title: Outcomes from stimulation of the caudal zona incerta and pedunculopontine nucleus in patients with Parkinson's disease.
abstract: BACKGROUND
  Axial symptoms including postural instability, falls and failure of gait initiation are some of the most disabling motor symptoms of Parkinson's disease (PD). We performed bilateral deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) in combination with the caudal zona incerta (cZi) in order to determine their efficacy in alleviating these symptoms.
  
  
  METHODS
  Seven patients with predominant axial symptoms in both the 'on' and 'off' medication states underwent bilateral cZi and PPN DBS. Motor outcomes were assessed using the motor component of the Unified Parkinson's Disease Rating Scale (UPDRS 3) and a composite axial subscore was derived from items 27, 28, 29 and 30 (arising from chair, posture, gait and postural stability). Quality of life was measured using the PDQ39. Comparisons were made between scores obtained at baseline and those at a mean follow-up of 12 months.
  
  
  RESULTS
  In both the off and on medication states, a statistically significant improvement in the UPDRS part 3 score was achieved by stimulation of the PPN, cZi and both in combination. In the off medication state, our composite axial subscore of the UPDRS part 3 improved with stimulation of the PPN, cZi and both in combination. The composite axial subscore, in the 'on' medication state, however, only showed a statistically significant improvement when a combination of cZi and PPN stimulation was used.
  
  
  CONCLUSIONS
  This study provides evidence that a combination of PPN and cZi stimulation can achieve a significant improvement in the hitherto untreatable 'on' medication axial symptoms of PD.
authors.affiliation: Department of Neurosurgery, Institute of Neurosciences, Frenchay Hospital, Bristol, UK.
authors.forename: Sadaquate
authors.initials: S
authors.lastname: Khan
authors.forename: Lucy
authors.initials: L
authors.lastname: Mooney
authors.forename: Puneet
authors.initials: P
authors.lastname: Plaha
authors.forename: Shazia
authors.initials: S
authors.lastname: Javed
authors.forename: Paul
authors.initials: P
authors.lastname: White
authors.forename: Alan L
authors.initials: AL
authors.lastname: Whone
authors.forename: Steven S
authors.initials: SS
authors.lastname: Gill
mesh_terms: D000328:Adult; D000978:Antiparkinson Agents / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D045042:Pedunculopontine Tegmental Nucleus / Q000503:physiopathology*; D011788:Quality of Life; D012720:Severity of Illness Index; D020530:Subthalamus / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents