Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson's disease
Identifieur interne : 000498 ( PascalFrancis/Checkpoint ); précédent : 000497; suivant : 000499Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson's disease
Auteurs : M. U. Ferraye [France] ; B. Debu [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. Chabardes [France] ; P. Pollak [France]Source :
- Brain [ 0006-8950 ] ; 2010.
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- Pascal (Inist)
English descriptors
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 risk-benefit ratio.
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Le Bas</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>University of Grenoble</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University of Grenoble</wicri:noRegion><wicri:noRegion>University of Grenoble</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>INSERM, U836, Grenoble Institute of Neuroscience</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>INSERM, U836, Grenoble Institute of Neuroscience</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University Hospital of Grenoble</s1><s3>FRA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion></affiliation></author><author><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A.-L." last="Benabid">A.-L. 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U." last="Ferraye">M. U. Ferraye</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>University of Grenoble</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University of Grenoble</wicri:noRegion><wicri:noRegion>University of Grenoble</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>INSERM, U836, Grenoble Institute of Neuroscience</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>INSERM, U836, Grenoble Institute of Neuroscience</wicri:noRegion></affiliation></author><author><name sortKey="Debu, B" sort="Debu, B" uniqKey="Debu B" first="B." last="Debu">B. Debu</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>University of Grenoble</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University of Grenoble</wicri:noRegion><wicri:noRegion>University of Grenoble</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>INSERM, U836, Grenoble Institute of Neuroscience</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>INSERM, U836, Grenoble Institute of Neuroscience</wicri:noRegion></affiliation></author><author><name sortKey="Fraix, V" sort="Fraix, V" uniqKey="Fraix V" first="V." last="Fraix">V. Fraix</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>University of Grenoble</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University of Grenoble</wicri:noRegion><wicri:noRegion>University of Grenoble</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>INSERM, U836, Grenoble Institute of Neuroscience</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>INSERM, U836, 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"><inist:fA14 i1="01"><s1>University of Grenoble</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University of Grenoble</wicri:noRegion><wicri:noRegion>University of Grenoble</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>INSERM, U836, Grenoble Institute of Neuroscience</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>INSERM, U836, 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"><inist:fA14 i1="03"><s1>University Hospital of Grenoble</s1><s3>FRA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion></affiliation></author><author><name sortKey="Yelnik, J" sort="Yelnik, J" uniqKey="Yelnik J" first="J." last="Yelnik">J. Yelnik</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>INSERM UMR_S975, Fédération de Neurologie</s1><s2>Paris</s2><s3>FRA</s3><sZ>6 aut.</sZ></inist:fA14><country>France</country><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"><inist:fA14 i1="05"><s1>University Pierre et Marie Curie</s1><s2>Paris</s2><s3>FRA</s3><sZ>6 aut.</sZ></inist:fA14><country>France</country><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"><inist:fA14 i1="06"><s1>Hôpital de la Pitié-Salpêtrière</s1><s2>Paris</s2><s3>FRA</s3><sZ>6 aut.</sZ></inist:fA14><country>France</country><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"><inist:fA14 i1="01"><s1>University of Grenoble</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University of Grenoble</wicri:noRegion><wicri:noRegion>University of Grenoble</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>INSERM, U836, Grenoble Institute of Neuroscience</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>INSERM, U836, 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"><inist:fA14 i1="03"><s1>University Hospital of Grenoble</s1><s3>FRA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion></affiliation></author><author><name sortKey="Piallat, B" sort="Piallat, B" uniqKey="Piallat B" first="B." last="Piallat">B. Piallat</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>University of Grenoble</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University of Grenoble</wicri:noRegion><wicri:noRegion>University of Grenoble</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>INSERM, U836, Grenoble Institute of Neuroscience</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>INSERM, U836, 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"><inist:fA14 