Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson's disease
Identifieur interne : 001C18 ( Main/Merge ); précédent : 001C17; suivant : 001C19Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson's disease
Auteurs : M. U. Ferraye [France] ; B. Deb [France] ; V. Fraix [France] ; L. Goetz [France] ; C. Ardouin [France] ; J. Yelnik [France] ; C. Henry-Lagrange [France] ; E. Seigneuret [France] ; B. Piallat [France] ; P. Krack [France] ; J.-F. Le Bas [France] ; A.-L. Benabid [France] ; S. Chabards [France] ; P. Pollak [France]Source :
- Brain [ 0006-8950 ] ; 2010-01.
English descriptors
- KwdEn :
- Aged, Cross-Over Studies, Deep Brain Stimulation (methods), Double-Blind Method, Female, Follow-Up Studies, Gait Disorders, Neurologic (etiology), Gait Disorders, Neurologic (physiopathology), Gait Disorders, Neurologic (therapy), Humans, Male, Middle Aged, Parkinson Disease (complications), Parkinson Disease (physiopathology), Parkinson Disease (therapy), Pedunculopontine Tegmental Nucleus (physiology), Treatment Outcome.
- MESH :
- complications : Parkinson Disease.
- etiology : Gait Disorders, Neurologic.
- methods : Deep Brain Stimulation.
- physiology : Pedunculopontine Tegmental Nucleus.
- physiopathology : Gait Disorders, Neurologic, Parkinson Disease.
- therapy : Gait Disorders, Neurologic, Parkinson Disease.
- Aged, Cross-Over Studies, Double-Blind Method, Female, Follow-Up Studies, Humans, Male, Middle Aged, Treatment Outcome.
Abstract
Gait disturbances are frequent and disabling in advanced Parkinson's disease. These symptoms respond poorly to usual medical and surgical treatments but were reported to be improved by stimulation of the pedunculopontine nucleus. We studied the effects of stimulating the pedunculopontine nucleus area in six patients with severe freezing of gait, unresponsive to levodopa and subthalamic nucleus stimulation. Electrodes were implanted bilaterally in the pedunculopontine nucleus area. Electrode placement was checked by postoperative magnetic resonance imaging. The primary outcome measures were a composite gait score, freezing of gait questionnaire score and duration of freezing episodes occurring during a walking protocol at baseline and one-year follow-up. A double-blind cross-over study was carried out from months 4 to 6 after surgery with or without pedunculopontine nucleus area stimulation. At one-year follow-up, the duration of freezing episodes under off-drug condition improved, as well as falls related to freezing. The other primary outcome measures did not significantly change, nor did the results during the double-blind evaluation. Individual results showed major improvement of all gait measures in one patient, moderate improvement of some tests in four patients and global worsening in one patient. Stimulation frequency ranged between 15 and 25 Hz. Oscillopsia and limb myoclonus could hinder voltage increase. No serious adverse events occurred. Although freezing of gait can be improved by low-frequency electrical stimulation of the pedunculopontine nucleus area in some patients with Parkinson's disease our overall results are disappointing compared to the high levels of expectation raised by previous open label studies. Further controlled studies are needed to determine whether optimization of patient selection, targeting and setting of stimulation parameters might improve the outcome to a point that could transform this experimental approach to a treatment with a reasonable riskbenefit ratio.
