Unilateral pedunculopontine stimulation improves falls in Parkinson's disease
Identifieur interne : 001B19 ( Main/Exploration ); précédent : 001B18; suivant : 001B20Unilateral pedunculopontine stimulation improves falls in Parkinson's disease
Auteurs : Elena Moro [Canada] ; Clement Hamani [Canada] ; Yu-Yan Poon [Canada] ; Thamar Al-Khairallah [Canada, Arabie saoudite] ; Jonathan O. Dostrovsky [Canada] ; William D. Hutchison [Canada] ; Andres M. Lozano [Canada]Source :
- Brain [ 0006-8950 ] ; 2010-01.
Descripteurs français
English descriptors
- KwdEn :
- Accidental Falls (prevention & control), Aged, Deep Brain Stimulation (methods), Deep brain stimulation, Double-Blind Method, Female, Humans, Male, Middle Aged, Nervous system diseases, Parkinson Disease (complications), Parkinson Disease (physiopathology), Parkinson Disease (therapy), Parkinson disease, Pedunculopontine Tegmental Nucleus (physiology), Pilot Projects, Postural Balance (physiology).
- MESH :
- complications : Parkinson Disease.
- methods : Deep Brain Stimulation.
- physiology : Pedunculopontine Tegmental Nucleus, Postural Balance.
- physiopathology : Parkinson Disease.
- prevention & control : Accidental Falls.
- therapy : Parkinson Disease.
- Aged, Double-Blind Method, Female, Humans, Male, Middle Aged, Pilot Projects.
Abstract
Postural instability and falls are a major source of disability in patients with advanced Parkinson's disease. These problems are currently not well addressed by either pharmacotherapy nor by subthalamic nucleus deep-brain stimulation surgery. The neuroanatomical substrates of posture and gait are poorly understood but a number of important observations suggest a major role for the pedunculopontine nucleus and adjacent areas in the brainstem. We conducted a double-blinded evaluation of unilateral pedunculopontine nucleus deep-brain stimulation in a pilot study in six advanced Parkinson's disease patients with significant gait and postural abnormalities. There was no significant difference in the double-blinded on versus off stimulation Unified Parkinson's Disease Rating Scale motor scores after 3 or 12 months of continuous stimulation and no improvements in the Unified Parkinson's Disease Rating Scale part III scores compared to baseline. In contrast, patients reported a significant reduction in falls in the on and off medication states both at 3 and 12 months after pedunculopontine nucleus deep-brain stimulation as captured in the Unified Parkinson's Disease Rating Scale part II scores. Our results suggest that pedunculopontine nucleus deep-brain stimulation may be effective in preventing falls in patients with advanced Parkinson's disease but that further evaluation of this procedure is required.
Url:
DOI: 10.1093/brain/awp261
Affiliations:
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These problems are currently not well addressed by either pharmacotherapy nor by subthalamic nucleus deep-brain stimulation surgery. The neuroanatomical substrates of posture and gait are poorly understood but a number of important observations suggest a major role for the pedunculopontine nucleus and adjacent areas in the brainstem. We conducted a double-blinded evaluation of unilateral pedunculopontine nucleus deep-brain stimulation in a pilot study in six advanced Parkinson's disease patients with significant gait and postural abnormalities. There was no significant difference in the double-blinded on versus off stimulation Unified Parkinson's Disease Rating Scale motor scores after 3 or 12 months of continuous stimulation and no improvements in the Unified Parkinson's Disease Rating Scale part III scores compared to baseline. In contrast, patients reported a significant reduction in falls in the on and off medication states both at 3 and 12 months after pedunculopontine nucleus deep-brain stimulation as captured in the Unified Parkinson's Disease Rating Scale part II scores. Our results suggest that pedunculopontine nucleus deep-brain stimulation may be effective in preventing falls in patients with advanced Parkinson's disease but that further evaluation of this procedure is required.</div></front></TEI><affiliations><list><country><li>Arabie saoudite</li><li>Canada</li></country><region><li>Ontario</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name></region><name sortKey="Al Khairallah, Thamar" sort="Al Khairallah, Thamar" uniqKey="Al Khairallah T" first="Thamar" last="Al-Khairallah">Thamar Al-Khairallah</name><name sortKey="Dostrovsky, Jonathan O" sort="Dostrovsky, Jonathan O" uniqKey="Dostrovsky J" first="Jonathan O." last="Dostrovsky">Jonathan O. Dostrovsky</name><name sortKey="Dostrovsky, Jonathan O" sort="Dostrovsky, Jonathan O" uniqKey="Dostrovsky J" first="Jonathan O." last="Dostrovsky">Jonathan O. Dostrovsky</name><name sortKey="Hamani, Clement" sort="Hamani, Clement" uniqKey="Hamani C" first="Clement" last="Hamani">Clement Hamani</name><name sortKey="Hutchison, William D" sort="Hutchison, William D" uniqKey="Hutchison W" first="William D." last="Hutchison">William D. Hutchison</name><name sortKey="Hutchison, William D" sort="Hutchison, William D" uniqKey="Hutchison W" first="William D." last="Hutchison">William D. Hutchison</name><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><name sortKey="Poon, Yu Yan" sort="Poon, Yu Yan" uniqKey="Poon Y" first="Yu-Yan" last="Poon">Yu-Yan Poon</name></country><country name="Arabie saoudite"><noRegion><name sortKey="Al Khairallah, Thamar" sort="Al Khairallah, Thamar" uniqKey="Al Khairallah T" first="Thamar" last="Al-Khairallah">Thamar Al-Khairallah</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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