J Neurol Neurosurg Psychiatry doi:10.1136/jnnp.2010.213462
  • Short report

Pedunculopontine nucleus deep brain stimulation produces sustained improvement in primary progressive freezing of gait

  1. Graham Kerr3
  1. 1Saint Andrew's Memorial Hospital, Brisbane, Australia
  2. 2Comprehensive Movement Disorder Service, Neurology Department, Flinders Medical Centre, Bedford Park, Australia
  3. 3Movement Neuroscience Program, Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
  4. 4The Wesley PET Centre, Wesley Hospital, Auchenflower, Brisbane, Australia
  5. 5University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston, Brisbane, Australia
  1. Correspondence to Dr Robert Wilcox, Comprehensive Movement Disorder Service, Neurology Department, Level 2, Flinders Medical Centre, Bedford Park, SA 5042, Australia; robert.wilcox{at}
  1. Contributors RAW and TC undertook the DBS procedure and postoperative clinical management. RAW and PS conducted clinical assessments. DW and RAW undertook the positron emission tomography study, and the positron emission tomography images were reviewed by DW. MHC, GK and RAW undertook the gait and posture analysis. All the authors contributed to the preparation of the manuscript.

  • Received 4 May 2010
  • Revised 7 September 2010
  • Accepted 13 September 2010
  • Published Online First 22 October 2010


Objective To assess the efficacy of bilateral pedunculopontine nucleus (PPN) deep brain stimulation (DBS) as a treatment for primary progressive freezing of gait (PPFG).

Methods A patient with PPFG underwent bilateral PPN-DBS and was followed clinically for over 14 months.

Results The PPFG patient exhibited a robust improvement in gait and posture following PPN-DBS. When PPN stimulation was deactivated, postural stability and gait skills declined to pre-DBS levels, and fluoro-2-deoxy-d-glucose positron emission tomography revealed hypoactive cerebellar and brainstem regions, which significantly normalised when PPN stimulation was reactivated.

Conclusions This case demonstrates that the advantages of PPN-DBS may not be limited to addressing freezing of gait (FOG) in idiopathic Parkinson's disease. The PPN may also be an effective DBS target to address other forms of central gait failure.


  • Funding This study was self-funded by the authors as an extension of the patient's clinical management and not supported by specific funding. RAW, TC and PS received financial support from Medtronic Australasia to attend the Australasian Deep Brain Stimulation Meeting in 2009.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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