title: PPNa-DBS for gait and balance disorders in Parkinson's disease: a double-blind, randomised study.
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.
authors.affiliation: U1127, Inserm, 75013, Paris, France, marie-laure.welter@psl.aphp.fr.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Welter
authors.forename: Adele
authors.initials: A
authors.lastname: Demain
authors.forename: Claire
authors.initials: C
authors.lastname: Ewenczyk
authors.forename: Virginie
authors.initials: V
authors.lastname: Czernecki
authors.forename: Brian
authors.initials: B
authors.lastname: Lau
authors.forename: Amine
authors.initials: A
authors.lastname: El Helou
authors.forename: Hayat
authors.initials: H
authors.lastname: Belaid
authors.forename: Jérôme
authors.initials: J
authors.lastname: Yelnik
authors.forename: Chantal
authors.initials: C
authors.lastname: François
authors.forename: Eric
authors.initials: E
authors.lastname: Bardinet
authors.forename: Carine
authors.initials: C
authors.lastname: Karachi
authors.forename: David
authors.initials: D
authors.lastname: Grabli
mesh_terms: D000368:Aged; D000977:Antiparasitic Agents / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000628:therapy*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007980:Levodopa / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy; D045042:Pedunculopontine Tegmental Nucleus / Q000502:physiology*; D004856:Postural Balance / Q000502:physiology*; D012678:Sensation Disorders / Q000209:etiology / Q000628:therapy*; D011795:Surveys and Questionnaires
chemical_list: D000977:Antiparasitic Agents; D007980:Levodopa