Abstract
INTRODUCTION: Axial symptoms are some of the most disabling
symptoms of Parkinson’s disease (PD). These symptoms may be responsive to Pedunculopontine nucleus (PPN) stimulation. We present the 1
year outcomes of bilateral subthalamic region (STr) and PPN stimulation in a cohort of 5 PD patients along with PET scan data from 4 PD
patients with predominant axial symptoms.
METHODS: All patients had predominant symptoms of On-medication postural instability, gait freezing, and falls. Bilateral STr and PPN
electrodes were implanted using an MRI guided technique. We report
the 1 year On-medication clinical outcomes from this group. We have
also performed PET scans on 4 PD patients who had previously undergone PPN and STr electrode implantation. Each subject had a block of
16 [(15)O] H2O PET measurements of rCBF at rest after surgery. We performed the following rCBF measurements: PPN off/ STr off, PPN on/
STr off, PPN off/ STr on, PPN on/ STr on.
RESULTS: In the On medication state a statistically significant improvement in the UPDRS part 3 was achieved with stimulation of the PPN,
STr and both in combination. A composite UPDRS axial subscore, in
the “On” medication state, however, only showed a statistically significant
improvement when a combination of STr and PPN stimulation was used.
At 1 year all patients chose to be on dual site stimulation. PPN stimulation induced significant rCBF increases in thalamus, cerebellum, and
midbrain region. STr stimulation also induced significant rCBF increases
in these regions but caused rCBF decreases in sensorimotor cortical areas.
Concomitant PPN and ST stimulation resulted in a cumulative effect
on rCBF by combining the changes induced by stimulation of either target in isolation.
CONCLUSION: Concomitant stimulation of both the STr region
and PPN induces additive functional changes in the areas of the motor
networks and provides improved control of PD symptoms.
symptoms of Parkinson’s disease (PD). These symptoms may be responsive to Pedunculopontine nucleus (PPN) stimulation. We present the 1
year outcomes of bilateral subthalamic region (STr) and PPN stimulation in a cohort of 5 PD patients along with PET scan data from 4 PD
patients with predominant axial symptoms.
METHODS: All patients had predominant symptoms of On-medication postural instability, gait freezing, and falls. Bilateral STr and PPN
electrodes were implanted using an MRI guided technique. We report
the 1 year On-medication clinical outcomes from this group. We have
also performed PET scans on 4 PD patients who had previously undergone PPN and STr electrode implantation. Each subject had a block of
16 [(15)O] H2O PET measurements of rCBF at rest after surgery. We performed the following rCBF measurements: PPN off/ STr off, PPN on/
STr off, PPN off/ STr on, PPN on/ STr on.
RESULTS: In the On medication state a statistically significant improvement in the UPDRS part 3 was achieved with stimulation of the PPN,
STr and both in combination. A composite UPDRS axial subscore, in
the “On” medication state, however, only showed a statistically significant
improvement when a combination of STr and PPN stimulation was used.
At 1 year all patients chose to be on dual site stimulation. PPN stimulation induced significant rCBF increases in thalamus, cerebellum, and
midbrain region. STr stimulation also induced significant rCBF increases
in these regions but caused rCBF decreases in sensorimotor cortical areas.
Concomitant PPN and ST stimulation resulted in a cumulative effect
on rCBF by combining the changes induced by stimulation of either target in isolation.
CONCLUSION: Concomitant stimulation of both the STr region
and PPN induces additive functional changes in the areas of the motor
networks and provides improved control of PD symptoms.
| Original language | English |
|---|---|
| Journal | Neurosurgery |
| Volume | 67 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Aug 2010 |