Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review.
Identifieur interne : 000632 ( Main/Exploration ); précédent : 000631; suivant : 000633Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review.
Auteurs : Wesley Thevathasan [Australie] ; Bettina Debu [France] ; Tipu Aziz [Royaume-Uni] ; Bastiaan R. Bloem [Pays-Bas] ; Christian Blahak [Allemagne] ; Christopher Butson [États-Unis] ; Virginie Czernecki [France] ; Thomas Foltynie [Royaume-Uni] ; Valerie Fraix [France] ; David Grabli [France] ; Carole Joint [Royaume-Uni] ; Andres M. Lozano [Canada] ; Michael S. Okun [États-Unis] ; Jill Ostrem [États-Unis] ; Nicola Pavese [Royaume-Uni] ; Christoph Schrader [Allemagne] ; Chun-Hwei Tai [Taïwan] ; Joachim K. Krauss [Allemagne] ; Elena Moro [France]Source :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2017.
Abstract
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.
DOI: 10.1002/mds.27098
PubMed: 28960543
Affiliations:
- Allemagne, Australie, Canada, France, Pays-Bas, Royaume-Uni, Taïwan, États-Unis
- Angleterre, Auvergne-Rhône-Alpes, Bade-Wurtemberg, Basse-Saxe, Californie, District de Karlsruhe, Floride, Grand Londres, Gueldre, Ontario, Oxfordshire, Rhône-Alpes, Victoria (État), Île-de-France
- Grenoble, Hanovre, Heidelberg, Londres, Melbourne, Nimègue, Oxford, Paris, San Francisco, Toronto
- University College de Londres, Université d'Oxford, Université de Melbourne, Université de Toronto
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wicri:level="3"><nlm:affiliation>Department of Neurology, Institut de Cerveau et de la Moelle épinière, Sorbonne Universités, University Pierre-and-Marie-Curie (UPMC) Université, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Neurology, Institut de Cerveau et de la Moelle épinière, Sorbonne Universités, University Pierre-and-Marie-Curie (UPMC) Université, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Foltynie, Thomas" sort="Foltynie, Thomas" uniqKey="Foltynie T" first="Thomas" last="Foltynie">Thomas Foltynie</name><affiliation wicri:level="4"><nlm:affiliation>Sobell Department of Motor Neuroscience, University College London (UCL) Institute of Neurology, United Kingdom.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Sobell Department of Motor Neuroscience, University College London (UCL) Institute of Neurology</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">University College de Londres</orgName></affiliation></author><author><name sortKey="Fraix, Valerie" sort="Fraix, Valerie" uniqKey="Fraix V" first="Valerie" last="Fraix">Valerie Fraix</name><affiliation wicri:level="3"><nlm:affiliation>Movement Disorders Center, Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Movement Disorders Center, Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble</wicri:regionArea><placeName><region 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wicri:level="4"><nlm:affiliation>Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford</wicri:regionArea><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region><settlement type="city">Oxford</settlement></placeName><orgName type="university">Université d'Oxford</orgName></affiliation></author><author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M" last="Lozano">Andres M. Lozano</name><affiliation wicri:level="4"><nlm:affiliation>Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Okun, Michael S" sort="Okun, Michael S" uniqKey="Okun M" first="Michael S" last="Okun">Michael S. Okun</name><affiliation wicri:level="2"><nlm:affiliation>Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders, Gainesville, Florida, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders, Gainesville, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Ostrem, Jill" sort="Ostrem, Jill" uniqKey="Ostrem J" first="Jill" last="Ostrem">Jill Ostrem</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, UCSF Movement Disorder and Neuromodulation Center, University of California, San Francisco, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, UCSF Movement Disorder and Neuromodulation Center, University of California, San Francisco</wicri:regionArea><placeName><settlement type="city">San Francisco</settlement><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Pavese, Nicola" sort="Pavese, Nicola" uniqKey="Pavese N" first="Nicola" last="Pavese">Nicola Pavese</name><affiliation wicri:level="1"><nlm:affiliation>Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Institute