Url:
- https://api.istex.fr/document/8CD3E269DDE0A53AB7BE2EBA33B1CF022C12187E/fulltext/pdf
- http://www.hal.inserm.fr/inserm-00522442
DOI: 10.1093/brain/awp229
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Pollak</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>1 University of Grenoble</wicri:regionArea></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>2 INSERM, U836, Grenoble Institute of Neuroscience</wicri:regionArea><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>3 University Hospital of Grenoble</wicri:regionArea></affiliation></author></analytic><monogr></monogr><series><title level="j">Brain</title><idno type="ISSN">0006-8950</idno><idno type="eISSN">1460-2156</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2010-01">2010-01</date><biblScope unit="volume">133</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="205">205</biblScope><biblScope unit="page" to="214">214</biblScope></imprint><idno type="ISSN">0006-8950</idno></series><idno type="istex">8CD3E269DDE0A53AB7BE2EBA33B1CF022C12187E</idno><idno type="DOI">10.1093/brain/awp229</idno><idno type="ArticleID">awp229</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Cross-Over Studies</term><term>Deep Brain Stimulation (methods)</term><term>Double-Blind Method</term><term>Female</term><term>Follow-Up Studies</term><term>Gait Disorders, Neurologic (etiology)</term><term>Gait Disorders, Neurologic (physiopathology)</term><term>Gait Disorders, Neurologic (therapy)</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Parkinson Disease (complications)</term><term>Parkinson Disease (physiopathology)</term><term>Parkinson Disease (therapy)</term><term>Pedunculopontine Tegmental Nucleus (physiology)</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Gait Disorders, Neurologic</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></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Gait Disorders, Neurologic</term><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Gait Disorders, Neurologic</term><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Cross-Over Studies</term><term>Double-Blind Method</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract">Gait disturbances are frequent and disabling in advanced Parkinson's disease. These symptoms respond poorly to usual medical and surgical treatments but were reported to be improved by stimulation of the pedunculopontine nucleus. We studied the effects of stimulating the pedunculopontine nucleus area in six patients with severe freezing of gait, unresponsive to levodopa and subthalamic nucleus stimulation. Electrodes were implanted bilaterally in the pedunculopontine nucleus area. Electrode placement was checked by postoperative magnetic resonance imaging. The primary outcome measures were a composite gait score, freezing of gait questionnaire score and duration of freezing episodes occurring during a walking protocol at baseline and one-year follow-up. A double-blind cross-over study was carried out from months 4 to 6 after surgery with or without pedunculopontine nucleus area stimulation. At one-year follow-up, the duration of freezing episodes under off-drug condition improved, as well as falls related to freezing. The other primary outcome measures did not significantly change, nor did the results during the double-blind evaluation. Individual results showed major improvement of all gait measures in one patient, moderate improvement of some tests in four patients and global worsening in one patient. Stimulation frequency ranged between 15 and 25 Hz. Oscillopsia and limb myoclonus could hinder voltage increase. No serious adverse events occurred. Although freezing of gait can be improved by low-frequency electrical stimulation of the pedunculopontine nucleus area in some patients with Parkinson's disease our overall results are disappointing compared to the high levels of expectation raised by previous open label studies. Further controlled studies are needed to determine whether optimization of patient selection, targeting and setting of stimulation parameters might improve the outcome to a point that could transform this experimental approach to a treatment with a reasonable riskbenefit ratio.</div></front></TEI><double doi="10.1093/brain/awp229"><HAL><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson's disease.