Bilateral deep brain stimulation of the pedunculopontine nucleus for Parkinson's disease

Abstract

Gait disturbance and postural instability are some the most disabling symptoms of idiopathic Parkinson's disease and in late stage disease can be resistant to both medical and surgical therapies. We implanted bilateral deep brain stimulation electrodes into the pedunculopontine nucleus in two patients with advanced Parkinson's disease. We demonstrate for the first time that low frequency (20-25 Hz) stimulation of this nucleus significantly improves gait dysfunction and postural instability in both the 'on' and 'off' medication states. Their combined total Unified Parkinson's Disease Rating Scale score improved by 53% and motor score by 57%. No procedure or stimulation-related complications were observed. If these findings are replicated in a larger number of patients, pedunculopontine nucleus stimulation may provide the means to alleviate these disabling and otherwise treatment-resistant symptoms of advanced Parkinson's disease.

Postural control anomalies in children with Tourette syndrome

“…There is evidence of mesencephalic anomalies in TS (Garraux et al 2006). Also, PTN dysfunction has been associated with postural instability and gait akinesia in Parkinson's disease (Pahapill and Lozano 2000) and stimulation of the PTN in patients with Parkinson's disease can result in a decrease in postural instability (Plaha and Gill 2005). The basal ganglia contribute to many aspects of feedback-based postural control including sensory signal processing, sensorimotor integration as well as attentional modulation (Abbruzzese and Berardelli 2003;Visser and Bloem 2005).…”

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

“…In light of these data, small experimental trials of low frequency PPN stimulation in humans were carried out. These studies have lead to variable results (Plaha and Gill, 2005;Stefani et al, 2007Stefani et al, , 2010Mazzone et al, 2007Mazzone et al, , 2008Pereira et al, 2008;Pierantozzi et al, 2008;Alessandro et al, 2010;Peppe et al, 2010;Rauch et al, 2010). In some patients, PPN DBS reduces gait and freezing problems unresponsive to drug and conventional stimulation approaches directed at subthalamic and pallidal targets, reduces falls and occasionally improves patients' state of vigilance and quality of sleep (Pereira et al, 2008;Ferraye et al, 2010).…”

Altered neuronal activity relationships between the pedunculopontine nucleus and motor cortex in a rodent model of Parkinson's disease

“…The PPN has also recently emerged as a target for deep brain stimulation (DBS) in Parkinson's disease (PD) and early DBS results show amelioration of medically intractable akinesia and gait abnormalities (Mazzone et al, 2005;Plaha and Gill, 2005;Stefani et al, 2007).…”