2009
DOI: 10.1159/000268742
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Pedunculopontine Nucleus Deep Brain Stimulation in a Patient with Primary Progressive Freezing Gait Disorder

Abstract: Background: Pedunculopontine nucleus (PPN) deep brain stimulation (DBS) has recently been suggested for treatment of medication-unresponsive gait and axial symptoms in Parkinson’s disease. Patients with the rare primary progressive freezing gait disorder (PPFG) have similar disabling symptoms and few therapeutic options. We report here on our experience with PPN DBS in treating a 76-year-old man with medication-refractory PPFG. Methods: The patient was treated with staged PPN DBS and underwent careful pre- and… Show more

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Cited by 43 publications
(34 citation statements)
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“…Further, studies have used different landmarks when assessing their data, including the AC-PC or the B-F system. Another issue is that, even when electrodes were placed in apparently the same brainstem region, patients were stimulated through different contacts (some in the caudal PPN, others in the rostral PPN) [6,7,8,13,17,22,23,25,28,30,52,53]. …”
Section: Postoperative Imagingmentioning
confidence: 99%
“…Further, studies have used different landmarks when assessing their data, including the AC-PC or the B-F system. Another issue is that, even when electrodes were placed in apparently the same brainstem region, patients were stimulated through different contacts (some in the caudal PPN, others in the rostral PPN) [6,7,8,13,17,22,23,25,28,30,52,53]. …”
Section: Postoperative Imagingmentioning
confidence: 99%
“…However, the amount of dual innervation has not been quantified. Besides, the case studies of PPN stimulation (as a single target) for FOG have shown benefit with bilateral stimulation [19,20]. We feel that bilateral surgery will offer additional benefits in patients compared to unilateral surgery.…”
Section: Discussionmentioning
confidence: 99%
“…It also has connections with the contralateral PPN [10,11,12]. Considering these observations, PPN stimulation has been performed with beneficial effects, improving gait and freezing in patients with Parkinson's disease [13,14,15,16,17,18] and primary freezing of gait (FOG) [19,20]. To date, results of the first open and blinded study series of Parkinson's disease patients treated with PPN deep brain stimulation (DBS) have shown promising results in improving gait and balance [14,16,17].…”
Section: Introductionmentioning
confidence: 99%
“…The influence of the PPTg on fastigial and interpositus nuclei may also play a role in the origin of gait and postural instability in advanced PD, a point at which patients are refractory to dopaminergic medication but are able to benefit from deep brain stimulation of the PPTg [29,[32][33][34][35]131]. This evidence has led some authors to consider gait and axial disturbances in PD as possible consequences of a disruption of ACh mechanisms in the brainstem rather than of the nigrostriatal dopaminergic system; and the severity of these motor disabilities has been directly related to the degree of ACh neuronal loss in the PPTg [132,133].…”
Section: Investigating Whether the Pptg Influences The Cerebral Cortementioning
confidence: 99%