title: Efficacy and Safety of Pedunculopontine Nuclei (PPN) Deep Brain Stimulation in the Treatment of Gait Disorders: A Meta-Analysis of Clinical Studies.
abstract: BACKGROUND
  Pedunculopontine nucleus (PPN) has complex reciprocal connections with basal ganglia, especially with internal globus pallidus and substantia nigra, and it has been postulated that PPN stimulation may improve gait instability and freezing of gait. In this meta-analysis, we will assess the evidence for PPN deep brain stimulation in treatment of gait and motor abnormalities especially focusing on Parkinson disease patients.
  
  
  METHODS
  PubMed and Scopus electronic databases were searched for related studies published before February 2014. Medline (1966-2014), Embase (1974-2010), CINAHL, Web of Science, Scopus bibliographic, and Google Scholar databases (1960-2014) were also searched for studies investigating effect of PPN deep brain stimulation in treatment of postural and postural instability and total of ten studies met the inclusion criteria for this analysis.
  
  
  RESULTS
  Our findings showed a significant improvement in postural instability (p<0.001) and motor symptoms of Parkinson disease on and off medications (p<0.05), but failed to show improvement in freezing of gait.
  
  
  CONCLUSIONS
  Despite significant improvement in postural instability observed in included studies, evidence from current literature is not sufficient to generalize these findings to the majority of patients.
authors.affiliation: 1Athinoula A. Martinos Center for Biomedical Imaging,Department of Radiology,Massachusetts General Hospital,Boston,MA.
authors.forename: Laleh
authors.initials: L
authors.lastname: Golestanirad
authors.affiliation: 3Tufts Medical Center,Division of Neurology,800 Washington St.BostonMA.
authors.forename: Behzad
authors.initials: B
authors.lastname: Elahi
authors.affiliation: 4Faculty of Medicine,Department of Medical Biophysics,University of Toronto,Toronto,Canada.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Graham
authors.affiliation: 5Faculty of Medicine,Division of Neurosurgery,University of Toronto,Toronto,Canada.
authors.forename: Sunit
authors.initials: S
authors.lastname: Das
authors.affiliation: 1Athinoula A. Martinos Center for Biomedical Imaging,Department of Radiology,Massachusetts General Hospital,Boston,MA.
authors.forename: Lawrence L
authors.initials: LL
authors.lastname: Wald
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000628:therapy*; D006801:Humans; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy*; D045042:Pedunculopontine Tegmental Nucleus; D004856:Postural Balance; D016896:Treatment Outcome
keywords: Deep Brain Stimulation (DBS); Parkinson’s disease; Pedunculopontine Nucleus (PPN); systematic reviews