</title><author><name sortKey="Ferraye, Murielle" sort="Ferraye, Murielle" uniqKey="Ferraye M" first="Murielle" last="Ferraye">Murielle Ferraye</name><affiliation wicri:level="1"><hal:affiliation type="researchteam" xml:id="struct-391045" status="INCOMING"> <orgName>INSERM U836, équipe 10, Dynamique des réseaux neuronaux du mouvement</orgName> <desc> <address> <country key="FR"></country> </address> </desc> <listRelation> <relation active="#struct-86972" type="direct"></relation> <relation active="#struct-51016" type="indirect"></relation> <relation name="DSV/IRTSV" active="#struct-300016" type="indirect"></relation> <relation active="#struct-300071" type="indirect"></relation> <relation name="U836" active="#struct-303623" type="indirect"></relation> </listRelation><tutelles><tutelle active="#struct-86972" type="direct"><org type="laboratory" xml:id="struct-86972" status="VALID"> <orgName>Grenoble Institut des Neurosciences</orgName> <orgName type="acronym">GIN</orgName> <desc> <address> <addrLine>UJF - 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Site Santé La Tronche - BP 170 - 38042 Grenoble Cedex 9</addrLine> <country key="FR"></country> </address> <ref type="url">http://neurosciences.ujf-grenoble.fr/</ref> </desc> <listRelation> <relation active="#struct-51016" type="direct"></relation> <relation name="DSV/IRTSV" active="#struct-300016" type="direct"></relation> <relation active="#struct-300071" type="direct"></relation> <relation name="U836" active="#struct-303623" type="direct"></relation> </listRelation></org></tutelle><tutelle active="#struct-51016" type="indirect"><org type="institution" xml:id="struct-51016" status="OLD"> <idno type="IdRef">026404796</idno> <orgName>Université Joseph Fourier - Grenoble 1</orgName> <orgName type="acronym">UJF</orgName> <date type="end">2015-12-31</date> <desc> <address> <addrLine>BP 53 - 38041 Grenoble Cedex 9</addrLine> <country key="FR"></country> </address> <ref type="url">http://www.ujf-grenoble.fr/</ref> </desc></org></tutelle><tutelle name="DSV/IRTSV" active="#struct-300016" type="indirect"><org type="institution" xml:id="struct-300016" status="VALID"> <orgName>Commissariat à l'énergie atomique et aux énergies alternatives</orgName> <orgName type="acronym">CEA</orgName> <desc> <address> <addrLine>Centre de SaclayCentre de GrenobleCentre de Cadaracheetc</addrLine> <country key="FR"></country> </address> <ref type="url">http://www.cea.fr/</ref> </desc></org></tutelle><tutelle active="#struct-300071" type="indirect"><org type="institution" xml:id="struct-300071" status="VALID"> <orgName>CHU Grenoble</orgName> <desc> <address> <country key="FR"></country> </address> </desc></org></tutelle><tutelle name="U836" active="#struct-303623" type="indirect"><org type="institution" xml:id="struct-303623" status="VALID"> <idno type="IdRef">026388278</idno> <orgName>Institut National de la Santé et de la Recherche Médicale</orgName> <orgName type="acronym">INSERM</orgName> <desc> <address> <addrLine>101, rue de Tolbiac, 75013 Paris </addrLine> <country key="FR"></country> </address> <ref type="url">http://www.inserm.fr</ref> </desc></org></tutelle><tutelle active="#struct-93013" type="direct"><org type="laboratory" xml:id="struct-93013" status="VALID"> <orgName>CHU Grenoble</orgName> <desc> <address> <country key="FR"></country> </address> </desc> <listRelation> <relation active="#struct-300071" type="direct"></relation> <relation active="#struct-51016" type="direct"></relation> </listRelation></org></tutelle></tutelles></hal:affiliation><country>France</country><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName><orgName type="university">Université Joseph Fourier</orgName><orgName type="institution" wicri:auto="newGroup">Université de Grenoble</orgName></affiliation></author><author><name sortKey="Pollak, Pierre" sort="Pollak, Pierre" uniqKey="Pollak P" first="Pierre" last="Pollak">Pierre Pollak</name><affiliation wicri:level="1"><hal:affiliation type="researchteam" xml:id="struct-391246" status="INCOMING"> <orgName>INSERM U836, équipe 10, Dynamique des réseaux neuronaux du mouvement</orgName> <desc> <address> <country key="FR"></country> </address> </desc> <listRelation> <relation active="#struct-93013" type="direct"></relation> <relation active="#struct-51016" type="indirect"></relation> <relation active="#struct-300071" type="indirect"></relation> <relation active="#struct-86972" type="direct"></relation> <relation name="DSV/IRTSV" active="#struct-300016" type="indirect"></relation> <relation name="U836" active="#struct-303623" type="indirect"></relation> </listRelation><tutelles><tutelle active="#struct-93013" type="direct"><org type="laboratory" xml:id="struct-93013" status="VALID"> <orgName>CHU Grenoble</orgName> <desc> <address> <country key="FR"></country> </address> </desc> <listRelation> <relation active="#struct-300071" type="direct"></relation> <relation active="#struct-51016" type="direct"></relation> </listRelation></org></tutelle><tutelle active="#struct-51016" type="indirect"><org type="institution" xml:id="struct-51016" status="OLD"> <idno type="IdRef">026404796</idno> <orgName>Université Joseph Fourier - Grenoble 1</orgName> <orgName type="acronym">UJF</orgName> <date type="end">2015-12-31</date> <desc> <address> <addrLine>BP 