Tiago A Mestre1,2, Christos Sidiropoulos3,4, Clement Hamani5, Yu-Yan Poon3, Andres M Lozano5, Anthony E Lang3, Elena Moro3,6. 1. Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada. tmestre@toh.on.ca. 2. Parkinson's disease and Movement Disorders Center, Division of Neurology, Department of Medicine, University of Ottawa Brain and Mind Institute, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (current affiliation). tmestre@toh.on.ca. 3. Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada. 4. Parkinson's Disease and Movement Disorders Program, Henry Ford Health System, West Bloomfield, Michigan, USA (current affiliation). 5. Department of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada. 6. Service de Neurologie, Centre Hospitalier Universitaire de Grenoble, Université Joseph Fourier, Grenoble, France (current affiliation).
Abstract
BACKGROUND: Gait-related symptoms are often refractory to current available treatment options with a significant reduction in quality of life in Parkinson's disease. OBJECTIVES: The objective of this study was to determine the long-term efficacy and safety of unilateral pedunculopontine area stimulation for refractory gait and balance impairment in Parkinson's disease. METHODS: This study used periodic randomized double-blinded assessments until 4 years postoperatively. The primary outcomes were gait-related items of the UPDRS part II and the MDS-UPDRS part III. RESULTS: At baseline, the median age and disease durationwas 63 years (interquartile range: 62, 65) and 15 years (interquartile range: 11, 20). At 2 years, patient-reported freezing (UPDRS part II, off-time) was significantly better when compared with baseline (P =.028), with 62.5% of responders. At 4 years, there was no significant change in the used outcomes, but 66.7 % (n = 4 of 6) were responders for off-time patient-reported freezing and falling. CONCLUSIONS: Pedunculopontine area stimulation has an initial but not sustained benefit for gait-related symptoms.
RCT Entities:
BACKGROUND: Gait-related symptoms are often refractory to current available treatment options with a significant reduction in quality of life in Parkinson's disease. OBJECTIVES: The objective of this study was to determine the long-term efficacy and safety of unilateral pedunculopontine area stimulation for refractory gait and balance impairment in Parkinson's disease. METHODS: This study used periodic randomized double-blinded assessments until 4 years postoperatively. The primary outcomes were gait-related items of the UPDRS part II and the MDS-UPDRS part III. RESULTS: At baseline, the median age and disease duration was 63 years (interquartile range: 62, 65) and 15 years (interquartile range: 11, 20). At 2 years, patient-reported freezing (UPDRS part II, off-time) was significantly better when compared with baseline (P =.028), with 62.5% of responders. At 4 years, there was no significant change in the used outcomes, but 66.7 % (n = 4 of 6) were responders for off-time patient-reported freezing and falling. CONCLUSIONS: Pedunculopontine area stimulation has an initial but not sustained benefit for gait-related symptoms.
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