DOI QR코드

DOI QR Code

Deep Brain Stimulation of the Subthalamic and Pedunculopontine Nucleus in a Patient with Parkinson's Disease

  • Liu, Huan-Guang (Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University) ;
  • Zhang, Kai (Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University) ;
  • Yang, An-Chao (Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University) ;
  • Zhang, Jian-Guo (Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University)
  • Received : 2014.03.17
  • Accepted : 2014.08.18
  • Published : 2015.04.28

Abstract

Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) is a novel therapy developed to treat Parkinson's disease. We report a patient who underwent bilateral DBS of the PPN and subthalamic nucleus (STN). He suffered from freezing of gait (FOG), bradykinesia, rigidity and mild tremors. The patient underwent bilateral DBS of the PPN and STN. We compared the benefits of PPN-DBS and STN-DBS using motor and gait subscores. The PPN-DBS provided modest improvements in the gait disorder and freezing episodes, while the STN-DBS failed to improve the dominant problems. This special case suggests that PPN-DBS may have a unique role in ameliorating the locomotor symptoms and has the potential to provide improvement in FOG.

Keywords

References

  1. Aravamuthan BR, Bergstrom DA, French RA, Taylor JJ, Parr-Brownlie LC, Walters JR : Altered neuronal activity relationships between the pedunculopontine nucleus and motor cortex in a rodent model of Parkinson's disease. Exp Neurol 213 : 268-280, 2008 https://doi.org/10.1016/j.expneurol.2008.05.023
  2. Aravamuthan BR, Muthusamy KA, Stein JF, Aziz TZ, Johansen-Berg H : Topography of cortical and subcortical connections of the human pedunculopontine and subthalamic nuclei. Neuroimage 37 : 694-705, 2007 https://doi.org/10.1016/j.neuroimage.2007.05.050
  3. Classen J, Schnitzler A : What does the pedunculopontine nucleus do? Neurology 75 : 944-945, 2010 https://doi.org/10.1212/WNL.0b013e3181f25b73
  4. Ferraye MU, Debû B, Fraix V, Goetz L, Ardouin C, Yelnik J, et al. : Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson's disease. Brain 133 (Pt 1) : 205-214, 2010 https://doi.org/10.1093/brain/awp229
  5. Follett KA, Weaver FM, Stern M, Hur K, Harris CL, Luo P, et al. : Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. N Engl J Med 362 : 2077-2091, 2010 https://doi.org/10.1056/NEJMoa0907083
  6. Garcia-Rill E, Houser CR, Skinner RD, Smith W, Woodward DJ : Locomotion-inducing sites in the vicinity of the pedunculopontine nucleus. Brain Res Bull 18 : 731-738, 1987 https://doi.org/10.1016/0361-9230(87)90208-5
  7. Giladi N, McDermott MP, Fahn S, Przedborski S, Jankovic J, Stern M, et al. : Freezing of gait in PD : prospective assessment in the DATATOP cohort. Neurology 56 : 1712-1721, 2001 https://doi.org/10.1212/WNL.56.12.1712
  8. Giladi N, McMahon D, Przedborski S, Flaster E, Guillory S, Kostic V, et al. : Motor blocks in Parkinson's disease. Neurology 42 : 333-339, 1992 https://doi.org/10.1212/WNL.42.2.333
  9. Giladi N, Shabtai H, Simon ES, Biran S, Tal J, Korczyn AD : Construction of freezing of gait questionnaire for patients with Parkinsonism. Parkinsonism Relat Disord 6 : 165-170, 2000 https://doi.org/10.1016/S1353-8020(99)00062-0
  10. Giladi N, Tal J, Azulay T, Rascol O, Brooks DJ, Melamed E, et al. : Validation of the freezing of gait questionnaire in patients with Parkinson's disease. Mov Disord 24 : 655-661, 2009 https://doi.org/10.1002/mds.21745
  11. Jenkinson N, Nandi D, Miall RC, Stein JF, Aziz TZ : Pedunculopontine nucleus stimulation improves akinesia in a Parkinsonian monkey. Neuroreport 15 : 2621-2624, 2004 https://doi.org/10.1097/00001756-200412030-00012
  12. Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, et al. : Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 349 : 1925-1934, 2003 https://doi.org/10.1056/NEJMoa035275
  13. Mazzone P, Lozano A, Stanzione P, Galati S, Scarnati E, Peppe A, et al. : Implantation of human pedunculopontine nucleus : a safe and clinically relevant target in Parkinson's disease. Neuroreport 16 : 1877-1881, 2005 https://doi.org/10.1097/01.wnr.0000187629.38010.12
  14. Moro E, Hamani C, Poon YY, Al-Khairallah T, Dostrovsky JO, Hutchison WD, et al. : Unilateral pedunculopontine stimulation improves falls in Parkinson's disease. Brain 133 (Pt 1) : 215-224, 2010 https://doi.org/10.1093/brain/awp261
  15. Moro E, Lozano AM, Pollak P, Agid Y, Rehncrona S, Volkmann J, et al. : Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson's disease. Mov Disord 25 : 578-586, 2010 https://doi.org/10.1002/mds.22735
  16. Muslimovic D, Post B, Speelman JD, Schmand B, de Haan RJ; CARPA Study Group : Determinants of disability and quality of life in mild to moderate Parkinson disease. Neurology 70 : 2241-2247, 2008 https://doi.org/10.1212/01.wnl.0000313835.33830.80
  17. Nandi D, Aziz TZ, Giladi N, Winter J, Stein JF : Reversal of akinesia in experimental parkinsonism by GABA antagonist microinjections in the pedunculopontine nucleus. Brain 125 (Pt 11) : 2418-2430, 2002 https://doi.org/10.1093/brain/awf259
  18. Pahapill PA, Lozano AM : The pedunculopontine nucleus and Parkinson's disease. Brain 123 (Pt 9) : 1767-1783, 2000 https://doi.org/10.1093/brain/123.9.1767
  19. Plaha P, Gill SS : Bilateral deep brain stimulation of the pedunculopontine nucleus for Parkinson's disease. Neuroreport 16 : 1883-1887, 2005 https://doi.org/10.1097/01.wnr.0000187637.20771.a0
  20. Rodriguez-Oroz MC, Obeso JA, Lang AE, Houeto JL, Pollak P, Rehncrona S, et al. : Bilateral deep brain stimulation in Parkinson's disease : a multicentre study with 4 years follow-up. Brain 128 (Pt 10) : 2240-2249, 2005 https://doi.org/10.1093/brain/awh571
  21. St George RJ, Nutt JG, Burchiel KJ, Horak FB : A meta-regression of the long-term effects of deep brain stimulation on balance and gait in PD. Neurolog 75 : 1292-1299, 2010 https://doi.org/10.1212/WNL.0b013e3181f61329
  22. Stefani A, Lozano AM, Peppe A, Stanzione P, Galati S, Tropepi D, et al. : Bilateral deep brain stimulation of the pedunculopontine and subthalamic nuclei in severe Parkinson's disease. Brain 130 (Pt 6) : 1596-1607, 2007 https://doi.org/10.1093/brain/awl346
  23. Thevathasan W, Coyne TJ, Hyam JA, Kerr G, Jenkinson N, Aziz TZ, et al. : Pedunculopontine nucleus stimulation improves gait freezing in Parkinson disease. Neurosurgery 69 : 1248-1253; discussion 1254, 2011 https://doi.org/10.1227/NEU.0b013e31822b6f71
  24. Tsang EW, Hamani C, Moro E, Mazzella F, Poon YY, Lozano AM : Involvement of the human pedunculopontine nucleus region in voluntary movements. Neurology 75 : 950-959, 2010 https://doi.org/10.1212/WNL.0b013e3181f25b35
  25. Voges J : Deep brain stimulation for treatment of movement disorders. J Korean Neurosurg Soc 34 : 281-298, 2003
  26. Zrinzo L, Zrinzo LV, Tisch S, Limousin PD, Yousry TA, Afshar F, et al. : Stereotactic localization of the human pedunculopontine nucleus : atlas-based coordinates and validation of a magnetic resonance imaging protocol for direct localization. Brain 131 (Pt 6) : 1588-1598, 2008 https://doi.org/10.1093/brain/awn075
  27. Zweig RM, Jankel WR, Hedreen JC, Mayeux R, Price DL : The pedunculopontine nucleus in Parkinson's disease. Ann Neurol 26 : 41-46, 1989 https://doi.org/10.1002/ana.410260106

