gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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Low-frequency stimulation of the pedunculo-pontine nuclei can improve posture and gait in Parkinsonian syndromes

Meeting Abstract

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  • I. Galazky - Universitätsklinik für Neurologie, Otto-von-Guericke-Universität Magdeburg
  • L. Büntjen - Universitätsklinik für Stereotaktische Neurochirurgie, Otto-von-Guericke-Universität Magdeburg
  • S. Stallforth - Universitätsklinik für Neurologie, Otto-von-Guericke-Universität Magdeburg
  • H.J. Heinze - Universitätsklinik für Neurologie, Otto-von-Guericke-Universität Magdeburg
  • J. Voges - Universitätsklinik für Stereotaktische Neurochirurgie, Otto-von-Guericke-Universität Magdeburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.04.06

doi: 10.3205/12dgnc051, urn:nbn:de:0183-12dgnc0515

Published: June 4, 2012

© 2012 Galazky et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Deep brain stimulation (DBS) of the pedunculo-pontine nucleus (PPN) has been proven to be effective in severe gait disorders in idiopathic Parkinson's disease. Axial motor symptoms like freezing of gait and postural instability are disabling motor features of other Parkinsonian disorders too. Since pharmacological treatment does not improve such disabilities PPN DBS might provide alleviation of symptoms. We report the clinical results of PPN DBS in six patients with Parkinson disorders of different etiologies.

Methods: Six patients with Parkinsonian disorders and severe gait disorders underwent surgery for PPN DBS. Two patients with probable progressive supranuclear palsy (PSP) had electrodes implanted into the PPN as a single target, two patients with idiopathic Parkinson's disease and one patient with a levodopa-responsive atypical Parkinsonian syndrome received PPN electrodes in addition to bilateral DBS of the subthalamic nucleus (STN), one patient with Parkinson's disease and dystonia received PPN electrodes in addition to DBS of the internal pallidum (GPi). Clinical evaluation included history (falls diary, SF 36 [36-Item Short Form Survey]), motor scales (UPDRS [Unified Parkinson's disease rating scale] motor scale, PSP-RS [PSP rating scale], TUG [Timed “Up and Go”], Tinetti-Test, posturography, automatized gait analysis), and cognitive examination.

Results: Changes of gait and balance disorders were observed in varying degrees. All patients experienced a relevant stabilisation of gait which was presented by a reduction of start hesitation and freezing in the clinical exams. Especially PSP patients reported reduced falls. The clinical improvement was not reflected by the motor scales used except the gait changes which were partially pictured by the TUG. Detailed posturography and automatized gait analysis provided better information about clinical changes.

Conclusions: In view of these first preliminary results, we discuss that PPN DBS could serve as a symptomatic treatment for carefully selected patients with atypical Parkinsonism. For a well-documented decision SWOT analysis is needed in a larger population and the long-term effectiveness has to be evaluated.