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Deep brain stimulation of globus pallidus interna, subthalamic nucleus, and pedunculopontine nucleus for Parkinson's disease: which target?
Parkinsonism Relat Disord. 2012 Jan; 18 Suppl 1:S165-7.PR

Abstract

Deep brain stimulation (DBS) is an accepted therapy for people with Parkinson's disease (PD) motor symptoms that are refractory to pharmacologic therapy. Standard DBS targets are globus pallidus interna (GPi) and subthalamic nucleus (STN). The pedunculopontine nucleus (PPN) is being investigated as a novel target. Which target provides the best outcomes is unknown. The utility of GPi and STN as targets has been confirmed in numerous studies, including randomized comparisons of GPi DBS and STN DBS that demonstrated no difference in motor outcomes. DBS at either site improves appendicular motor symptoms, but beneficial effects on axial manifestations of PD such as postural instability or gait dysfunction (PIGD) are less apparent. PPN has been introduced as a DBS target due to failure of GPi and STN DBS to improve PIGD. Small observational studies indicate improved PIGD with PPN DBS, but small blinded trials show only subjective reduction in falls with no other impact on PIGD or other PD manifestations. No single DBS target is superior to the others. Each target offers relative advantages. Further studies are needed to better define the roles of each target, particularly PPN. Choice of target should be individualized according to providers' preferences and patients' needs.

Authors+Show Affiliations

Division of Neurosurgery, University of Nebraska Medical Center, Omaha, NE 68198, USA. kfollett@unmc.eduNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22166422

Citation

Follett, Kenneth A., and Diego Torres-Russotto. "Deep Brain Stimulation of Globus Pallidus Interna, Subthalamic Nucleus, and Pedunculopontine Nucleus for Parkinson's Disease: Which Target?" Parkinsonism & Related Disorders, vol. 18 Suppl 1, 2012, pp. S165-7.
Follett KA, Torres-Russotto D. Deep brain stimulation of globus pallidus interna, subthalamic nucleus, and pedunculopontine nucleus for Parkinson's disease: which target? Parkinsonism Relat Disord. 2012;18 Suppl 1:S165-7.
Follett, K. A., & Torres-Russotto, D. (2012). Deep brain stimulation of globus pallidus interna, subthalamic nucleus, and pedunculopontine nucleus for Parkinson's disease: which target? Parkinsonism & Related Disorders, 18 Suppl 1, S165-7. https://doi.org/10.1016/S1353-8020(11)70051-7
Follett KA, Torres-Russotto D. Deep Brain Stimulation of Globus Pallidus Interna, Subthalamic Nucleus, and Pedunculopontine Nucleus for Parkinson's Disease: Which Target. Parkinsonism Relat Disord. 2012;18 Suppl 1:S165-7. PubMed PMID: 22166422.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Deep brain stimulation of globus pallidus interna, subthalamic nucleus, and pedunculopontine nucleus for Parkinson's disease: which target? AU - Follett,Kenneth A, AU - Torres-Russotto,Diego, PY - 2011/12/15/entrez PY - 2011/12/23/pubmed PY - 2012/8/28/medline SP - S165 EP - 7 JF - Parkinsonism & related disorders JO - Parkinsonism Relat Disord VL - 18 Suppl 1 N2 - Deep brain stimulation (DBS) is an accepted therapy for people with Parkinson's disease (PD) motor symptoms that are refractory to pharmacologic therapy. Standard DBS targets are globus pallidus interna (GPi) and subthalamic nucleus (STN). The pedunculopontine nucleus (PPN) is being investigated as a novel target. Which target provides the best outcomes is unknown. The utility of GPi and STN as targets has been confirmed in numerous studies, including randomized comparisons of GPi DBS and STN DBS that demonstrated no difference in motor outcomes. DBS at either site improves appendicular motor symptoms, but beneficial effects on axial manifestations of PD such as postural instability or gait dysfunction (PIGD) are less apparent. PPN has been introduced as a DBS target due to failure of GPi and STN DBS to improve PIGD. Small observational studies indicate improved PIGD with PPN DBS, but small blinded trials show only subjective reduction in falls with no other impact on PIGD or other PD manifestations. No single DBS target is superior to the others. Each target offers relative advantages. Further studies are needed to better define the roles of each target, particularly PPN. Choice of target should be individualized according to providers' preferences and patients' needs. SN - 1873-5126 UR - https://www.unboundmedicine.com/medline/citation/22166422/Deep_brain_stimulation_of_globus_pallidus_interna_subthalamic_nucleus_and_pedunculopontine_nucleus_for_Parkinson's_disease:_which_target L2 - https://linkinghub.elsevier.com/retrieve/pii/S1353-8020(11)70051-7 DB - PRIME DP - Unbound Medicine ER -