title: Understanding the human pedunculopontine nucleus in Parkinson's disease.
abstract: This paper presents the Brisbane experience of pedunculopontine nucleus (PPN) deep brain stimulation (DBS) in Parkinson's disease (PD). Clinical outcomes along with studies of the mechanisms and neurophysiology of PPN in PD patients with severe freezing of gait (FoG) and postural imbalance (PI) are summarised and presented. Our results indicate that PPN DBS improves FoG and falls in the relatively uncommon group of PD patients who respond well to medication other than for continuing on time FoG and falls. Our studies indicate that bilateral DBS is more beneficial than unilateral DBS, and that the more caudal region of the PPN seems preferable for stimulation. There is evidence that rapid-release programs for initiation and correction of gait and posture are modulated by the PPN, possibly to some extent independently of the cerebral cortex. These functions were found to be impaired in PD patients with severe FoG/PI, but to some extent corrected by bilateral PPN DBS.
authors.affiliation: St. Andrews and Wesley Hospitals, Brisbane, QLD, Australia.|Asia-Pacific Centre for Neuromodulation, University of Queensland, Brisbane, Australia.|Department of Clinical Neuroscience, Neurosurgery, Karolinska Institute, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Fytagoridis
authors.affiliation: St. Andrews and Wesley Hospitals, Brisbane, QLD, Australia.|Asia-Pacific Centre for Neuromodulation, University of Queensland, Brisbane, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Silburn
authors.affiliation: St. Andrews and Wesley Hospitals, Brisbane, QLD, Australia. tcoyne@brizbrain.com.au.|Asia-Pacific Centre for Neuromodulation, University of Queensland, Brisbane, Australia. tcoyne@brizbrain.com.au.
authors.forename: Terry J
authors.initials: TJ
authors.lastname: Coyne
authors.affiliation: Melbourne Brain Centre, Department of Medicine, Royal Melbourne Hospital, University of Melbourne and the Bionics Institute, Melbourne, Australia.
authors.forename: Wesley
authors.initials: W
authors.lastname: Thevathasan
mesh_terms: D000328:Adult; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000000981:diagnostic imaging; D045042:Pedunculopontine Tegmental Nucleus / Q000502:physiology*; D011795:Surveys and Questionnaires
keywords: Deep brain stimulation; Freezing of gait; Pedunculopontine nucleus