T
AD  - Department of Neurosurgery, John Radcliffe Hospital, University of Oxford,
      Oxford, UK.
FAU - Bloem, Bastiaan R
AU  - Bloem BR
AD  - Department of Neurology, Donders Institute for Brain, Cognition and Behaviour,
      Radboud University, Nijmegen, the Netherlands.
FAU - Blahak, Christian
AU  - Blahak C
AD  - Department of Neurology, Universitatsmedizin Mannheim, University of Heidelberg, 
      Heidelberg, Germany.
FAU - Butson, Christopher
AU  - Butson C
AD  - Department of Bioengineering, Scientific Computing and Imaging Institute,
      University of Utah, Salt Lake City, USA.
FAU - Czernecki, Virginie
AU  - Czernecki V
AD  - Department of Neurology, Institut de Cerveau et de la Moelle epiniere, Sorbonne
      Universites, University Pierre-and-Marie-Curie (UPMC) Universite, Paris, France.
FAU - Foltynie, Thomas
AU  - Foltynie T
AD  - Sobell Department of Motor Neuroscience, University College London (UCL)
      Institute of Neurology, United Kingdom.
FAU - Fraix, Valerie
AU  - Fraix V
AD  - Movement Disorders Center, Division of Neurology, Centre Hospitalier
      Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble, France.
FAU - Grabli, David
AU  - Grabli D
AD  - Department of Neurology, Assistance Publique-Hopitaux de Paris, Pitie-Salpetiere 
      University Hospital, Paris, France.
FAU - Joint, Carole
AU  - Joint C
AD  - Department of Neurosurgery, John Radcliffe Hospital, University of Oxford,
      Oxford, UK.
FAU - Lozano, Andres M
AU  - Lozano AM
AD  - Department of Neurosurgery, Toronto Western Hospital, University of Toronto,
      Toronto, Canada.
FAU - Okun, Michael S
AU  - Okun MS
AD  - Departments of Neurology and Neurosurgery, University of Florida Center for
      Movement Disorders, Gainesville, Florida, USA.
FAU - Ostrem, Jill
AU  - Ostrem J
AD  - Department of Neurology, UCSF Movement Disorder and Neuromodulation Center,
      University of California, San Francisco, USA.
FAU - Pavese, Nicola
AU  - Pavese N
AD  - Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
AD  - Department of Clinical Medicine, Centre for Functionally Integrative
      Neuroscience, University of Aarhus, Aarhus, Denmark.
AD  - Department of Neurology, Hannover Medical School, Hannover, Germany.
FAU - Schrader, Christoph
AU  - Schrader C
AD  - Department of Neurology, Hannover Medical School, Hannover, Germany.
FAU - Tai, Chun-Hwei
AU  - Tai CH
AD  - Department of Neurology, National Taiwan University Hospital, College of
      Medicine, National Taiwan University, Taipei, Taiwan.
FAU - Krauss, Joachim K
AU  - Krauss JK
AD  - Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
FAU - Moro, Elena
AU  - Moro E
AD  - Movement Disorders Center, Division of Neurology, Centre Hospitalier
      Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble, France.
CN  - Movement Disorders Society PPN DBS Working Groupin collaboration with the World
      Society for Stereotactic and Functional Neurosurgery
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20170928
PL  - United States
TA  - Mov Disord
JT  - Movement disorders : official journal of the Movement Disorder Society
JID - 8610688
OTO - NOTNLM
OT  - Parkinson's disease
OT  - deep brain stimulation
OT  - gait freezing
OT  - pedunculopontine nucleus
EDAT- 2017/09/30 06:00
MHDA- 2017/09/30 06:00
CRDT- 2017/09/30 06:00
PHST- 2016/10/26 00:00 [received]
PHST- 2017/06/08 00:00 [revised]
PHST- 2017/06/14 00:00 [accepted]
PHST- 2017/09/30 06:00 [pubmed]
PHST- 2017/09/30 06:00 [medline]
PHST- 2017/09/30 06:00 [entrez]
AID - 10.1002/mds.27098 [doi]
PST - ppublish
SO  - Mov Disord. 2018 Jan;33(1):10-20. doi: 10.1002/mds.27098. Epub 2017 Sep 28.