PPNa-DBS for gait and balance disorders in Parkinson's disease: a double-blind, randomised study.
Identifieur interne : 000551 ( Main/Exploration ); précédent : 000550; suivant : 000552PPNa-DBS for gait and balance disorders in Parkinson's disease: a double-blind, randomised study.
Auteurs : Marie-Laure Welter [France] ; Adele Demain ; Claire Ewenczyk ; Virginie Czernecki ; Brian Lau ; Amine El Helou ; Hayat Belaid ; Jérôme Yelnik ; Chantal François ; Eric Bardinet ; Carine Karachi ; David GrabliSource :
- Journal of neurology [ 1432-1459 ] ; 2015.
English descriptors
- KwdEn :
- Aged, Antiparasitic Agents (therapeutic use), Deep Brain Stimulation (methods), Double-Blind Method, Female, Gait Disorders, Neurologic (etiology), Gait Disorders, Neurologic (therapy), Humans, Imaging, Three-Dimensional, Levodopa (therapeutic use), Magnetic Resonance Imaging, Male, Middle Aged, Neuropsychological Tests, Outcome Assessment (Health Care), Parkinson Disease (complications), Parkinson Disease (drug therapy), Pedunculopontine Tegmental Nucleus (physiology), Postural Balance (physiology), Sensation Disorders (etiology), Sensation Disorders (therapy), Surveys and Questionnaires.
- MESH :
- chemical , therapeutic use : Antiparasitic Agents, Levodopa.
- complications : Parkinson Disease.
- drug therapy : Parkinson Disease.
- etiology : Gait Disorders, Neurologic, Sensation Disorders.
- methods : Deep Brain Stimulation.
- physiology : Pedunculopontine Tegmental Nucleus, Postural Balance.
- therapy : Gait Disorders, Neurologic, Sensation Disorders.
- Aged, Double-Blind Method, Female, Humans, Imaging, Three-Dimensional, Magnetic Resonance Imaging, Male, Middle Aged, Neuropsychological Tests, Outcome Assessment (Health Care), Surveys and Questionnaires.
Abstract
Gait and balance disorders are the major source of motor disabilities in advanced forms of Parkinson's disease (PD). Low-frequency stimulation of the pedunculopontine nucleus area (PPNa-DBS) has been recently proposed to treat these symptoms with variable clinical results. To further understand the effects of PPNa-DBS on resistant gait and balance disorders, we performed a randomised double-blind cross-over study in six PD patients. Evaluation included clinical assessment of parkinsonian disability, quality of life and neurophysiological recordings of gait. Evaluations were done 1 month before, 4 and 6 months after surgery with four double-blinded conditions assessed: with and without PPNa-DBS, with and without levodopa treatment. Four patients completed the study and two patients were excluded from the final analysis because of peri-operative adverse events (haematoma, infection). Clinically, the combination of PPNa-DBS and levodopa treatment produced a significant decrease of the freezing episodes. The frequency of falls also decreased in three out of four patients. From a neurophysiological point of view, PPNa-DBS significantly improved the anticipatory postural adjustments and double-stance duration, but not the length and speed of the first step. Interestingly, step length and speed improved after surgery without PPNa-DBS, suggesting that the lesioning effect of PPNa-DBS surgery alleviates parkinsonian akinesia. Quality of life was also significantly improved with PPNa-DBS. These results suggest that PPNa-DBS could improve gait and balance disorders in well-selected PD patients. However, this treatment may be riskier than others DBS surgeries in these patients with an advanced form of PD.