53 - 38041 Grenoble Cedex 9</addrLine> <country key="FR"></country> </address> <ref type="url">http://www.ujf-grenoble.fr/</ref> </desc></org></tutelle><tutelle active="#struct-300071" type="indirect"><org type="institution" xml:id="struct-300071" status="VALID"> <orgName>CHU Grenoble</orgName> <desc> <address> <country key="FR"></country> </address> </desc></org></tutelle><tutelle active="#struct-86972" type="direct"><org type="laboratory" xml:id="struct-86972" status="VALID"> <orgName>Grenoble Institut des Neurosciences</orgName> <orgName type="acronym">GIN</orgName> <desc> <address> <addrLine>UJF - Site Santé La Tronche - BP 170 - 38042 Grenoble Cedex 9</addrLine> <country key="FR"></country> </address> <ref type="url">http://neurosciences.ujf-grenoble.fr/</ref> </desc> <listRelation> <relation active="#struct-51016" type="direct"></relation> <relation name="DSV/IRTSV" active="#struct-300016" type="direct"></relation> <relation active="#struct-300071" type="direct"></relation> <relation name="U836" active="#struct-303623" type="direct"></relation> </listRelation></org></tutelle><tutelle name="DSV/IRTSV" active="#struct-300016" type="indirect"><org type="institution" xml:id="struct-300016" status="VALID"> <orgName>Commissariat à l'énergie atomique et aux énergies alternatives</orgName> <orgName type="acronym">CEA</orgName> <desc> <address> <addrLine>Centre de SaclayCentre de GrenobleCentre de Cadaracheetc</addrLine> <country key="FR"></country> </address> <ref type="url">http://www.cea.fr/</ref> </desc></org></tutelle><tutelle name="U836" active="#struct-303623" type="indirect"><org type="institution" xml:id="struct-303623" status="VALID"> <idno type="IdRef">026388278</idno> <orgName>Institut National de la Santé et de la Recherche Médicale</orgName> <orgName type="acronym">INSERM</orgName> <desc> <address> <addrLine>101, rue de Tolbiac, 75013 Paris </addrLine> <country key="FR"></country> </address> <ref type="url">http://www.inserm.fr</ref> </desc></org></tutelle></tutelles></hal:affiliation><country>France</country><placeName><settlement type="city">Grenoble</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName><orgName type="university">Université Joseph Fourier</orgName><orgName type="institution" wicri:auto="newGroup">Université de Grenoble</orgName></affiliation></author></analytic><idno type="DOI">10.1093/brain/awp229</idno><series><title level="j">Brain - A Journal of Neurology </title><idno type="ISSN">0006-8950</idno><imprint><date type="datePub">2010-01</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Gait disturbances are frequent and disabling in advanced Parkinson's disease. These symptoms respond poorly to usual medical and surgical treatments but were reported to be improved by stimulation of the pedunculopontine nucleus. We studied the effects of stimulating the pedunculopontine nucleus area in six patients with severe freezing of gait, unresponsive to levodopa and subthalamic nucleus stimulation. Electrodes were implanted bilaterally in the pedunculopontine nucleus area. Electrode placement was checked by postoperative magnetic resonance imaging. The primary outcome measures were a composite gait score, freezing of gait questionnaire score and duration of freezing episodes occurring during a walking protocol at baseline and one-year follow-up. A double-blind cross-over study was carried out from months 4 to 6 after surgery with or without pedunculopontine nucleus area stimulation. At one-year follow-up, the duration of freezing episodes under off-drug condition improved, as well as falls related to freezing. The other primary outcome measures did not significantly change, nor did the results during the double-blind evaluation. Individual results showed major improvement of all gait measures in one patient, moderate improvement of some tests in four patients and global worsening in one patient. Stimulation frequency ranged between 15 and 25 Hz. Oscillopsia and limb myoclonus could hinder voltage increase. No serious adverse events occurred. Although freezing of gait can be improved by low-frequency electrical stimulation of the pedunculopontine nucleus area in some patients with Parkinson's disease our overall results are disappointing compared to the high levels of expectation raised by previous open label studies. Further controlled studies are needed to determine whether optimization of patient selection, targeting and setting of stimulation parameters might improve the outcome to a point that could transform this experimental approach to a treatment with a reasonable risk-benefit ratio.</div></front></TEI></HAL><ISTEX><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson's disease</title><author><name sortKey="Ferraye, M U" sort="Ferraye, M U" uniqKey="Ferraye M" first="M. U." last="Ferraye">M. U. Ferraye</name></author><author><name sortKey="Deb, B" sort="Deb, B" uniqKey="Deb B" first="B." last="Deb">B. Deb</name></author><author><name sortKey="Fraix, V" sort="Fraix, V" uniqKey="Fraix V" first="V." last="Fraix">V. Fraix</name></author><author><name sortKey="Goetz, L" sort="Goetz, L" uniqKey="Goetz L" first="L." last="Goetz">L. Goetz</name></author><author><name sortKey="Ardouin, C" sort="Ardouin, C" uniqKey="Ardouin C" first="C." last="Ardouin">C. Ardouin</name></author><author><name sortKey="Yelnik, J" sort="Yelnik, J" uniqKey="Yelnik J" first="J." last="Yelnik">J. Yelnik</name></author><author><name sortKey="Henry Lagrange, C" sort="Henry Lagrange, C" uniqKey="Henry Lagrange C" first="C." last="Henry-Lagrange">C. Henry-Lagrange</name></author><author><name sortKey="Seigneuret, E" sort="Seigneuret, E" uniqKey="Seigneuret E" first="E." last="Seigneuret">E. Seigneuret</name></author><author><name sortKey="Piallat, B" sort="Piallat, B" uniqKey="Piallat B" first="B." last="Piallat">B. Piallat</name></author><author><name sortKey="Krack, P" sort="Krack, P" uniqKey="Krack P" first="P." last="Krack">P. Krack</name></author><author><name sortKey="Le Bas, J F" sort="Le Bas, J F" uniqKey="Le Bas J" first="J.-F." last="Le Bas">J.-F. Le Bas</name></author><author><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A.-L." last="Benabid">A.-L. Benabid</name></author><author><name sortKey="Chabards, S" sort="Chabards, S" uniqKey="Chabards S" first="S." last="Chabards">S. Chabards</name></author><author><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P." last="Pollak">P. Pollak</name></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:8CD3E269DDE0A53AB7BE2EBA33B1CF022C12187E</idno><date when="2010" year="2010">2010</date><idno type="doi">10.1093/brain/awp229</idno><idno type="url">https://api.istex.fr/document/8CD3E269DDE0A53AB7BE2EBA33B1CF022C12187E/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">002505</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">002505</idno><idno type="wicri:Area/Istex/Curation">002503</idno><idno type="wicri:Area/Istex/Checkpoint">000441</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Checkpoint">000441</idno><idno type="wicri:doubleKey">0006-8950:2010:Ferraye M:effects:of:pedunculopontine</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson's disease</title><author><name sortKey="Ferraye, M U" sort="Ferraye, M U" uniqKey="Ferraye M" first="M. U." last="Ferraye">M. U. Ferraye</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>1 University of Grenoble</wicri:regionArea></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>2 INSERM, U836, Grenoble Institute of Neuroscience</wicri:regionArea><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion></affiliation></author><author><name sortKey="Deb, B" sort="Deb, B" uniqKey="Deb B" first="B." last="Deb">B. Deb</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>1 University of Grenoble</wicri:regionArea></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>2 INSERM, U836, Grenoble Institute of Neuroscience</wicri:regionArea><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion></affiliation><affiliation wicri:level="1"><country wicri:rule="url">France</country></affiliation></author><author><name sortKey="Fraix, V" sort="Fraix, V" uniqKey="Fraix V" first="V." last="Fraix">V. Fraix</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>1 University of Grenoble</wicri:regionArea></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>2 INSERM, U836, Grenoble Institute of Neuroscience</wicri:regionArea><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion></affiliation></author><author><name sortKey="Goetz, L" sort="Goetz, L" uniqKey="Goetz L" first="L." last="Goetz">L. Goetz</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>1 University of Grenoble</wicri:regionArea></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>2 INSERM, U836, Grenoble Institute of Neuroscience</wicri:regionArea><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion></affiliation></author><author><name sortKey="Ardouin, C" sort="Ardouin, C" uniqKey="Ardouin C" first="C." last="Ardouin">C. Ardouin</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>3 University Hospital of Grenoble</wicri:regionArea></affiliation></author><author><name sortKey="Yelnik, J" sort="Yelnik, J" uniqKey="Yelnik J" first="J." last="Yelnik">J. Yelnik</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>4 INSERM UMR_S975, Fdration de Neurologie, 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><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>5 University Pierre et Marie Curie, 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><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>6 Hpital de la Piti-Salptrire, 