of Neuroscience, Newcastle University, Newcastle upon Tyne</wicri:regionArea><wicri:noRegion>Newcastle upon Tyne</wicri:noRegion></affiliation></author><author><name sortKey="Schrader, Christoph" sort="Schrader, Christoph" uniqKey="Schrader C" first="Christoph" last="Schrader">Christoph Schrader</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, Hannover Medical School, Hannover, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Hannover Medical School, Hannover</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Hanovre</settlement></placeName></affiliation></author><author><name sortKey="Tai, Chun Hwei" sort="Tai, Chun Hwei" uniqKey="Tai C" first="Chun-Hwei" last="Tai">Chun-Hwei Tai</name><affiliation wicri:level="1"><nlm:affiliation>Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.</nlm:affiliation><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Krauss, Joachim K" sort="Krauss, Joachim K" uniqKey="Krauss J" first="Joachim K" last="Krauss">Joachim K. Krauss</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurosurgery, Hannover Medical School, Hannover, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurosurgery, Hannover Medical School, Hannover</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Hanovre</settlement></placeName></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation wicri:level="3"><nlm:affiliation>Movement Disorders Center, Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Movement Disorders Center, Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2017">2017</date><idno type="RBID">pubmed:28960543</idno><idno type="pmid">28960543</idno><idno type="doi">10.1002/mds.27098</idno><idno type="wicri:Area/PubMed/Corpus">000464</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000464</idno><idno type="wicri:Area/PubMed/Curation">000462</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">000462</idno><idno type="wicri:Area/PubMed/Checkpoint">000462</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">000462</idno><idno type="wicri:Area/Ncbi/Merge">004F55</idno><idno type="wicri:Area/Ncbi/Curation">004F55</idno><idno type="wicri:Area/Ncbi/Checkpoint">004F55</idno><idno type="wicri:Area/Main/Merge">000627</idno><idno type="wicri:Area/Main/Curation">000632</idno><idno type="wicri:Area/Main/Exploration">000632</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review.</title><author><name sortKey="Thevathasan, Wesley" sort="Thevathasan, Wesley" uniqKey="Thevathasan W" first="Wesley" last="Thevathasan">Wesley Thevathasan</name><affiliation wicri:level="4"><nlm:affiliation>Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia and the Bionics Institute of Australia, Melbourne, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia and the Bionics Institute of Australia, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region><settlement type="city">Melbourne</settlement></placeName><orgName type="university">Université de Melbourne</orgName></affiliation></author><author><name sortKey="Debu, Bettina" sort="Debu, Bettina" uniqKey="Debu B" first="Bettina" last="Debu">Bettina Debu</name><affiliation wicri:level="3"><nlm:affiliation>Movement Disorders Center, Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Movement Disorders Center, Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Aziz, Tipu" sort="Aziz, Tipu" uniqKey="Aziz T" first="Tipu" last="Aziz">Tipu Aziz</name><affiliation wicri:level="4"><nlm:affiliation>Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford</wicri:regionArea><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region><settlement type="city">Oxford</settlement></placeName><orgName type="university">Université d'Oxford</orgName></affiliation></author><author><name sortKey="Bloem, Bastiaan R" sort="Bloem, Bastiaan R" uniqKey="Bloem B" first="Bastiaan R" last="Bloem">Bastiaan R. Bloem</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.