Pedunculopontine Nucleus Region Deep Brain Stimulation in Parkinson Disease: Surgical Techniques, Side Effects, and Postoperative Imaging

Abstract BACKGROUND Subthalamic nucleus (STN) and globus pallidus interna (GPi) are the most effective targets in deep brain stimulation (DBS) treatment for Parkinson disease (PD). However, the individualized selection of targets remains a clinical challenge. OBJECTIVE To combine unilateral STN and contralateral GPi stimulation (STN DBS in one brain hemisphere and GPi DBS in the other) to maximize the clinical advantages of each target while inducing fewer adverse side effects in selected patients with PD because each target has its own clinical effects and risk profiles. METHODS We reviewed the clinical outcomes of 8 patients with idiopathic PD treated with combined unilateral STN and contralateral GPi DBS. Clinical outcome assessments, focusing on motor and nonmotor symptoms, were performed at baseline and 6-mo and 12-mo follow-up. We performed the assessments under the following conditions: medication on and off (bilateral stimulation on and off and unilateral STN stimulation on). RESULTS Patients showed a significant improvement in motor symptoms, as assessed by the Unified Parkinson Disease Rating Scale III (UPDRS-III) and Timed Up-and-Go Test (TUG), in the off-medication/on-stimulation state at 6-mo and 12-mo follow-up. Also, patients reported a better quality of life, and their intake of levodopa was reduced at 12-mo follow-up. In the on-medication condition, bilateral stimulation was associated with an improvement in axial symptoms, with a 64% improvement in measures of gait and falls at 12-mo follow-up. No irreversible adverse side effects were observed. CONCLUSION Our findings suggest that combined unilateral STN and contralateral GPi DBS could offer an effective and well-tolerated DBS treatment for certain PD patients.

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Severe agitation following deep brain stimulation for parkinsonism

CJEM ◽

10.2310/10.2310/8000.2011.110001 ◽

2011 ◽

Vol 13 (04) ◽

pp. 279-283

Author(s):

Nicholas G.W. Rose ◽

Michael Mostrenko ◽

Jacqueline McMaster ◽

Christopher R. Honey

Keyword(s):

Emergency Department ◽

Case Report ◽

Deep Brain Stimulation ◽

Side Effects ◽

Parkinson Disease ◽

Brain Stimulation ◽

Movement Disorders ◽

Emergency Physician ◽

Practical Information ◽

Deep Brain

ABSTRACT: The use of deep brain stimulation has become increasingly common for the treatment of movement disorders, including Parkinson disease. Although deep brain stimulation is generally very successful in alleviating the extrapyramidal symptoms of Parkinson disease, side effects can occur. This case report describes a patient presenting to the emergency department in a state of extreme aggression 3 days after a change in the parameters of his bilateral subthalamic nucleus stimulator. We review the complications of deep brain stimulation relevant to the emergency physician and provide some practical information on stimulator adjustment in an emergency.

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2.Subthalamic Deep Brain Stimulation for Parkinson Disease(PS-9 Parkinson's Disease:To Overcome Side-effects of Dopa,The 26^ Annual Meeting of The Japanese Congress of Neurological Surgeons)

Japanese Journal of Neurosurgery ◽

10.7887/jcns.15.328_2 ◽

2006 ◽

Vol 15 (4) ◽

pp. 328

Author(s):

Chikashi Fukaya

Keyword(s):

Deep Brain Stimulation ◽

Side Effects ◽

Parkinson Disease ◽

Annual Meeting ◽

Brain Stimulation ◽

Deep Brain

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Improved Outcome on Interleaved Deep Brain Stimulation Settings

Deep Brain Stimulation ◽

10.1093/med/9780190647209.003.0032 ◽

2020 ◽

pp. 155-160

Author(s):

Svjetlana Miocinovic ◽

Pravin Khemani ◽

Rebecca Whiddon ◽

Shilpa Chitnis

Keyword(s):

Deep Brain Stimulation ◽

Side Effects ◽

Parkinson Disease ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Programming Method ◽

Additional Advantage ◽

Stimulation Parameters ◽

Improved Outcome ◽

Deep Brain

Interleaving is a DBS programming method whereby two sets of stimulation parameters are applied interchangeably (on a millisecond level). This chapter describes a patient with Parkinson disease who was implanted with subthalamic nucleus deep brain stimulation but achieved suboptimal tremor control with conventional programming (monopolar, double monopolar, or bipolar settings). Interleaving allowed the dorsal contact to be set to a higher setting, while the contact below was set to a tolerable lower setting. Together, the two contacts provided complete tremor resolution without side effects. It is unknown whether interleaving provides any additional advantage over simply allowing use of different amplitudes at different contacts, but potential mechanisms are discussed.

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

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.318 ◽

2015 ◽

Vol 43 (1) ◽

pp. 120-126 ◽

Cited By ~ 20

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.

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