Fytagoridis Anders, Silburn Peter A, Coyne Terry J, Thevathasan Wesley
St. Andrews and Wesley Hospitals, Brisbane, QLD, Australia.
Asia-Pacific Centre for Neuromodulation, University of Queensland, Brisbane, Australia.
J Neural Transm (Vienna). 2016 Jul;123(7):769-774. doi: 10.1007/s00702-016-1505-x. Epub 2016 Jan 16.
This paper presents the Brisbane experience of pedunculopontine nucleus (PPN) deep brain stimulation (DBS) in Parkinson's disease (PD). Clinical outcomes along with studies of the mechanisms and neurophysiology of PPN in PD patients with severe freezing of gait (FoG) and postural imbalance (PI) are summarised and presented. Our results indicate that PPN DBS improves FoG and falls in the relatively uncommon group of PD patients who respond well to medication other than for continuing on time FoG and falls. Our studies indicate that bilateral DBS is more beneficial than unilateral DBS, and that the more caudal region of the PPN seems preferable for stimulation. There is evidence that rapid-release programs for initiation and correction of gait and posture are modulated by the PPN, possibly to some extent independently of the cerebral cortex. These functions were found to be impaired in PD patients with severe FoG/PI, but to some extent corrected by bilateral PPN DBS.
本文介绍了布里斯班在帕金森病（PD）中进行脚桥核（PPN）深部脑刺激（DBS）的经验。总结并呈现了临床结果以及对PD患者中严重步态冻结（FoG）和姿势失衡（PI）患者的PPN机制和神经生理学研究。我们的结果表明，PPN DBS可改善FoG，并减少在对除持续FoG和跌倒外的其他药物反应良好的相对罕见的PD患者群体中的跌倒情况。我们的研究表明，双侧DBS比单侧DBS更有益，并且PPN的更靠尾侧区域似乎更适合刺激。有证据表明，PPN可调节用于启动和纠正步态及姿势的快速释放程序，可能在一定程度上独立于大脑皮层。这些功能在患有严重FoG/PI的PD患者中受损，但通过双侧PPN DBS在一定程度上得到纠正。