</nlm:affiliation><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Blahak, Christian" sort="Blahak, Christian" uniqKey="Blahak C" first="Christian" last="Blahak">Christian Blahak</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Heidelberg, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Butson, Christopher" sort="Butson, Christopher" uniqKey="Butson C" first="Christopher" last="Butson">Christopher Butson</name><affiliation wicri:level="1"><nlm:affiliation>Department of Bioengineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Bioengineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City</wicri:regionArea><wicri:noRegion>Salt Lake City</wicri:noRegion></affiliation></author><author><name sortKey="Czernecki, Virginie" sort="Czernecki, Virginie" uniqKey="Czernecki V" first="Virginie" last="Czernecki">Virginie Czernecki</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, Institut de Cerveau et de la Moelle épinière, Sorbonne Universités, University Pierre-and-Marie-Curie (UPMC) Université, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Neurology, Institut de Cerveau et de la Moelle épinière, Sorbonne Universités, University Pierre-and-Marie-Curie (UPMC) Université, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Foltynie, Thomas" sort="Foltynie, Thomas" uniqKey="Foltynie T" first="Thomas" last="Foltynie">Thomas Foltynie</name><affiliation wicri:level="4"><nlm:affiliation>Sobell Department of Motor Neuroscience, University College London (UCL) Institute of Neurology, United Kingdom.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Sobell Department of Motor Neuroscience, University College London (UCL) Institute of Neurology</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">University College de Londres</orgName></affiliation></author><author><name sortKey="Fraix, Valerie" sort="Fraix, Valerie" uniqKey="Fraix V" first="Valerie" last="Fraix">Valerie Fraix</name><affiliation wicri:level="3"><nlm:affiliation>Movement Disorders Center, Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Movement Disorders Center, Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Grabli, David" sort="Grabli, David" uniqKey="Grabli D" first="David" last="Grabli">David Grabli</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtière University Hospital, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtière University Hospital, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Joint, Carole" sort="Joint, Carole" uniqKey="Joint C" first="Carole" last="Joint">Carole Joint</name><affiliation wicri:level="4"><nlm:affiliation>Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford</wicri:regionArea><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region><settlement type="city">Oxford</settlement></placeName><orgName type="university">Université d'Oxford</orgName></affiliation></author><author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M" last="Lozano">Andres M. Lozano</name><affiliation wicri:level="4"><nlm:affiliation>Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Okun, Michael S" sort="Okun, Michael S" uniqKey="Okun M" first="Michael S" last="Okun">Michael S. Okun</name><affiliation wicri:level="2"><nlm:affiliation>Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders, Gainesville, Florida, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders, Gainesville, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Ostrem, Jill" sort="Ostrem, Jill" uniqKey="Ostrem J" first="Jill" last="Ostrem">Jill Ostrem</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, UCSF Movement Disorder and Neuromodulation Center, University of California, San Francisco, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, UCSF Movement Disorder and Neuromodulation Center, University of California, San Francisco</wicri:regionArea><placeName><settlement type="city">San Francisco</settlement><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Pavese, Nicola" sort="Pavese, Nicola" uniqKey="Pavese N" first="Nicola" last="Pavese">Nicola Pavese</name><affiliation wicri:level="1"><nlm:affiliation>Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Institute of Neuroscience, Newcastle University, Newcastle upon Tyne</wicri:regionArea><wicri:noRegion>Newcastle upon Tyne</wicri:noRegion></affiliation></author><author><name sortKey="Schrader, Christoph" sort="Schrader, Christoph" uniqKey="Schrader C" first="Christoph" last="Schrader">Christoph Schrader</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, Hannover Medical School, Hannover, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Hannover Medical School, Hannover</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Hanovre</settlement></placeName></affiliation></author><author><name sortKey="Tai, Chun Hwei" sort="Tai, Chun Hwei" uniqKey="Tai C" first="Chun-Hwei" last="Tai">Chun-Hwei Tai</name><affiliation wicri:level="1"><nlm:affiliation>Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.