title: Clinical Experience with Pedunculopontine Nucleus Stimulation in Conditions with Nigrostriatal Disconnection.
abstract: The pedunculopontine nucleus (PPN) is a part of the mesencephalic locomotor region and, in recent years, it has been considered a new surgical target for deep brain stimulation (DBS) for movement disorders including atypical parkinsonian syndromes such as progressive supranuclear palsy (PSP) and multiple system atrophy. Involvement of the PPN may play an important role in gait impairment in these disorders and the development of PPN DBS could potentially provide treatment for this disabling problem. However, the role of the PPN and the specific pathways involved in gait control and other motor functions are poorly understood.
  
  
  
  We present a chronological account of our group's experience in the use of PPN DBS. This entails the treatment of four patients with disabling movement disorders who all exhibited either marked damage or disconnection of the nigro-striatal pathway.
  
  
  
  Within our series, the results were variable in that 2 of the 4 patients benefited greatly from DBS but the other 2 did not.
  
  
  
  Our findings suggest that in carefully selected patients, PPN DBS can potentially alleviate symptoms due to dopaminergic striatal inactivity; symptoms that are typically resistant to stimulation of other subcortical targets used for parkinsonian syndromes and movement disorders.
authors.affiliation: Department of Neurosurgery, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Rowe
authors.affiliation: Department of Neurology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
authors.forename: Aijaz
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Romanowski
authors.affiliation: Department of Clinical Neuropsychology Services, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Isaac
authors.affiliation: Department of Neurosurgery, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
authors.forename: Sadequate
authors.initials: S
authors.lastname: Khan
authors.affiliation: Department of Neurosurgery, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Mair
authors.affiliation: Department of Neurosurgery, Oxford Radcliffe NHS Trust, Oxford, UK.
authors.forename: Tipu
authors.initials: T
authors.lastname: Aziz
authors.affiliation: Department of Neurosurgery, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK. Electronic address: John.yianni@sth.nhs.uk.
authors.forename: John
authors.initials: J
authors.lastname: Yianni
mesh_terms: D000328:Adult; D002648:Child; D046690:Deep Brain Stimulation / Q000379:methods; D005260:Female; D020233:Gait Disorders, Neurologic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D045042:Pedunculopontine Tegmental Nucleus / Q000000981:diagnostic imaging / Q000503:physiopathology; D016896:Treatment Outcome
keywords: Nigrostriatal; Parkinsonian; Pedunculopontine; Stimulation