Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom,
Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
Stereotact Funct Neurosurg. 2021;99(4):287-294. doi: 10.1159/000511978. Epub 2020 Dec 4.
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.
To summarize the clinical outcomes of PPN-DBS-treated patients at our centre and elicit any patterns that may guide future research.
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.
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.
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.
深部脑刺激（DBS）的脑桥被盖核（PPN）已被研究用于治疗帕金森病患者的左旋多巴难治性步态障碍，但迄今为止结果喜忧参半。
总结我们中心接受 PPN-DBS 治疗的患者的临床结果，并得出可能指导未来研究的任何模式。
记录了 6 名接受 PPN-DBS 治疗的患者（3 名帕金森病患者和 3 名进行性核上性麻痹患者）的术前和术后客观整体运动和步态亚组评分以及患者报告的结果。使用 MRI 引导的 MRI 验证技术，将电极单侧植入前 3 名患者，双侧植入后 3 名患者。刺激以 20-30 Hz 起始，并以迭代方式进行优化。
单侧治疗的患者在步态问卷、UPDRS-III 或 PSPRS 评分或各自的步态亚组中没有显示出明显的改善。这与双侧治疗的患者至少有一个初始反应形成对比。一名帕金森病患者的刺激昼夜循环伴初始获益的习惯化，术后 3 年再次出现显著改善的冻结步态（FOG）。在 PSP 患者中，1 名具有帕金森亚型的患者的 FOG 持续改善，而另 1 名具有 Richardson 综合征（PSP-RS）的患者则没有受益。
PPN-DBS 仍然是一种治疗左旋多巴难治性 FOG 的试验性治疗方法。本系列研究证实了一些先前报道的发现：双侧刺激可能比单侧刺激更有效；PSP 患者的反应可能取决于疾病亚型；以及为克服习惯化而进行的刺激昼夜循环值得进一步研究。
