https://scholars.lib.ntu.edu.tw/handle/123456789/520118
標題: | Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review | 作者: | Thevathasan W. Debu B. Aziz T. Bloem B.R. Blahak C. Butson C. Czernecki V. Foltynie T. Fraix V. Grabli D. Joint C. Lozano A.M. Okun M.S. Ostrem J. Pavese N. Schrader C. CHUN-HWEI TAI Krauss J.K. Moro E. on behalf of the Movement Disorders Society PPN DBS Working Groupin collaboration with the World Society for Stereotactic Functional Neurosurgery |
關鍵字: | deep brain stimulation; gait freezing; Parkinson's disease; pedunculopontine nucleus | 公開日期: | 2018 | 出版社: | John Wiley and Sons Inc. | 卷: | 33 | 期: | 1 | 起(迄)頁: | 10-20 | 來源出版物: | Movement Disorders | 摘要: | Pedunculopontine nucleus region deep brain stimulation (DBS) is a promising but experimental therapy for axial motor deficits in Parkinson's disease (PD), particularly gait freezing and falls. Here, we summarise the clinical application and outcomes reported during the past 10 years. The published dataset is limited, comprising fewer than 100 cases. Furthermore, there is great variability in clinical methodology between and within surgical centers. The most common indication has been severe medication refractory gait freezing (often associated with postural instability). Some patients received lone pedunculopontine nucleus DBS (unilateral or bilateral) and some received costimulation of the subthalamic nucleus or internal pallidum. Both rostral and caudal pedunculopontine nucleus subregions have been targeted. However, the spread of stimulation and variance in targeting means that neighboring brain stem regions may be implicated in any response. Low stimulation frequencies are typically employed (20-80 Hertz). The fluctuating nature of gait freezing can confound programming and outcome assessments. Although firm conclusions cannot be drawn on therapeutic efficacy, the literature suggests that medication refractory gait freezing and falls can improve. The impact on postural instability is unclear. Most groups report a lack of benefit on gait or limb akinesia or dopaminergic medication requirements. The key question is whether pedunculopontine nucleus DBS can improve quality of life in PD. So far, the evidence supporting such an effect is minimal. Development of pedunculopontine nucleus DBS to become a reliable, established therapy would likely require a collaborative effort between experienced centres to clarify biomarkers predictive of response and the optimal clinical methodology. ? 2017 International Parkinson and Movement Disorder Society. ? 2017 International Parkinson and Movement Disorder Society |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85040690558&doi=10.1002%2fmds.27098&partnerID=40&md5=27abf9f7fd74c10d1e971f7698621667 https://scholars.lib.ntu.edu.tw/handle/123456789/520118 |
ISSN: | 0885-3185 | DOI: | 10.1002/mds.27098 | SDG/關鍵字: | akinesia; brain depth stimulation; brain stem; clinical outcome; dopaminergic system; falling; gait disorder; globus pallidus; human; outcome assessment; Parkinson disease; pedunculopontine tegmental nucleus; predictive value; priority journal; quality of life; Review; subthalamic nucleus; surgical risk; treatment indication; brain depth stimulation; Medline; Parkinson disease; pedunculopontine tegmental nucleus; physiology; procedures; statistics and numerical data; Deep Brain Stimulation; Humans; Parkinson Disease; Pedunculopontine Tegmental Nucleus; PubMed |
顯示於: | 醫學系 |
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