scholarly journals Efficacy and Safety of Pedunculopontine Nuclei (PPN) Deep Brain Stimulation in the Treatment of Gait Disorders: A Meta-Analysis of Clinical Studies

2015 ◽  
Vol 43 (1) ◽  
pp. 120-126 ◽  
Author(s):  
Laleh Golestanirad ◽  
Behzad Elahi ◽  
Simon J. Graham ◽  
Sunit Das ◽  
Lawrence L. Wald
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Freezing Of Gait ◽  
Pedunculopontine Nucleus ◽  
Postural Instability ◽  
Internal Globus Pallidus ◽  
Motor Abnormalities ◽  
Deep Brain

AbstractBackground: Pedunculopontine nucleus (PPN) has complex reciprocal connections with basal ganglia, especially with internal globus pallidus and substantia nigra, and it has been postulated that PPN stimulation may improve gait instability and freezing of gait. In this meta-analysis, we will assess the evidence for PPN deep brain stimulation in treatment of gait and motor abnormalities especially focusing on Parkinson disease patients. Methods: PubMed and Scopus electronic databases were searched for related studies published before February 2014. Medline (1966-2014), Embase (1974-2010), CINAHL, Web of Science, Scopus bibliographic, and Google Scholar databases (1960-2014) were also searched for studies investigating effect of PPN deep brain stimulation in treatment of postural and postural instability and total of ten studies met the inclusion criteria for this analysis. Results: Our findings showed a significant improvement in postural instability (p<0.001) and motor symptoms of Parkinson disease on and off medications (p<0.05), but failed to show improvement in freezing of gait. Conclusions: Despite significant improvement in postural instability observed in included studies, evidence from current literature is not sufficient to generalize these findings to the majority of patients.

scholarly journals Pedunculopontine Nucleus Region Deep Brain Stimulation in Parkinson Disease: Surgical Anatomy and Terminology

2016 ◽  
Vol 94 (5) ◽  
pp. 298-306 ◽  
Author(s):  
Clement Hamani ◽  
Tipu Aziz ◽  
Bastiaan R. Bloem ◽  
Peter Brown ◽  
Stephan Chabardes ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Pedunculopontine Nucleus ◽  
Surgical Anatomy ◽  
Deep Brain

Deep Brain Stimulation of the Pedunculopontine Nucleus in a Patient with Freezing of Gait

2011 ◽  
Vol 89 (4) ◽  
pp. 214-219 ◽  
Author(s):  
Feridun Acar ◽  
Göksemin Acar ◽  
Levent Sinan Bir ◽  
Bengi Gedik ◽  
Attila Oğuzhanoğlu
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Freezing Of Gait ◽  
Pedunculopontine Nucleus ◽  
Deep Brain ◽  
Stimulation Of

Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease

2014 ◽  
Vol 121 (3) ◽  
pp. 709-718 ◽  
Author(s):  
Yi Liu ◽  
Weina Li ◽  
Changhong Tan ◽  
Xi Liu ◽  
Xin Wang ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Motor Function ◽  
Brain Stimulation ◽  
Daily Living ◽  
Psychiatric Symptoms ◽  
Meta Analysis ◽  
Stn Dbs ◽  
Deep Brain ◽  
Stimulation Of

Object Deep brain stimulation (DBS) is the surgical procedure of choice for patients with advanced Parkinson disease (PD). The globus pallidus internus (GPi) and the subthalamic nucleus (STN) are commonly targeted by this procedure. The purpose of this meta-analysis was to compare the efficacy of DBS in each region. Methods MEDLINE/PubMed, EMBASE, Web of Knowledge, and the Cochrane Library were searched for English-language studies published before April 2013. Results of studies investigating the efficacy and clinical outcomes of DBS of the GPi and STN for PD were analyzed. Results Six eligible trials containing a total of 563 patients were included in the analysis. Deep brain stimulation of the GPi or STN equally improved motor function, measured by the Unified Parkinson's Disease Rating Scale Section III (UPDRSIII) (motor section, for patients in on- and off-medication phases), within 1 year postsurgery. The change score for the on-medication phase was 0.68 (95% CI – 2.12 to 3.47, p > 0.05; 5 studies, 518 patients) and for the off-medication phase was 1.83 (95% CI – 3.12 to 6.77, p > 0.05; 5 studies, 518 patients). The UPDRS Section II (activities of daily living) scores for patients on medication improved equally in both DBS groups (p = 0.97). STN DBS allowed medication dosages to be reduced more than GPi DBS (95% CI 129.27–316.64, p < 0.00001; 5 studies, 540 patients). Psychiatric symptoms, measured by Beck Depression Inventory, 2nd edition scores, showed greater improvement from baseline after GPi DBS than after STN DBS (standardized mean difference −2.28, 95% CI −3.73 to −0.84, p = 0.002; 3 studies, 382 patients). Conclusions GPi and STN DBS improve motor function and activities of daily living for PD patients. Differences in therapeutic efficacy for PD were not observed between the 2 procedures. STN DBS allowed greater reduction in medication for patients, whereas GPi DBS provided greater relief from psychiatric symptoms. An understanding of other symptomatic aspects of targeting each region and long-term observations on therapeutic effects are needed.

scholarly journals Deep brain stimulation in the treatment of Parkinson’s disease

2021 ◽  
Author(s):  
Bruna Alves Rocha ◽  
Lucas Oliveira Braga ◽  
Julia Beatriz Xavier do Nascimento ◽  
Angela dos Santos Avakian
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Postural Instability ◽  
Motor Symptoms ◽  
Subcortical Structures ◽  
Pubmed Database ◽  
Deep Brain

Introduction: Parkinson’s disease (PD) is neurodegenerative and has bradykinesia, rest tremor, stiffnes and postural instability. These changes come from the degeneration of dopaminergic neurons. The treatment, carried out based on levodopa, provides improvements in the condition of the patients, however, they provide side effects. Based on this, the Deep Brain Stimulation (DBS) technique - stimulation of subcortical structures with electrodes - is a good treatment option. Methods: A narrative review of the literature was carried out, using the PubMed database with the keywords “Deep brain stimulation”, “Therapeutic use” and “Parkinson’s disease”. Included articles of meta-analysis, systematic review and review published in the last year. Results: The DBS offers a significant improvement in motor symptoms, gait, postural instability, reduction in tremors and in their progression. However, DBS can offer risks to the patient. Comparing the effectiveness of DBS with other therapies for Parkinson’s, such as levodopa/ carbidopa intestinal infusion gel (LCIG) and best medical therapy (BMT), it was found that BMT is botton. The cost-effectiveness comparison of these techniques, showed that DBS is the most costly procedure. It stands out comparisons can have intrinsic biases, such as the conflict of interest with pharmaceutical companies. Conclusion: DBS is a beneficial intervention for patients with PD who have important motor symptoms. Performed only in cases with indication, due to the possibility of complications.

STN vs. GPi deep brain stimulation for tremor suppression in Parkinson disease: A systematic review and meta-analysis

2019 ◽  
Vol 58 ◽  
pp. 56-62 ◽  
Author(s):  
Joshua K. Wong ◽  
James H. Cauraugh ◽  
Kwo Wei David Ho ◽  
Matthew Broderick ◽  
Adolfo Ramirez-Zamora ◽  
...  
Keyword(s):  
Systematic Review ◽  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Tremor Suppression ◽  
Deep Brain
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