i1="01"><s1>University of Grenoble</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University of Grenoble</wicri:noRegion><wicri:noRegion>University of Grenoble</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>INSERM, U836, Grenoble Institute of Neuroscience</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>INSERM, U836, Grenoble Institute of Neuroscience</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University Hospital of Grenoble</s1><s3>FRA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion></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"><inist:fA14 i1="01"><s1>University of Grenoble</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University of Grenoble</wicri:noRegion><wicri:noRegion>University of Grenoble</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>INSERM, U836, Grenoble Institute of Neuroscience</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>INSERM, U836, Grenoble Institute of Neuroscience</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University Hospital of Grenoble</s1><s3>FRA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion></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"><inist:fA14 i1="01"><s1>University of Grenoble</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University of Grenoble</wicri:noRegion><wicri:noRegion>University of Grenoble</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>INSERM, U836, Grenoble Institute of Neuroscience</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>INSERM, U836, Grenoble Institute of Neuroscience</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University Hospital of Grenoble</s1><s3>FRA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion></affiliation></author><author><name sortKey="Chabardes, S" sort="Chabardes, S" uniqKey="Chabardes S" first="S." last="Chabardes">S. Chabardes</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>University of Grenoble</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University of Grenoble</wicri:noRegion><wicri:noRegion>University of Grenoble</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>INSERM, U836, Grenoble Institute of Neuroscience</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>INSERM, U836, Grenoble Institute of Neuroscience</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University Hospital of Grenoble</s1><s3>FRA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion></affiliation></author><author><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P." last="Pollak">P. Pollak</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>University of Grenoble</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University of Grenoble</wicri:noRegion><wicri:noRegion>University of Grenoble</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>INSERM, U836, Grenoble Institute of Neuroscience</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Grenoble Institute of Neuroscience</wicri:noRegion><wicri:noRegion>INSERM, U836, Grenoble Institute of Neuroscience</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University Hospital of Grenoble</s1><s3>FRA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion><wicri:noRegion>University Hospital of Grenoble</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Brain</title><title level="j" type="abbreviated">Brain</title><idno type="ISSN">0006-8950</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Brain</title><title level="j" type="abbreviated">Brain</title><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Gait disorder</term><term>Nervous system diseases</term><term>Parkinson disease</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Trouble de la marche</term><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</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><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0006-8950</s0></fA01><fA03 i2="1"><s0>Brain</s0></fA03><fA05><s2>133</s2></fA05><fA06><s3>p. 1</s3></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson's disease</s1></fA08><fA11 i1="01" i2="1"><s1>FERRAYE (M. U.)</s1></fA11><fA11 i1="02" i2="1"><s1>DEBU (B.)</s1></fA11><fA11 i1="03" i2="1"><s1>FRAIX (V.)</s1></fA11><fA11 i1="04" i2="1"><s1>GOETZ (L.)</s1></fA11><fA11 i1="05" i2="1"><s1>ARDOUIN (C.)</s1></fA11><fA11 i1="06" i2="1"><s1>YELNIK (J.)</s1></fA11><fA11 i1="07" i2="1"><s1>HENRY-LAGRANGE (C.)</s1></fA11><fA11 i1="08" i2="1"><s1>SEIGNEURET (E.)</s1></fA11><fA11 i1="09" i2="1"><s1>PIALLAT (B.)</s1></fA11><fA11 i1="10" i2="1"><s1>KRACK (P.)</s1></fA11><fA11 i1="11" i2="1"><s1>LE BAS (J.-F.)</s1></fA11><fA11 i1="12" i2="1"><s1>BENABID (A.-L.)</s1></fA11><fA11 i1="13" i2="1"><s1>CHABARDES (S.)</s1></fA11><fA11 i1="14" i2="1"><s1>POLLAK (P.)</s1></fA11><fA14 i1="01"><s1>University of Grenoble</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></fA14><fA14 i1="02"><s1>INSERM, U836, Grenoble Institute of Neuroscience</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></fA14><fA14 i1="03"><s1>University Hospital of Grenoble</s1><s3>FRA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ></fA14><fA14 i1="04"><s1>INSERM UMR_S975, Fédération de Neurologie</s1><s2>Paris</s2><s3>FRA</s3><sZ>6 aut.</sZ></fA14><fA14 i1="05"><s1>University Pierre et Marie Curie</s1><s2>Paris</s2><s3>FRA</s3><sZ>6 aut.