Pedunculopontine Nucleus Deep Brain Stimulation for Parkinsonian Disorders: A Case Series.

Dayal, V; Rajabian, A; Jahanshahi, M; Aviles-Olmos, I; Cowie, D; Peters, A; Day, B; Hyam, J; Akram, H; Limousin, P; Hariz, M; Zrinzo, L; Foltynie, T

Abstract

Background: Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) has been investigated for the treatment of levodopa-refractory gait dysfunction in parkinsonian disorders, with equivocal results so far. Objectives: To summarize the clinical outcomes of PPN-DBS-treated patients at our centre and elicit any patterns that may guide future research. Materials and Methods: Pre- and post-operative objective overall motor and gait subsection scores as well as patient-reported outcomes were recorded for 6 PPN-DBS-treated patients, 3 with Parkinson’s disease (PD), and 3 with progressive supranuclear palsy (PSP). Electrodes were implanted unilaterally in the first 3 patients and bilaterally in the latter 3, using an MRI-guided MRI-verified technique. Stimulation was initiated at 20–30 Hz and optimized in an iterative manner. Results: Unilaterally treated patients did not demonstrate significant improvements in gait questionnaires, UPDRS-III or PSPRS scores or their respective gait subsections. This contrasted with at least an initial response in bilaterally treated patients. Diurnal cycling of stimulation in a PD patient with habituation to the initial benefit reproduced substantial improvements in freezing of gait (FOG) 3 years post-operatively. Among the PSP patients, 1 with a parkinsonian subtype had a sustained improvement in FOG while another with Richardson syndrome (PSP-RS) did not benefit. Conclusions: PPN-DBS remains an investigational treatment for levodopa-refractory FOG. This series corroborates some previously reported findings: bilateral stimulation may be more effective than unilateral stimulation; the response in PSP patients may depend on the disease subtype; and diurnal cycling of stimulation to overcome habituation merits further investigation.

Citation

Dayal, V., Rajabian, A., Jahanshahi, M., Aviles-Olmos, I., Cowie, D., Peters, A., Day, B., Hyam, J., Akram, H., Limousin, P., Hariz, M., Zrinzo, L., & Foltynie, T. (2021). Pedunculopontine Nucleus Deep Brain Stimulation for Parkinsonian Disorders: A Case Series. Stereotactic and Functional Neurosurgery, 99(4), 287–294. https://doi.org/10.1159/000511978

• Journal Article Type: Article
• Acceptance Date: Sep 29, 2020
• Online Publication Date: Dec 4, 2020
• Publication Date: 2021
• Deposit Date: Oct 18, 2022
• Journal: Stereotactic and Functional Neurosurgery
• Print ISSN: 1011-6125
• Publisher: Karger Publishers
• Volume: 99
• Issue: 4
• Pages: 287–294
• DOI: https://doi.org/10.1159/000511978
• Public URL: https://durham-repository.worktribe.com/output/1188784