{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T04:59:08Z","timestamp":1792299548966,"version":"4.4.0"},"reference-count":88,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,9,28]],"date-time":"2017-09-28T00:00:00Z","timestamp":1506556800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100004374","name":"Medtronic","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004374","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Pedunculopontine nucleus region deep brain stimulation (DBS) is a promising but experimental therapy for axial motor deficits in Parkinson's disease (PD), particularly gait freezing and falls. Here, we summarise the clinical application and outcomes reported during the past 10 years. The published dataset is limited, comprising fewer than 100 cases. Furthermore, there is great variability in clinical methodology between and within surgical centers. The most common indication has been severe medication refractory gait freezing (often associated with postural instability). Some patients received lone pedunculopontine nucleus DBS (unilateral or bilateral) and some received costimulation of the subthalamic nucleus or internal pallidum. Both rostral and caudal pedunculopontine nucleus subregions have been targeted. However, the spread of stimulation and variance in targeting means that neighboring brain stem regions may be implicated in any response. Low stimulation frequencies are typically employed (20\u201080 Hertz). The fluctuating nature of gait freezing can confound programming and outcome assessments. Although firm conclusions cannot be drawn on therapeutic efficacy, the literature suggests that medication refractory gait freezing and falls can improve. The impact on postural instability is unclear. Most groups report a lack of benefit on gait or limb akinesia or dopaminergic medication requirements. The key question is whether pedunculopontine nucleus DBS can improve quality of life in PD. So far, the evidence supporting such an effect is minimal. Development of pedunculopontine nucleus DBS to become a reliable, established therapy would likely require a collaborative effort between experienced centres to clarify biomarkers predictive of response and the optimal clinical methodology. \u00a9 2017 International Parkinson and Movement Disorder Society<\/jats:p>","DOI":"10.1002\/mds.27098","type":"journal-article","created":{"date-parts":[[2017,9,28]],"date-time":"2017-09-28T12:05:20Z","timestamp":1506600320000},"page":"10-20","source":"Crossref","is-referenced-by-count":218,"title":["Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review"],"prefix":"10.1002","volume":"33","author":[{"given":"Wesley","family":"Thevathasan","sequence":"first","affiliation":[{"name":"Department of Medicine Royal Melbourne Hospital, University of Melbourne, Australia and the Bionics Institute of Australia Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Debu","sequence":"additional","affiliation":[{"name":"Movement Disorders Center Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University Grenoble France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tipu","family":"Aziz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery John Radcliffe Hospital, University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastiaan R.","family":"Bloem","sequence":"additional","affiliation":[{"name":"Department of Neurology Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Blahak","sequence":"additional","affiliation":[{"name":"Department of Neurology Universit\u00e4tsmedizin Mannheim, University of Heidelberg Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Butson","sequence":"additional","affiliation":[{"name":"Department of Bioengineering Scientific Computing and Imaging Institute, University of Utah Salt Lake City USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Czernecki","sequence":"additional","affiliation":[{"name":"Department of Neurology Institut de Cerveau et de la Moelle \u00e9pini\u00e8re, Sorbonne Universit\u00e9s, University Pierre\u2010and\u2010Marie\u2010Curie (UPMC) Universit\u00e9 Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Foltynie","sequence":"additional","affiliation":[{"name":"Sobell Department of Motor Neuroscience University College London (UCL) Institute of Neurology  United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Fraix","sequence":"additional","affiliation":[{"name":"Movement Disorders Center Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University Grenoble France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Grabli","sequence":"additional","affiliation":[{"name":"Department of Neurology Assistance Publique\u2010H\u00f4pitaux de Paris, Piti\u00e9\u2010Salp\u00eati\u00e8re University Hospital Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Joint","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery John Radcliffe Hospital, University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andres M.","family":"Lozano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Toronto Western Hospital, University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Okun","sequence":"additional","affiliation":[{"name":"Departments of Neurology and Neurosurgery University of Florida Center for Movement Disorders Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill","family":"Ostrem","sequence":"additional","affiliation":[{"name":"Department of Neurology UCSF Movement Disorder and Neuromodulation Center, University of California San Francisco USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Pavese","sequence":"additional","affiliation":[{"name":"Institute of Neuroscience Newcastle University Newcastle upon Tyne UK"},{"name":"Department of Clinical Medicine Centre for Functionally Integrative Neuroscience, University