Deep brain stimulation of the pedunculopontine nucleus in Parkinson's disease. Preliminary experience at Oxford

Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) is a novel neurosurgical therapy developed to address symptoms of gait freezing and postural instability in Parkinson's disease and related disorders. Here, we summarize our non-human primate and neuroimaging research of relevance to our surgical targeting of the PPN. We also describe our clinical experience of PPN DBS with greatest motor improvements achieved by stimulation at low frequencies.

[1]  J. Stein,et al.  Localisation of the Subthalamic Nucleus Using Radionics Image FusionTM and StereoplanTM Combined with Field Potential Recording , 2002, Stereotactic and Functional Neurosurgery.

[2]  P. Stanzione,et al.  Implantation of human pedunculopontine nucleus: a safe and clinically relevant target in Parkinson's disease , 2005, Neuroreport.

[3]  T. Aziz,et al.  Lesion of the subthalamic nucleus for the alleviation of 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine (MPTP)‐induced parkinsonism in the primate , 1991, Movement disorders : official journal of the Movement Disorder Society.

[4]  J. Stein,et al.  Connectivity of the human pedunculopontine nucleus region and diffusion tensor imaging in surgical targeting. , 2007, Journal of neurosurgery.

[5]  Ludvic Zrinzo,et al.  The peripeduncular nucleus: a novel target for deep brain stimulation? , 2007, Neuroreport.

[6]  J. Stein,et al.  Kainate acid lesions of the pedunculopontine region in the normal behaving primate , 2001, Movement disorders : official journal of the Movement Disorder Society.

[7]  J. Stein,et al.  The role of the pedunculopontine region in basal-ganglia mechanisms of akinesia , 1999, Experimental Brain Research.

[8]  R. Miall,et al.  Pedunculopontine nucleus stimulation improves akinesia in a Parkinsonian monkey , 2004, Neuroreport.

[9]  J. Parisi,et al.  Mesopontine cholinergic neuron involvement in Lewy body dementia and multiple system atrophy , 2008, Neurology.

[10]  M. Hariz,et al.  The peripeduncular nucleus: a novel target for deep brain stimulation? , 2007, Neuroreport.

[11]  J. Jankovic,et al.  Bilateral pedunculopontine nuclei strokes presenting as freezing of gait , 2008, Movement disorders : official journal of the Movement Disorder Society.

[12]  Ludvic Zrinzo,et al.  The pedunculopontine and peripeduncular nuclei: a tale of two structures. , 2007, Brain : a journal of neurology.

[13]  Tipu Z. Aziz,et al.  Topography of cortical and subcortical connections of the human pedunculopontine and subthalamic nuclei , 2007, NeuroImage.

[14]  P. Blumbergs,et al.  A clinical and pathological study of progressive supranuclear palsy. , 1991, Clinical and experimental neurology.

[15]  P. Stanzione,et al.  Bilateral deep brain stimulation of the pedunculopontine and subthalamic nuclei in severe Parkinson's disease. , 2007, Brain : a journal of neurology.

[16]  J. Jankovic,et al.  Freezing of gait in PD: Prospective assessment in the DATATOP cohort , 2001 .

[17]  Tipu Z. Aziz,et al.  Deep brain stimulation for movement disorders and pain , 2005, Journal of Clinical Neuroscience.

[18]  J. Stein,et al.  The role of descending basal ganglia connections to the brain stem in parkinsonian akinesia. , 1998, British journal of neurosurgery.

[19]  Jérôme Yelnik,et al.  PPN or PPD, what is the target for deep brain stimulation in Parkinson's disease? , 2007, Brain : a journal of neurology.

[20]  J. Rinne,et al.  Loss of cholinergic neurons in the pedunculopontine nucleus in Parkinson's disease is related to disability of the patients. , 2008, Parkinsonism & related disorders.

[21]  Nir Giladi,et al.  Reversal of akinesia in experimental parkinsonism by GABA antagonist microinjections in the pedunculopontine nucleus. , 2002, Brain : a journal of neurology.

[22]  S. Gill,et al.  Bilateral deep brain stimulation of the pedunculopontine nucleus for Parkinson's disease , 2005, Neuroreport.

[23]  A M Graybiel,et al.  Neuronal loss in the pedunculopontine tegmental nucleus in Parkinson disease and in progressive supranuclear palsy. , 1987, Proceedings of the National Academy of Sciences of the United States of America.