PPNa-DBS for gait and balance disorders in Parkinson's disease: a double-blind, randomised study

J Neurol. 2015 Jun;262(6):1515-25. doi: 10.1007/s00415-015-7744-1. Epub 2015 Apr 23.

Abstract

Gait and balance disorders are the major source of motor disabilities in advanced forms of Parkinson's disease (PD). Low-frequency stimulation of the pedunculopontine nucleus area (PPNa-DBS) has been recently proposed to treat these symptoms with variable clinical results. To further understand the effects of PPNa-DBS on resistant gait and balance disorders, we performed a randomised double-blind cross-over study in six PD patients. Evaluation included clinical assessment of parkinsonian disability, quality of life and neurophysiological recordings of gait. Evaluations were done 1 month before, 4 and 6 months after surgery with four double-blinded conditions assessed: with and without PPNa-DBS, with and without levodopa treatment. Four patients completed the study and two patients were excluded from the final analysis because of peri-operative adverse events (haematoma, infection). Clinically, the combination of PPNa-DBS and levodopa treatment produced a significant decrease of the freezing episodes. The frequency of falls also decreased in three out of four patients. From a neurophysiological point of view, PPNa-DBS significantly improved the anticipatory postural adjustments and double-stance duration, but not the length and speed of the first step. Interestingly, step length and speed improved after surgery without PPNa-DBS, suggesting that the lesioning effect of PPNa-DBS surgery alleviates parkinsonian akinesia. Quality of life was also significantly improved with PPNa-DBS. These results suggest that PPNa-DBS could improve gait and balance disorders in well-selected PD patients. However, this treatment may be riskier than others DBS surgeries in these patients with an advanced form of PD.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antiparasitic Agents / therapeutic use
  • Deep Brain Stimulation / methods*
  • Double-Blind Method
  • Female
  • Gait Disorders, Neurologic / etiology
  • Gait Disorders, Neurologic / therapy*
  • Humans
  • Imaging, Three-Dimensional
  • Levodopa / therapeutic use
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Outcome Assessment, Health Care
  • Parkinson Disease / complications
  • Parkinson Disease / drug therapy
  • Pedunculopontine Tegmental Nucleus / physiology*
  • Postural Balance / physiology*
  • Sensation Disorders / etiology
  • Sensation Disorders / therapy*
  • Surveys and Questionnaires

Substances

  • Antiparasitic Agents
  • Levodopa