@article{ref1,
title="Stimulation of the pedunculopontine and cuneiform nuclei for freezing of gait and falls in Parkinson disease: cross-over single-blinded study and long-term follow-up",
journal="Parkinsonism and related disorders",
year="2022",
author="Bourilhon, Julie and Mullie, Yannick and Olivier, Claire and Cherif, Saoussen and Belaid, Hayat and Grabli, David and Czernecki, Virginie and Karachi, Carine and Welter, Marie-Laure",
volume="96",
number="",
pages="13-17",
abstract="INTRODUCTION: Deep brain stimulation (DBS) of the mesencephalic locomotor region, composed of the pedunculopontine (PPN) and cuneiform (CuN) nuclei, has been proposed to treat dopa-resistant gait and balance disorders in Parkinson's disease (PD). Here, we report the long-term effects of PPN- or CuN-DBS on these axial disorders. <br><br>METHODS: In 6 PD patients operated for mesencephalic locomotor region DBS and prospectively followed for more than 2 years, we assessed the effects of both PPN- and CuN-DBS (On-dopa) in a cross-over single-blind study by using clinical scales and recording gait parameters. Patients were also examined Off-DBS. <br><br>RESULTS: More than 2 years after surgery, axial and Tinetti scores were significantly aggravated with both PPN- or CuN-DBS relative to before and one year after surgery. Gait recordings revealed an increased double-stance duration with both PPN- or CuN-DBS, higher swing phase duration with CuN-DBS and step width with PPN-DBS. With PPN- versus CuN-DBS, the step length, velocity and cadence were significantly higher; and the double-stance and turn durations significantly lower. Irrespective the target, we found no significant change in clinical scores Off-DBS compared to On-DBS. The duration of anticipatory postural adjustments as well as step length were lower with versus without PPN-DBS. We found no other significant changes in motor, cognitive or psychiatric scores, except an increased anxiety severity. <br><br>CONCLUSION: In this long-term follow-up study with controlled assessments, PPN- or CuN-DBS did not improve dopa-resistant gait and balance disorders with a worsening of these axial motor signs with time, thus indicating no significant clinical effect.<p /> <p>Language: en</p>",
language="en",
issn="1353-8020",
doi="10.1016/j.parkreldis.2022.01.010",
url="http://dx.doi.org/10.1016/j.parkreldis.2022.01.010"
}