</sZ></fA14><fA14 i1="06"><s1>Hôpital de la Pitié-Salpêtrière</s1><s2>Paris</s2><s3>FRA</s3><sZ>6 aut.</sZ></fA14><fA20><s1>205-214</s1></fA20><fA21><s1>2010</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>998</s2><s5>354000189974790160</s5></fA43><fA44><s0>0000</s0><s1>© 2010 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>3/4 p.</s0></fA45><fA47 i1="01" i2="1"><s0>10-0060220</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Brain</s0></fA64><fA66 i1="01"><s0>GBR</s0></fA66><fC01 i1="01" l="ENG"><s0>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.</s0></fC01><fC02 i1="01" i2="X"><s0>002B17</s0></fC02><fC02 i1="02" i2="X"><s0>002B17G</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Trouble de la marche</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Gait disorder</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Trastorno marcha</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Maladie de Parkinson</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Parkinson disease</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Parkinson enfermedad</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Pathologie du système nerveux</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>03</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Pathologie de l'encéphale</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Syndrome extrapyramidal</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Maladie dégénérative</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Degenerative disease</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Pathologie du système nerveux central</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>40</s5></fC07><fN21><s1>039</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard></inist><affiliations><list><country><li>France</li></country><region><li>Île-de-France</li></region><settlement><li>Paris</li></settlement></list><tree><country name="France"><noRegion><name sortKey="Ferraye, M U" sort="Ferraye, M U" uniqKey="Ferraye M" first="M. U." last="Ferraye">M. U. Ferraye</name></noRegion><name sortKey="Ardouin, C" sort="Ardouin, C" uniqKey="Ardouin C" first="C." last="Ardouin">C. Ardouin</name><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A.-L." last="Benabid">A.-L. Benabid</name><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A.-L." last="Benabid">A.-L. Benabid</name><name sortKey="Benabid, A L" sort="Benabid, A L" uniqKey="Benabid A" first="A.-L." last="Benabid">A.-L. Benabid</name><name sortKey="Chabardes, S" sort="Chabardes, S" uniqKey="Chabardes S" first="S." last="Chabardes">S. Chabardes</name><name sortKey="Chabardes, S" sort="Chabardes, S" uniqKey="Chabardes S" first="S." last="Chabardes">S. Chabardes</name><name sortKey="Chabardes, S" sort="Chabardes, S" uniqKey="Chabardes S" first="S." last="Chabardes">S. Chabardes</name><name sortKey="Debu, B" sort="Debu, B" uniqKey="Debu B" first="B." last="Debu">B. Debu</name><name sortKey="Debu, B" sort="Debu, B" uniqKey="Debu B" first="B." last="Debu">B. Debu</name><name sortKey="Ferraye, M U" sort="Ferraye, M U" uniqKey="Ferraye M" first="M. U." last="Ferraye">M. U. Ferraye</name><name sortKey="Fraix, V" sort="Fraix, V" uniqKey="Fraix V" first="V." last="Fraix">V. Fraix</name><name sortKey="Fraix, V" sort="Fraix, V" uniqKey="Fraix V" first="V." last="Fraix">V. Fraix</name><name sortKey="Goetz, L" sort="Goetz, L" uniqKey="Goetz L" first="L." last="Goetz">L. Goetz</name><name sortKey="Goetz, L" sort="Goetz, L" uniqKey="Goetz L" first="L." last="Goetz">L. Goetz</name><name sortKey="Henry Lagrange, C" sort="Henry Lagrange, C" uniqKey="Henry Lagrange C" first="C." last="Henry-Lagrange">C. Henry-Lagrange</name><name sortKey="Henry Lagrange, C" sort="Henry Lagrange, C" uniqKey="Henry Lagrange C" first="C." last="Henry-Lagrange">C. Henry-Lagrange</name><name sortKey="Krack, P" sort="Krack, P" uniqKey="Krack P" first="P." last="Krack">P. Krack</name><name sortKey="Krack, P" sort="Krack, P" uniqKey="Krack P" first="P." last="Krack">P. Krack</name><name sortKey="Krack, P" sort="Krack, P" uniqKey="Krack P" first="P." last="Krack">P. Krack</name><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><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><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><name sortKey="Piallat, B" sort="Piallat, B" uniqKey="Piallat B" first="B." last="Piallat">B. Piallat</name><name sortKey="Piallat, B" sort="Piallat, B" uniqKey="Piallat B" first="B." last="Piallat">B. Piallat</name><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P." last="Pollak">P. Pollak</name><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P." last="Pollak">P. Pollak</name><name sortKey="Pollak, P" sort="Pollak, P" uniqKey="Pollak P" first="P." last="Pollak">P. Pollak</name><name sortKey="Seigneuret, E" sort="Seigneuret, E" uniqKey="Seigneuret E" first="E." last="Seigneuret">E. Seigneuret</name><name sortKey="Yelnik, J" sort="Yelnik, J" uniqKey="Yelnik J" first="J." last="Yelnik">J. Yelnik</name><name sortKey="Yelnik, J" sort="Yelnik, J" uniqKey="Yelnik J" first="J." last="Yelnik">J. Yelnik</name><name sortKey="Yelnik, J" sort="Yelnik, J" uniqKey="Yelnik J" first="J." last="Yelnik">J. Yelnik</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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