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="Henry Lagrange, C" sort="Henry Lagrange, C" uniqKey="Henry Lagrange C" first="C." last="Henry-Lagrange">C. Henry-Lagrange</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>1 University of Grenoble</wicri:regionArea></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>2 INSERM, U836, Grenoble Institute of Neuroscience</wicri:regionArea><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion></affiliation></author><author><name sortKey="Seigneuret, E" sort="Seigneuret, E" uniqKey="Seigneuret E" first="E." last="Seigneuret">E. Seigneuret</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>3 University Hospital of Grenoble</wicri:regionArea></affiliation></author><author><name sortKey="Piallat, B" sort="Piallat, B" uniqKey="Piallat B" first="B." last="Piallat">B. Piallat</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>1 University of Grenoble</wicri:regionArea></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>2 INSERM, U836, Grenoble Institute of Neuroscience</wicri:regionArea><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion></affiliation></author><author><name sortKey="Krack, P" sort="Krack, P" uniqKey="Krack P" first="P." last="Krack">P. Krack</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>1 University of Grenoble</wicri:regionArea></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>2 INSERM, U836, Grenoble Institute of Neuroscience</wicri:regionArea><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>3 University Hospital of Grenoble</wicri:regionArea></affiliation></author><author><name sortKey="Le Bas, J F" sort="Le Bas, J F" uniqKey="Le Bas J" first="J.-F." last="Le Bas">J.-F. Le Bas</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>1 University of Grenoble</wicri:regionArea></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>2 INSERM, U836, Grenoble Institute of Neuroscience</wicri:regionArea><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>3 University Hospital of Grenoble</wicri:regionArea></affiliation></author><author><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A.-L." last="Benabid">A.-L. Benabid</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>1 University of Grenoble</wicri:regionArea></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>2 INSERM, U836, Grenoble Institute of Neuroscience</wicri:regionArea><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>3 University Hospital of Grenoble</wicri:regionArea></affiliation></author><author><name sortKey="Chabards, S" sort="Chabards, S" uniqKey="Chabards S" first="S." last="Chabards">S. Chabards</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>1 University of Grenoble</wicri:regionArea></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>2 INSERM, U836, Grenoble Institute of Neuroscience</wicri:regionArea><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>3 University Hospital of Grenoble</wicri:regionArea></affiliation></author><author><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P." last="Pollak">P. Pollak</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>1 University of Grenoble</wicri:regionArea></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>2 INSERM, U836, Grenoble Institute of Neuroscience</wicri:regionArea><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>3 University Hospital of Grenoble</wicri:regionArea></affiliation></author></analytic><monogr></monogr><series><title level="j">Brain</title><idno type="ISSN">0006-8950</idno><idno type="eISSN">1460-2156</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2010-01">2010-01</date><biblScope unit="volume">133</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="205">205</biblScope><biblScope unit="page" to="214">214</biblScope></imprint><idno type="ISSN">0006-8950</idno></series><idno type="istex">8CD3E269DDE0A53AB7BE2EBA33B1CF022C12187E</idno><idno type="DOI">10.1093/brain/awp229</idno><idno type="ArticleID">awp229</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Gait disturbances are frequent and disabling in advanced Parkinson's disease. These symptoms respond poorly to usual medical and surgical treatments but were reported to be improved by stimulation of the pedunculopontine nucleus. We studied the effects of stimulating the pedunculopontine nucleus area in six patients with severe freezing of gait, unresponsive to levodopa and subthalamic nucleus stimulation. Electrodes were implanted bilaterally in the pedunculopontine nucleus area. Electrode placement was checked by postoperative magnetic resonance imaging. The primary outcome measures were a composite gait score, freezing of gait questionnaire score and duration of freezing episodes occurring during a walking protocol at baseline and one-year follow-up. A double-blind cross-over study was carried