Physiological identification of the human pedunculopontine nucleus

Shimamoto, Shoichi; Larson, Paul; Ostrem, Jill L.; Glass, Graham A.; Turner, Robert S.; Starr, Philip A.

doi:10.1136/jnnp.2009.179069

Cited by 47 publications

(46 citation statements)

References 28 publications

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“…In some patients, PPN DBS reduces gait and freezing problems unresponsive to drug and conventional stimulation approaches directed at subthalamic and pallidal targets, reduces falls and occasionally improves patients' state of vigilance and quality of sleep (Pereira et al, 2008;Ferraye et al, 2010). The magnitude of the effects, the exact location of the stimulation electrode and best technique of implantation of DBS leads into this nucleus are still being debated (Aravamuthan et al, 2007(Aravamuthan et al, , 2008(Aravamuthan et al, , 2009Weinberger et al, 2008;Fu et al, 2009;Shimamoto et al, 2010). There have also been several small experimental trials of extradural motor cortex stimulation in human patients (Benvenuti et al, 2006;Strafella et al, 2007;Cilia et al, 2007Cilia et al, , 2008Arle et al, 2008;Lefaucheur, 2009;Pagni et al, 2008).…”

Section: New Targets For Dbs In Pdmentioning

confidence: 99%

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

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The demonstration that dopamine loss is the key pathological feature of Parkinson's disease (PD), and the subsequent introduction of levodopa have revolutionalized the field of PD therapeutics. This review will discuss the significant progress that has been made in the development of new pharmacological and surgical tools to treat PD motor symptoms since this major breakthrough in the 1960s. However, we will also highlight some of the challenges the field of PD therapeutics has been struggling with during the past decades. The lack of neuroprotective therapies and the limited treatment strategies for the nonmotor symptoms of the disease (ie, cognitive impairments, autonomic dysfunctions, psychiatric disorders, etc.) are among the most pressing issues to be addressed in the years to come. It appears that the combination of early PD nonmotor symptoms with imaging of the nigrostriatal dopaminergic system offers a promising path toward the identification of PD biomarkers, which, once characterized, will set the stage for efficient use of neuroprotective agents that could slow down and alter the course of the disease.

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Section: New Targets For Dbs In Pdmentioning

confidence: 99%

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

View full text Add to dashboard Cite

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“…San Francisco, USA [33]. This group targeted the PPN based on MRI at a point superolateral to the decussation of the superior cerebellar peduncles on T2-weighted fast spin echo images.…”

Section: Stereotactic Targetingmentioning

confidence: 99%

Pedunculopontine Nucleus Region Deep Brain Stimulation in Parkinson Disease: Surgical Techniques, Side Effects, and Postoperative Imaging

Hamani

Lozano

Mazzone

et al. 2016

Stereotact Funct Neurosurg

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The pedunculopontine nucleus (PPN) region has received considerable attention in clinical studies as a target for deep brain stimulation (DBS) in Parkinson disease. These studies have yielded variable results with an overall impression of improvement in falls and freezing in many but not all patients treated. We evaluated the available data on the surgical anatomy and terminology of the PPN region in a companion paper. Here we focus on issues concerning surgical technique, imaging, and early side effects of surgery. The aim of this paper was to gain more insight into the reasoning for choosing specific techniques and to discuss shortcomings of available studies. Our data demonstrate the wide range in almost all fields which were investigated. There are a number of important challenges to be resolved, such as identification of the optimal target, the choice of the surgical approach to optimize electrode placement, the impact on the outcome of specific surgical techniques, the reliability of intraoperative confirmation of the target, and methodological differences in postoperative validation of the electrode position. There is considerable variability both within and across groups, the overall experience with PPN DBS is still limited, and there is a lack of controlled trials. Despite these challenges, the procedure seems to provide benefit to selected patients and appears to be relatively safe. One important limitation in comparing studies from different centers and analyzing outcomes is the great variability in targeting and surgical techniques, as shown in our paper. The challenges we identified will be of relevance when designing future studies to better address several controversial issues. We hope that the data we accumulated may facilitate the development of surgical protocols for PPN DBS.

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“…Shimamoto et al [29] found that PPN neurons had significantly more burst discharges compared with the neurons from the region dorsal to the PPN. Weinberger et al [30] also observed more ‘bursty' cells within the PPN than those neurons found superiorly or inferiorly to the PPN.…”

Section: Discussionmentioning

confidence: 99%

Effect of Subthalamic Nucleus Stimulation on Pedunculopontine Nucleus Neural Activity

Sitti

Acar

Zisakis

et al. 2016

Stereotact Funct Neurosurg

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Background: The pedunculopontine nucleus has recently been proposed as an alternative target for deep brain stimulation for the treatment of medically intractable Parkinson's disease. The suggested indication for pedunculopontine nucleus deep brain stimulation is severe and medically intractable axial symptoms such as gait and postural impairment. Objective: Our goal in this study was to describe the effects of subthalamic nucleus stimulation on pedunculopontine nucleus electrophysiological activity. Methods: Fourteen male Wistar rats were divided into a sham stimulation group and an experimental group. In both groups, electrodes were implanted bilaterally into the subthalamic nucleus and into the right pedunculopontine nucleus. Microelectrode recordings were carried out in both groups prior to and during subthalamic nucleus stimulation. Results: Subthalamic nucleus stimulation produced no clear inhibition of neuronal firing in the pedunculopontine nucleus. However, we found that stimulation of the subthalamic nucleus at 60 Hz produces some entrainment of pedunculopontine nucleus neuronal firing and a shift of subthalamic nucleus firing patterns to more tonic and random patterns. These results are consistent with the effects of deep brain stimulation on neuronal activity in the subthalamic nucleus and globus pallidus internus. Conclusion: The result of this study provides additional evidence to improve our understanding of the mechanism of subthalamic nucleus-deep brain stimulation, and its physiological consequences.

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Physiological identification of the human pedunculopontine nucleus

Cited by 47 publications

References 28 publications

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Pedunculopontine Nucleus Region Deep Brain Stimulation in Parkinson Disease: Surgical Techniques, Side Effects, and Postoperative Imaging

Effect of Subthalamic Nucleus Stimulation on Pedunculopontine Nucleus Neural Activity

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