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Pedunculopontine Nucleus Deep Brain Stimulation for Tremor and Gait Disorders

Deep brain stimulation of the pedunculopontine nucleus (PPN) targeting axial symptoms, gait freezing and falls in Parkinson disease.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

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What is Pedunculopontine Nucleus Deep Brain Stimulation for Tremor and Gait Disorders?

The pedunculopontine nucleus (PPN) within the brainstem tegmentum is a part of the mesencephalic locomotor region and contributes to gait initiation, postural control and arousal. PPN deep brain stimulation (DBS) has been investigated as an adjunct or alternative target to subthalamic nucleus (STN) DBS for axial motor symptoms in advanced Parkinson disease.

Indications include refractory freezing of gait, postural instability and falls that respond poorly to dopaminergic therapy and conventional STN DBS. Low-frequency stimulation (typically 20-25 Hz) is used, in contrast to higher-frequency stimulation typical for other DBS targets.

Clinical evidence is mixed but suggests benefit in selected patients, particularly when combined with STN stimulation. Surgical considerations include accurate anatomic targeting using diffusion tensor imaging, intraoperative microelectrode recording and postoperative programming optimization.

Symptoms

Freezing of gait
Postural instability and falls
Slow walking with festination
Axial rigidity
Tremor with gait disturbance
Levodopa-resistant gait freezing
Difficulty with turning

Risk Factors

Advanced Parkinson disease
Levodopa-resistant axial symptoms
Severe gait freezing
Recurrent falls
Concurrent STN DBS
Atypical parkinsonism (less response)
Contraindications to standard DBS

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Severe gait freezing despite optimized therapy
  • Recurrent falls in Parkinson disease
  • Axial-dominant motor symptoms
  • Failure of STN DBS for gait
  • Multidisciplinary movement disorder evaluation
  • Pre-DBS evaluation

Treatment Methods

01
Diffusion tensor imaging-guided targeting
02
Microelectrode recording confirmation
03
Low-frequency PPN stimulation
04
Combined STN-PPN stimulation
05
Programming optimization
06
Physical therapy and gait training
07
Multidisciplinary follow-up

Which Department to Visit?

You can visit our Nöroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.