Peduncolopontine nucleus stimulation in progressive supranuclear palsy: a randomised trial

Scelzo, Emma; Lozano, Andrés M.; Hamani, Clement; Poon, Yu‐Yan; AlDakheel, Amaal; Zadikoff, Cindy; Lang, Anthony E.; Moro, Elena

doi:10.1136/jnnp-2016-315192

Cited by 28 publications

(24 citation statements)

References 7 publications

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“…This is an unusual subgroup, perhaps comprising around 5% of patients with PD . Indeed, some of these patients may later declare features of an atypical parkinsonian disorder . Patients with medication responsive freezing and motor fluctuations are candidates for established therapies such as STN or GPi DBS …”

Section: Resultsmentioning

confidence: 99%

Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review

et al. 2017

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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. © 2017 International Parkinson and Movement Disorder Society

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Section: Resultsmentioning

confidence: 99%

Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review

et al. 2017

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“…58,64 Deep brain stimulation of the pedunculopontine nucleus has been attempted in advanced PSP-RS, however there were no clear benefits observed and unacceptable side effects. 65 …”

Section: Therapeutics (Table 2)mentioning

confidence: 99%

Advances in progressive supranuclear palsy: new diagnostic criteria, biomarkers, and therapeutic approaches

Boxer

Golbe

et al. 2017

The Lancet Neurology

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Progressive supranuclear palsy (PSP), once simply considered a common cause of atypical parkinsonism is now recognized as a spectrum of motor and behavioral syndromes associated with a specific four repeat (4R) tau neuropathology at autopsy. There are currently no effective treatments for PSP, but because PSP is strongly linked biochemically and genetically to tau protein abnormalities, there is a growing interest in pursuing clinical trials of new tau-directed therapies for this disorder. Such new tau therapies are envisioned to have disease-modifying effects by reducing brain levels of toxic forms of tau or compensating for loss of tau function. To be most effective, these treatments will need to be initiated at early stages of disease. New research criteria that recognize early forms of PSP and operationalize diagnosis of the full spectrum of clinical phenotypes have recently been published. These criteria and new clinical trial designs have benefited from rapid advances in MRI, physiological and fluid biomarker development for PSP. As tau pathology is also central to Alzheimer’s disease and chronic traumatic encephalopathy, it is believed that a successful tau therapeutic for PSP would inform the treatment of other neurodegenerative diseases.

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“…Of these, 62 articles were identi ed as irrelevant literatures based on their titles and abstracts and were therefore eliminated. Among 32 potentially relevant articles, 10 were excluded because they were the abstracts of poster presentations; patients from 5 articles [27][28][29][30][31] overlapped with those in other studies [21,32] and these 5 articles were excluded; 4 articles [33][34][35][36] had no extracted data and were excluded. 13 articles were nally included in the analysis containing 36 PSP patients: 32 with PPN-DBS, 1 with STN-DBS, 1 with GPi-DBS, 2 with compound DBS.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Additionally, 3 studies mentioned the adverse events about DBS. Intraoperative bleeding is a major surgical adverse event and it occurred in 2 patients with unknown reasons [32]. Other surgical adverse events included apathy and a buccofacial apraxia, which were transient and recoverable [20].…”

Section: Other Outcomesmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Deep Brain Stimulation for Progressive Supranuclear Palsy

Yan¹,

Jiao²,

Zhou³

et al. 2020

Preprint

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Background: Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease and currently no effective symptomatic or neuroprotective treatment is available for PSP. Deep brain stimulation (DBS), as a neurosurgical procedure, plays an important role in a range of neurological and psychiatric disorders. However, there are no systematic investigations about the DBS in PSP patients. Objective: We performed a systematic review and meta-analysis to evaluate the safety and efficacy of DBS for PSP. Methods: PubMed, EMBASE, Cochrane library, Chinese National Knowledge Infrastructure and Wan Fang databases were systematically searched without time restrictions. We assessed the data between DBS-OFF and DBS-ON groups, as measured by the Unifed Parkinson Disease Rating Scale (UPDRS). Results: Of 154 identified studies, 13 were eligible and were included in our meta-analysis (N = 36 participants). A reduction of UPDRS Ⅲ scores under DBS-ON conditions was observed, but the differences yielded no statistical significance. Conclusion: Since part of PSP patients could benefit from DBS, we speculate that DBS may become a safe and promising tool for PSP in axial symptoms as well as non-motor symptoms though further investgations are needed. Our findings will provide design strategies for following clinical trials and ultimately help improve the clinical application of DBS in PSP patients.

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Peduncolopontine nucleus stimulation in progressive supranuclear palsy: a randomised trial

Cited by 28 publications

References 7 publications

Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review

Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review

Advances in progressive supranuclear palsy: new diagnostic criteria, biomarkers, and therapeutic approaches

A Systematic Review and Meta-Analysis of Deep Brain Stimulation for Progressive Supranuclear Palsy

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