</nlm:affiliation><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Krauss, Joachim K" sort="Krauss, Joachim K" uniqKey="Krauss J" first="Joachim K" last="Krauss">Joachim K. Krauss</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurosurgery, Hannover Medical School, Hannover, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurosurgery, Hannover Medical School, Hannover</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Hanovre</settlement></placeName></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation wicri:level="3"><nlm:affiliation>Movement Disorders Center, Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Movement Disorders Center, Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author></analytic><series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title><idno type="eISSN">1531-8257</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Canada</li><li>France</li><li>Pays-Bas</li><li>Royaume-Uni</li><li>Taïwan</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Auvergne-Rhône-Alpes</li><li>Bade-Wurtemberg</li><li>Basse-Saxe</li><li>Californie</li><li>District de Karlsruhe</li><li>Floride</li><li>Grand Londres</li><li>Gueldre</li><li>Ontario</li><li>Oxfordshire</li><li>Rhône-Alpes</li><li>Victoria (État)</li><li>Île-de-France</li></region><settlement><li>Grenoble</li><li>Hanovre</li><li>Heidelberg</li><li>Londres</li><li>Melbourne</li><li>Nimègue</li><li>Oxford</li><li>Paris</li><li>San Francisco</li><li>Toronto</li></settlement><orgName><li>University College de Londres</li><li>Université d'Oxford</li><li>Université de Melbourne</li><li>Université de Toronto</li></orgName></list><tree><country name="Australie"><region name="Victoria (État)"><name sortKey="Thevathasan, Wesley" sort="Thevathasan, Wesley" uniqKey="Thevathasan W" first="Wesley" last="Thevathasan">Wesley Thevathasan</name></region></country><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Debu, Bettina" sort="Debu, Bettina" uniqKey="Debu B" first="Bettina" last="Debu">Bettina Debu</name></region><name sortKey="Czernecki, Virginie" sort="Czernecki, Virginie" uniqKey="Czernecki V" first="Virginie" last="Czernecki">Virginie Czernecki</name><name sortKey="Fraix, Valerie" sort="Fraix, Valerie" uniqKey="Fraix V" first="Valerie" last="Fraix">Valerie Fraix</name><name sortKey="Grabli, David" sort="Grabli, David" uniqKey="Grabli D" first="David" last="Grabli">David Grabli</name><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Aziz, Tipu" sort="Aziz, Tipu" uniqKey="Aziz T" first="Tipu" last="Aziz">Tipu Aziz</name></region><name sortKey="Foltynie, Thomas" sort="Foltynie, Thomas" uniqKey="Foltynie T" first="Thomas" last="Foltynie">Thomas Foltynie</name><name sortKey="Joint, Carole" sort="Joint, Carole" uniqKey="Joint C" first="Carole" last="Joint">Carole Joint</name><name sortKey="Pavese, Nicola" sort="Pavese, Nicola" uniqKey="Pavese N" first="Nicola" last="Pavese">Nicola Pavese</name></country><country name="Pays-Bas"><region name="Gueldre"><name sortKey="Bloem, Bastiaan R" sort="Bloem, Bastiaan R" uniqKey="Bloem B" first="Bastiaan R" last="Bloem">Bastiaan R. Bloem</name></region></country><country name="Allemagne"><region name="Bade-Wurtemberg"><name sortKey="Blahak, Christian" sort="Blahak, Christian" uniqKey="Blahak C" first="Christian" last="Blahak">Christian Blahak</name></region><name sortKey="Krauss, Joachim K" sort="Krauss, Joachim K" uniqKey="Krauss J" first="Joachim K" last="Krauss">Joachim K. Krauss</name><name sortKey="Schrader, Christoph" sort="Schrader, Christoph" uniqKey="Schrader C" first="Christoph" last="Schrader">Christoph Schrader</name></country><country name="États-Unis"><noRegion><name sortKey="Butson, Christopher" sort="Butson, Christopher" uniqKey="Butson C" first="Christopher" last="Butson">Christopher Butson</name></noRegion><name sortKey="Okun, Michael S" sort="Okun, Michael S" uniqKey="Okun M" first="Michael S" last="Okun">Michael S. Okun</name><name sortKey="Ostrem, Jill" sort="Ostrem, Jill" uniqKey="Ostrem J" first="Jill" last="Ostrem">Jill Ostrem</name></country><country name="Canada"><region name="Ontario"><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M" last="Lozano">Andres M. Lozano</name></region></country><country name="Taïwan"><noRegion><name sortKey="Tai, Chun Hwei" sort="Tai, Chun Hwei" uniqKey="Tai C" first="Chun-Hwei" last="Tai">Chun-Hwei Tai</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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