A spatiotemporal analysis of gait freezing and the impact of pedunculopontine nucleus stimulation

Thevathasan, Wesley, Cole, Michael H., Graepel, Cara L., Hyam, Jonathan A., Jenkinson, Ned, Brittain, John-Stuart, Coyne, Terry J., Silburn, Peter A., Aziz, Tipu Z., Kerr, Graham and Brown, Peter (2012) A spatiotemporal analysis of gait freezing and the impact of pedunculopontine nucleus stimulation. Brain, 135 5: 1446-1454.


Author Thevathasan, Wesley
Cole, Michael H.
Graepel, Cara L.
Hyam, Jonathan A.
Jenkinson, Ned
Brittain, John-Stuart
Coyne, Terry J.
Silburn, Peter A.
Aziz, Tipu Z.
Kerr, Graham
Brown, Peter
Title A spatiotemporal analysis of gait freezing and the impact of pedunculopontine nucleus stimulation
Journal name Brain  (ERA 2012 Listed)    (ERA 2010 Rank A*)   Check publisher's open access policy
Publication date 2012-05
Sub-type Article
DOI 10.1093/brain/aws039
Volume number 135
Issue number 5
ISSN 0006-8950;1460-2156
Start page 1446
End page 1454
Total pages 9
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Collection year 2013
Language eng
Abstract Gait freezing is an episodic arrest of locomotion due to an inability to take normal steps. Pedunculopontine nucleus stimulation is an emerging therapy proposed to improve gait freezing, even where refractory to medication. However, the efficacy and precise effects of pedunculopontine nucleus stimulation on Parkinsonian gait disturbance are not established. The clinical application of this new therapy is controversial and it is unknown if bilateral stimulation is more effective than unilateral. Here, in a double-blinded study using objective spatiotemporal gait analysis, we assessed the impact of unilateral and bilateral pedunculopontine nucleus stimulation on triggered episodes of gait freezing and on background deficits of unconstrained gait in Parkinson's disease. Under experimental conditions, while OFF medication, Parkinsonian patients with severe gait freezing implanted with pedunculopontine nucleus stimulators below the pontomesencephalic junction were assessed during three conditions; off stimulation, unilateral stimulation and bilateral stimulation. Results were compared to Parkinsonian patients without gait freezing matched for disease severity and healthy controls. Pedunculopontine nucleus stimulation improved objective measures of gait freezing, with bilateral stimulation more effective than unilateral. During unconstrained walking, Parkinsonian patients who experience gait freezing had reduced step length and increased step length variability compared to patients without gait freezing; however, these deficits were unchanged by pedunculopontine nucleus stimulation. Chronic pedunculopontine nucleus stimulation improved Freezing of Gait Questionnaire scores, reflecting a reduction of the freezing encountered in patients' usual environments and medication states. This study provides objective, double-blinded evidence that in a specific subgroup of Parkinsonian patients, stimulation of a caudal pedunculopontine nucleus region selectively improves gait freezing but not background deficits in step length. Bilateral stimulation was more effective than unilateral.
Keyword Parkinson's disease
Gait freezing
Deep brain stimulation
Pedunculopontine nucleus
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes First published online: 6 March 2012.

Document type: Journal Article
Sub-type: Article
Collections: UQ Centre for Clinical Research Publications
Official 2013 Collection
 
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