out from months 4 to 6 after surgery with or without pedunculopontine nucleus area stimulation. At one-year follow-up, the duration of freezing episodes under off-drug condition improved, as well as falls related to freezing. The other primary outcome measures did not significantly change, nor did the results during the double-blind evaluation. Individual results showed major improvement of all gait measures in one patient, moderate improvement of some tests in four patients and global worsening in one patient. Stimulation frequency ranged between 15 and 25 Hz. Oscillopsia and limb myoclonus could hinder voltage increase. No serious adverse events occurred. Although freezing of gait can be improved by low-frequency electrical stimulation of the pedunculopontine nucleus area in some patients with Parkinson's disease our overall results are disappointing compared to the high levels of expectation raised by previous open label studies. Further controlled studies are needed to determine whether optimization of patient selection, targeting and setting of stimulation parameters might improve the outcome to a point that could transform this experimental approach to a treatment with a reasonable riskbenefit ratio.</div></front></TEI></ISTEX><PubMed><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson's disease.</title><author><name sortKey="Ferraye, M U" sort="Ferraye, M U" uniqKey="Ferraye M" first="M U" last="Ferraye">M U Ferraye</name><affiliation wicri:level="3"><nlm:affiliation>Université de Grenoble, INSERM U836, CHU de Grenoble, Pavillon de Neurologie, BP217, 38043 Grenoble Cedex 9, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Université de Grenoble, INSERM U836, CHU de Grenoble, Pavillon de Neurologie, BP217, 38043 Grenoble Cedex 9</wicri:regionArea><placeName><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Debu, B" sort="Debu, B" uniqKey="Debu B" first="B" last="Debû">B. Debû</name></author><author><name sortKey="Fraix, V" sort="Fraix, V" uniqKey="Fraix V" first="V" last="Fraix">V. Fraix</name></author><author><name sortKey="Goetz, L" sort="Goetz, L" uniqKey="Goetz L" first="L" last="Goetz">L. Goetz</name></author><author><name sortKey="Ardouin, C" sort="Ardouin, C" uniqKey="Ardouin C" first="C" last="Ardouin">C. Ardouin</name></author><author><name sortKey="Yelnik, J" sort="Yelnik, J" uniqKey="Yelnik J" first="J" last="Yelnik">J. Yelnik</name></author><author><name sortKey="Henry Lagrange, C" sort="Henry Lagrange, C" uniqKey="Henry Lagrange C" first="C" last="Henry-Lagrange">C. Henry-Lagrange</name></author><author><name sortKey="Seigneuret, E" sort="Seigneuret, E" uniqKey="Seigneuret E" first="E" last="Seigneuret">E. Seigneuret</name></author><author><name sortKey="Piallat, B" sort="Piallat, B" uniqKey="Piallat B" first="B" last="Piallat">B. Piallat</name></author><author><name sortKey="Krack, P" sort="Krack, P" uniqKey="Krack P" first="P" last="Krack">P. Krack</name></author><author><name sortKey="Le Bas, J F" sort="Le Bas, J F" uniqKey="Le Bas J" first="J-F" last="Le Bas">J-F Le Bas</name></author><author><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A-L" last="Benabid">A-L Benabid</name></author><author><name sortKey="Chabardes, S" sort="Chabardes, S" uniqKey="Chabardes S" first="S" last="Chabardès">S. Chabardès</name></author><author><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P" last="Pollak">P. Pollak</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2010">2010</date><idno type="RBID">pubmed:19773356</idno><idno type="pmid">19773356</idno><idno type="doi">10.1093/brain/awp229</idno><idno type="wicri:Area/PubMed/Corpus">000B21</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000B21</idno><idno type="wicri:Area/PubMed/Curation">000A81</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">000A81</idno><idno type="wicri:Area/PubMed/Checkpoint">000A81</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">000A81</idno><idno type="wicri:Area/Ncbi/Merge">000A56</idno><idno type="wicri:Area/Ncbi/Curation">000A56</idno><idno type="wicri:Area/Ncbi/Checkpoint">000A56</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson's disease.