Combined stimulation of the substantia nigra pars reticulata and the subthalamic nucleus is effective in hypokinetic gait disturbance in Parkinson’s disease
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Severe gait disturbances in idiopathic Parkinson’s disease (PD) are observed in up to 80% of all patients in advanced disease stages [1, 2] with an important impact on quality of life [3, 4, 5]. While segmental symptoms generally respond well to dopaminergic medication and high-frequent deep brain stimulation of the subthalamic nucleus (STN-DBS), treatment of gait disturbances often remains unsatisfactory [5, 6, 7]. DBS of the pedunculopontine area is currently under investigation to treat gait disturbances and imbalance in PD; however, appropriate targeting and patient selection remain controversial [8, 9, 10]. Here, we describe a novel stimulation paradigm of simultaneous stimulation on distant electrode contacts located in the STN and the caudal border zone between the STN and substantia nigra pars reticulata (SNr) in a patient with a severe hypokinetic gait disturbance.
A 72-year-old female patient with PD (Hoehn & Yahr IV, disease duration 20 years) with severe...
KeywordsDeep Brain Stimulation Gait Disturbance Pedunculopontine Nucleus Psychiatric Side Effect Stimulator Setting
Daniel Weiss received funding from Medtronic GmbH and from the Medical Faculty of University of Tübingen (AKF 259-0-0). Christian Plewnia was supported by grants from the German Research Council [DFG PL 525/11] and from the University of Tübingen [AKF 238-0-0]. Alireza Gharabaghi was supported by grants from the German Research Council [DFG GH 94/2-1, DFG EC 307], Federal Ministry for Education and Research [Bernstein 01GQ0761, BMBF 16SV3783], Medtronic Research Grant, European Union [ERC 2276329], and the University of Tübingen [AKF 238-0-0]. Rejko Krüger is supported by grants of the German Research Council [DFG; KR2119/3-2, the Michael J Fox Foundation, the Federal Ministry for Education and Research [BMBF, NGFNplus; 01GS08134] and from the Medical Faculty of the University of Tübingen [AKF 238-0-0].
Conflict of interest
D. Weiss received speaker’s honoraria and travel grants from Medtronic and Solvay. T. Wächter has received speaker’s honoraria and travel grants from Medtronic, Schwarz Pharma, and Solvay. S. Breit, C. Plewnia, and A. Gharabaghi reports no conflict of interest. R. Krüger received speaker’s honoraria and/or travel grants from UCB Pharma, Cephalon, Abott Pharma, Takeda Pharma, and Medtronic.
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