DOI: 10.1007/s00415-015-7744-1
PubMed: 25904205
Affiliations:
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Le document en format XML
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Demain</name></author><author><name sortKey="Ewenczyk, Claire" sort="Ewenczyk, Claire" uniqKey="Ewenczyk C" first="Claire" last="Ewenczyk">Claire Ewenczyk</name></author><author><name sortKey="Czernecki, Virginie" sort="Czernecki, Virginie" uniqKey="Czernecki V" first="Virginie" last="Czernecki">Virginie Czernecki</name></author><author><name sortKey="Lau, Brian" sort="Lau, Brian" uniqKey="Lau B" first="Brian" last="Lau">Brian Lau</name></author><author><name sortKey="El Helou, Amine" sort="El Helou, Amine" uniqKey="El Helou A" first="Amine" last="El Helou">Amine El Helou</name></author><author><name sortKey="Belaid, Hayat" sort="Belaid, Hayat" uniqKey="Belaid H" first="Hayat" last="Belaid">Hayat Belaid</name></author><author><name sortKey="Yelnik, Jerome" sort="Yelnik, Jerome" uniqKey="Yelnik J" first="Jérôme" last="Yelnik">Jérôme Yelnik</name></author><author><name sortKey="Francois, Chantal" sort="Francois, Chantal" uniqKey="Francois C" first="Chantal" last="François">Chantal François</name></author><author><name sortKey="Bardinet, Eric" sort="Bardinet, Eric" uniqKey="Bardinet E" first="Eric" last="Bardinet">Eric Bardinet</name></author><author><name sortKey="Karachi, Carine" sort="Karachi, Carine" uniqKey="Karachi C" first="Carine" last="Karachi">Carine Karachi</name></author><author><name sortKey="Grabli, David" sort="Grabli, David" uniqKey="Grabli D" first="David" last="Grabli">David Grabli</name></author></analytic><series><title level="j">Journal of neurology</title><idno type="eISSN">1432-1459</idno><imprint><date when="2015" type="published">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Antiparasitic Agents (therapeutic use)</term><term>Deep Brain Stimulation (methods)</term><term>Double-Blind Method</term><term>Female</term><term>Gait Disorders, Neurologic (etiology)</term><term>Gait Disorders, Neurologic 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qualifier="etiology" xml:lang="en"><term>Gait Disorders, Neurologic</term><term>Sensation Disorders</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Deep Brain Stimulation</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Pedunculopontine Tegmental Nucleus</term><term>Postural Balance</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Gait Disorders, Neurologic</term><term>Sensation Disorders</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Double-Blind Method</term><term>Female</term><term>Humans</term><term>Imaging, Three-Dimensional</term><term>Magnetic Resonance Imaging</term><term>Male</term><term>Middle Aged</term><term>Neuropsychological Tests</term><term>Outcome Assessment (Health Care)</term><term>Surveys and Questionnaires</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Gait and balance disorders are the major source of motor disabilities in advanced forms of Parkinson's disease (PD). Low-frequency stimulation of the pedunculopontine nucleus area (PPNa-DBS) has been recently proposed to treat these symptoms with variable clinical results. To further understand the effects of PPNa-DBS on resistant gait and balance disorders, we performed a randomised double-blind cross-over study in six PD patients. Evaluation included clinical assessment of parkinsonian disability, quality of life and neurophysiological recordings of gait. Evaluations were done 1 month before, 4 and 6 months after surgery with four double-blinded conditions assessed: with and without PPNa-DBS, with and without levodopa treatment. Four patients completed the study and two patients were excluded from the final analysis because of peri-operative adverse events (haematoma, infection). Clinically, the combination of PPNa-DBS and levodopa treatment produced a significant decrease of the freezing episodes. The frequency of falls also decreased in three out of four patients. From a neurophysiological point of view, PPNa-DBS significantly improved the anticipatory postural adjustments and double-stance duration, but not the length and speed of the first step. Interestingly, step length and speed improved after surgery without PPNa-DBS, suggesting that the lesioning effect of PPNa-DBS surgery alleviates parkinsonian akinesia. Quality of life was also significantly improved with PPNa-DBS. These results suggest that PPNa-DBS could improve gait and balance disorders in well-selected PD patients. However, this treatment may be riskier than others DBS surgeries in these patients with an advanced form of PD.</div></front></TEI><affiliations><list><country><li>France</li></country></list><tree><noCountry><name sortKey="Bardinet, Eric" sort="Bardinet, Eric" uniqKey="Bardinet E" first="Eric" last="Bardinet">Eric Bardinet</name><name sortKey="Belaid, Hayat" sort="Belaid, Hayat" uniqKey="Belaid H" first="Hayat" last="Belaid">Hayat Belaid</name><name sortKey="Czernecki, Virginie" sort="Czernecki, Virginie" uniqKey="Czernecki V" first="Virginie" last="Czernecki">Virginie Czernecki</name><name sortKey="Demain, Adele" sort="Demain, Adele" uniqKey="Demain A" first="Adele" last="Demain">Adele Demain</name><name sortKey="El Helou, Amine" sort="El Helou, Amine" uniqKey="El Helou A" first="Amine" last="El Helou">Amine El Helou</name><name sortKey="Ewenczyk, Claire" sort="Ewenczyk, Claire" uniqKey="Ewenczyk C" first="Claire" last="Ewenczyk">Claire Ewenczyk</name><name sortKey="Francois, Chantal" sort="Francois, Chantal" uniqKey="Francois C" first="Chantal" last="François">Chantal François</name><name sortKey="Grabli, David" sort="Grabli, David" uniqKey="Grabli D" first="David" last="Grabli">David Grabli</name><name sortKey="Karachi, Carine" sort="Karachi, Carine" uniqKey="Karachi C" first="Carine" last="Karachi">Carine Karachi</name><name sortKey="Lau, Brian" sort="Lau, Brian" uniqKey="Lau B" first="Brian" last="Lau">Brian Lau</name><name sortKey="Yelnik, Jerome" sort="Yelnik, Jerome" uniqKey="Yelnik J" first="Jérôme" last="Yelnik">Jérôme Yelnik</name></noCountry><country name="France"><noRegion><name sortKey="Welter, Marie Laure" sort="Welter, Marie Laure" uniqKey="Welter M" first="Marie-Laure" last="Welter">Marie-Laure Welter</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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