Cited by

  1. Parkinson’s disease as a system-level disorder vol.2, pp.None, 2015, https://doi.org/10.1038/npjparkd.2016.25
  2. Protective Effect of Puerarin Against Oxidative Stress Injury of Neural Cells and Related Mechanisms vol.22, pp.None, 2015, https://doi.org/10.12659/msm.896058
  3. The Invention and Early History of the N-Localizer for Stereotactic Neurosurgery vol.8, pp.6, 2015, https://doi.org/10.7759/cureus.642
  4. Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders vol.6, pp.4, 2015, https://doi.org/10.3390/brainsci6040046
  5. Dopamine and the Brainstem Locomotor Networks: From Lamprey to Human vol.11, pp.None, 2017, https://doi.org/10.3389/fnins.2017.00295
  6. Neuroprotective effect of matrine on MPTP-induced Parkinson's disease and on Nrf2 expression vol.13, pp.1, 2015, https://doi.org/10.3892/ol.2016.5383
  7. Utilidad de la estimulación continua del núcleo pedunculopontino para el tratamiento de la enfermedad de Parkinson vol.58, pp.3, 2017, https://doi.org/10.11144/javeriana.umed58-3.park
  8. Vitexin protects dopaminergic neurons in MPTP-induced Parkinson’s disease through PI3K/Akt signaling pathway vol.12, pp.None, 2015, https://doi.org/10.2147/dddt.s156920
  9. Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review vol.33, pp.1, 2015, https://doi.org/10.1002/mds.27098
  10. Exercise Therapies for Parkinson's Disease: A Systematic Review and Meta-Analysis vol.2020, pp.None, 2015, https://doi.org/10.1155/2020/2565320