</title><author><name sortKey="Ferraye, M U" sort="Ferraye, M U" uniqKey="Ferraye M" first="M U" last="Ferraye">M U Ferraye</name><affiliation wicri:level="3"><nlm:affiliation>Université de Grenoble, INSERM U836, CHU de Grenoble, Pavillon de Neurologie, BP217, 38043 Grenoble Cedex 9, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Université de Grenoble, INSERM U836, CHU de Grenoble, Pavillon de Neurologie, BP217, 38043 Grenoble Cedex 9</wicri:regionArea><placeName><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Debu, B" sort="Debu, B" uniqKey="Debu B" first="B" last="Debû">B. Debû</name></author><author><name sortKey="Fraix, V" sort="Fraix, V" uniqKey="Fraix V" first="V" last="Fraix">V. Fraix</name></author><author><name sortKey="Goetz, L" sort="Goetz, L" uniqKey="Goetz L" first="L" last="Goetz">L. Goetz</name></author><author><name sortKey="Ardouin, C" sort="Ardouin, C" uniqKey="Ardouin C" first="C" last="Ardouin">C. Ardouin</name></author><author><name sortKey="Yelnik, J" sort="Yelnik, J" uniqKey="Yelnik J" first="J" last="Yelnik">J. Yelnik</name></author><author><name sortKey="Henry Lagrange, C" sort="Henry Lagrange, C" uniqKey="Henry Lagrange C" first="C" last="Henry-Lagrange">C. Henry-Lagrange</name></author><author><name sortKey="Seigneuret, E" sort="Seigneuret, E" uniqKey="Seigneuret E" first="E" last="Seigneuret">E. Seigneuret</name></author><author><name sortKey="Piallat, B" sort="Piallat, B" uniqKey="Piallat B" first="B" last="Piallat">B. Piallat</name></author><author><name sortKey="Krack, P" sort="Krack, P" uniqKey="Krack P" first="P" last="Krack">P. Krack</name></author><author><name sortKey="Le Bas, J F" sort="Le Bas, J F" uniqKey="Le Bas J" first="J-F" last="Le Bas">J-F Le Bas</name></author><author><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A-L" last="Benabid">A-L Benabid</name></author><author><name sortKey="Chabardes, S" sort="Chabardes, S" uniqKey="Chabardes S" first="S" last="Chabardès">S. Chabardès</name></author><author><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P" last="Pollak">P. Pollak</name></author></analytic><series><title level="j">Brain : a journal of neurology</title><idno type="eISSN">1460-2156</idno><imprint><date when="2010" type="published">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Cross-Over Studies</term><term>Deep Brain Stimulation (methods)</term><term>Double-Blind Method</term><term>Female</term><term>Follow-Up Studies</term><term>Gait Disorders, Neurologic (etiology)</term><term>Gait Disorders, Neurologic (physiopathology)</term><term>Gait Disorders, Neurologic (therapy)</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Parkinson Disease (complications)</term><term>Parkinson Disease (physiopathology)</term><term>Parkinson Disease (therapy)</term><term>Pedunculopontine Tegmental Nucleus (physiology)</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Gait Disorders, Neurologic</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></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Gait Disorders, Neurologic</term><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Gait Disorders, Neurologic</term><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Cross-Over Studies</term><term>Double-Blind Method</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Gait disturbances are frequent and disabling in advanced Parkinson's disease. These symptoms respond poorly to usual medical and surgical treatments but were reported to be improved by stimulation of the pedunculopontine nucleus. We studied the effects of stimulating the pedunculopontine nucleus area in six patients with severe freezing of gait, unresponsive to levodopa and subthalamic nucleus stimulation. Electrodes were implanted bilaterally in the pedunculopontine nucleus area. Electrode placement was checked by postoperative magnetic resonance imaging. The primary outcome measures were a composite gait score, freezing of gait questionnaire score and duration of freezing episodes occurring during a walking protocol at baseline and one-year follow-up. A double-blind cross-over study was carried out from months 4 to 6 after surgery with or without pedunculopontine nucleus area stimulation. At one-year follow-up, the duration of freezing episodes under off-drug condition improved, as well as falls related to freezing. The other primary outcome measures did not significantly change, nor did the results during the double-blind evaluation. Individual results showed major improvement of all gait measures in one patient, moderate improvement of some tests in four patients and global worsening in one patient. Stimulation frequency ranged between 15 and 25 Hz. Oscillopsia and limb myoclonus could hinder voltage increase. No serious adverse events occurred. Although freezing of gait can be improved by low-frequency electrical stimulation of the pedunculopontine nucleus area in some patients with Parkinson's disease our overall results are disappointing compared to the high levels of expectation raised by previous open label studies. Further controlled studies are needed to determine whether optimization of patient selection, targeting and setting of stimulation parameters might improve the outcome to a point that could transform this experimental approach to a treatment with a reasonable risk-benefit ratio.</div></front></TEI></PubMed></double></record>Pour manipuler ce document sous Unix (Dilib)
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