Brain Advance Access published online on October 21, 2009
Brain, doi:10.1093/brain/awp261
Unilateral pedunculopontine stimulation improves falls in Parkinson's disease
1 Movement Disorders Center, Division of Neurology, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada 2 Division of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada 3 Section of Neurology, Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia 4 Department of Physiology, University of Toronto, Toronto, ON, Canada 5 Toronto Western Research Institute, Toronto, ON, Canada
Correspondence to:
Andres Lozano, MD, PhD, Division of Neurosurgery, 4-447 Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8 Canada E-mail: lozano{at}uhnresearch.ca
Postural instability and falls are a major source of disability in patients with advanced Parkinson's disease. These problems are currently not well addressed by either pharmacotherapy nor by subthalamic nucleus deep-brain stimulation surgery. The neuroanatomical substrates of posture and gait are poorly understood but a number of important observations suggest a major role for the pedunculopontine nucleus and adjacent areas in the brainstem. We conducted a double-blinded evaluation of unilateral pedunculopontine nucleus deep-brain stimulation in a pilot study in six advanced Parkinson's disease patients with significant gait and postural abnormalities. There was no significant difference in the double-blinded on versus off stimulation Unified Parkinson's Disease Rating Scale motor scores after 3 or 12 months of continuous stimulation and no improvements in the Unified Parkinson's Disease Rating Scale part III scores compared to baseline. In contrast, patients reported a significant reduction in falls in the on and off medication states both at 3 and 12 months after pedunculopontine nucleus deep-brain stimulation as captured in the Unified Parkinson's Disease Rating Scale part II scores. Our results suggest that pedunculopontine nucleus deep-brain stimulation may be effective in preventing falls in patients with advanced Parkinson's disease but that further evaluation of this procedure is required.
Key Words: deep brain stimulation; Parkinson's disease; pedunculopontine nucleus
Abbreviations: DBS, deep-brain stimulation; OFF, off medication; ON, on medication; PPN, pedunculopontine nucleus; UPDRS, Unified Parkinson's Disease Rating Scale
Received May 22, 2009. Revised August 24, 2009. Accepted August 26, 2009.