of Aarhus Aarhus Denmark"},{"name":"Department of Neurology Hannover Medical School Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Schrader","sequence":"additional","affiliation":[{"name":"Department of Neurology Hannover Medical School Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun\u2010Hwei","family":"Tai","sequence":"additional","affiliation":[{"name":"Department of Neurology National Taiwan University Hospital, College of Medicine, National Taiwan University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim K.","family":"Krauss","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Hannover Medical School Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Moro","sequence":"additional","affiliation":[{"name":"Movement Disorders Center Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University Grenoble France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Movement Disorders Society PPN DBS Working Groupin collaboration with the World Society for Stereotactic and Functional Neurosurgery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,9,28]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"JacobsohnL.Uber About the nuclei of the human brainstem: medulla oblongta pons and pedunculus cerebri. Attachment to the Proceedings of the Royal Prussian Academy of Science1911."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22189"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.26556"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0361-9230(87)90208-5"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2008.04.030"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2008.153874"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001756-200412030-00012"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awf259"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.wnr.0000187637.20771.a0"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.wnr.0000187629.38010.12"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2014.252"},{"issue":"1","key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1093\/brain\/awp229","article-title":"Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson's disease","volume":"133","author":"Ferraye MU","year":"2009","journal-title":"Brain"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awp261"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e31822b6f71"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31824e8e96"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-015-7744-1"},{"issue":"5","key":"e_1_2_9_18_1","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1159\/000449010","article-title":"Pedunculopontine nucleus region deep brain stimulation in Parkinson disease: surgical anatomy and terminology","volume":"94","author":"Hamani C","year":"2016","journal-title":"Stereotact Funct Neurosurg"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1159\/000449011"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.20954"},{"issue":"1","key":"e_1_2_9_21_1","first-page":"S1","article-title":"Guest editors' introduction","volume":"26","author":"Moro E","year":"2011","journal-title":"Mov Disord"},{"key":"e_1_2_9_22_1","volume-title":"The Delphi Method: Techniques and Applications","author":"Linstone HA","year":"1975"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awl346"},{"issue":"10","key":"e_1_2_9_24_1","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1136\/jnnp.2009.189324","article-title":"The impact of low\u2010frequency stimulation of the pedunculopontine nucleus region on reaction time in parkinsonism","volume":"81","author":"Thevathasan W","year":"2010","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1080\/02688690802448335"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2013.05.005"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2015.57.4.303"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.12947"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awn075"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrn2196"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.56.12.1712"},{"key":"e_1_2_9_32_1","doi-asserted-by":"crossref","DOI":"10.1136\/jnnp-2016-315192","article-title":"Peduncolopontine nucleus stimulation in progressive supranuclear palsy: a randomised trial","author":"Scelzo E","year":"2017","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa060281"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0907083"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-011-0673-y"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2013-307511"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNR.0b013e3282638603"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awr315"},{"issue":"9","key":"e_1_2_9_39_1","doi-asserted-by":"crossref","first-page":"e79","DOI":"10.1093\/brain\/awm138","article-title":"PPN or PPD, what is the target for deep brain stimulation in Parkinson's disease?","volume":"130","author":"Yelnik J","year":"2007","journal-title":"Brain"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1038\/nn.3642"},{"issue":"1","key":"e_1_2_9_41_1","first-page":"1193","article-title":"Sub\u2010caudal pedunculopontine nucleus (PPN) deep brain stimulation (DBS) best predicts improvements in freezing of gait questionnaire (FOGQ) scores in Parkinson's disease patients","volume":"29","author":"Fu RZ","journal-title":"Mov Disord"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/aws039"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.26710"},{"key":"e_1_2_9_44_1","first-page":"293","volume-title":"Recent Developments in Parkinson's Disease","author":"Fahn S","year":"1987"},{"issue":"1","key":"e_1_2_9_45_1","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1212\/WNL.62.1.125","article-title":"Evaluation of the pull test technique in assessing postural instability in Parkinson's disease","volume":"62","author":"Munhoz RP","year":"2004","journal-title":"Neurology"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1353-8020(99)00062-0"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.21745"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awp053"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1002\/1531-8257(199907)14:4<572::AID-MDS1005>3.0.CO;2-C"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.20796"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.3109\/02688697.2010.544790"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000303972.16279.46"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.25123"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1159\/000326617"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1159\/000335871"},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-011-1155-6"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.3109\/02688697.2012.659297"},{"issue":"3","key":"e_1_2_9_58_1","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.gaitpost.2014.05.002","article-title":"Unilateral deep brain stimulation of the pedunculopontine tegmental nucleus in idiopathic Parkinson's disease: effects on gait initiation and performance","volume":"40","author":"Mazzone P","year":"2014","journal-title":"Gait Posture"},{"key":"e_1_2_9_59_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awr131"},{"key":"e_1_2_9_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaitpost.2010.07.012"},{"key":"e_1_2_9_61_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/124.8.1590"},{"key":"e_1_2_9_62_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22340"},{"key":"e_1_2_9_63_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.25301"},{"key":"e_1_2_9_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2014.10.006"},{"key":"e_1_2_9_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(11)70067-9"},{"key":"e_1_2_9_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2012.01.002"},{"issue":"8","key":"e_1_2_9_67_1","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.parkreldis.2008.12.003","article-title":"Grammar improvement following deep brain stimulation of the subthalamic and the pedunculopontine nuclei in advanced Parkinson's disease: a pilot study","volume":"15","author":"Zanini S","year":"2009","journal-title":"Parkinsonism Relat Disord"},{"key":"e_1_2_9_68_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awu209"},{"key":"e_1_2_9_69_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00221-005-0151-6"},{"key":"e_1_2_9_70_1","doi-asserted-by":"publisher","DOI":"10.1002\/1531-8249(199904)45:4<473::AID-ANA9>3.0.CO;2-V"},{"key":"e_1_2_9_71_1","doi-asserted-by":"publisher","DOI":"10.1054\/jocn.2001.0943"},{"issue":"4","key":"e_1_2_9_72_1","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1037\/neu0000179","article-title":"Modulation of attentional processing by deep brain stimulation of the pedunculopontine nucleus region in patients with parkinsonian disorders","volume":"29","author":"Fischer J","year":"2015","journal-title":"Neuropsychology"},{"key":"e_1_2_9_73_1","doi-asserted-by":"publisher","DOI":"10.1177\/089198879901100403"},{"key":"e_1_2_9_74_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2006.05.015"},{"issue":"1","key":"e_1_2_9_75_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.parkreldis.2009.05.009","article-title":"Effects of deep brain stimulation of the peduncolopontine area on working memory tasks in patients with Parkinson's disease","volume":"16","author":"Costa A","year":"2010","journal-title":"Parkinsonism Relat Disord"},{"key":"e_1_2_9_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2009.08.017"},{"key":"e_1_2_9_77_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2014.07.027"},{"key":"e_1_2_9_78_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2010.03254.x"},{"key":"e_1_2_9_79_1","doi-asserted-by":"publisher","DOI":"10.1002\/hbm.20815"},{"key":"e_1_2_9_80_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22055"},{"key":"e_1_2_9_81_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2008.02167.x"},{"key":"e_1_2_9_82_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.21912"},{"key":"e_1_2_9_83_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.21631"},{"key":"e_1_2_9_84_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature04284"},{"key":"e_1_2_9_85_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/30.7.823"},{"key":"e_1_2_9_86_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.25197"},{"key":"e_1_2_9_87_1","doi-asserted-by":"publisher","DOI":"10.1162\/jocn.1997.9.4.534"},{"issue":"4","key":"e_1_2_9_88_1","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1016\/j.neuroscience.2008.10.046","article-title":"Gait is associated with an increase in tonic firing of the sub\u2010cuneiform nucleus neurons","volume":"158","author":"Piallat B","year":"2009","journal-title":"Neuroscience"},{"key":"e_1_2_9_89_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awp234"}],"container-title":["Movement Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fmds.27098","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mds.27098","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T11:00:33Z","timestamp":1760958033000},"score":1,"resource":{"primary":{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/10.1002\/mds.27098"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,28]]},"references-count":88,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,1]]}},"alternative-id":["10.1002\/mds.27098"],"URL":"https:\/\/doi.org\/10.1002\/mds.27098","archive":["Portico"],"relation":{},"ISSN":["0885-3185","1531-8257"],"issn-type":[{"value":"0885-3185","type":"print"},{"value":"1531-8257","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,28]]}}}