Gait disturbances and akinesia are extremely disabling in advanced Parkinson's disease. It has been suggested that modulation of the activity of the pedunculopontine nucleus (PPN) may be beneficial in the treatment of these symptoms. We report the clinical affects of deep brain stimulation (DBS) in the PPN and subthalamic nucleus (STN). Six patients with unsatisfactory pharmacological control of axial signs such as gait and postural stability underwent bilateral implantation of DBS electrodes in the STN and PPN. Clinical effects were evaluated 2-6 months after surgery in the OFF- and ON-medication state, with both STN and PPN stimulation ON or OFF, or with only one target being stimulated. Bilateral PPN-DBS at 25 Hz in OFF-medication produced an immediate 45% amelioration of the motor Unified Parkinson's Disease Rating Scale (UPDRS) subscale score, followed by a decline to give a final improvement of 32% in the score after 3-6 months. In contrast, bilateral STN-DBS at 130-185 Hz led to about 54% improvement. PPN-DBS was particularly effective on gait and postural items. In ON-medication state, the association of STN and PPN-DBS provided a significant further improvement when compared to the specific benefit mediated by the activation of either single target. Moreover, the combined DBS of both targets promoted a substantial amelioration in the performance of daily living activities. These findings indicate that, in patients with advanced Parkinson's disease, PPN-DBS associated with standard STN-DBS may be useful in improving gait and in optimizing the dopamine-mediated ON-state, particularly in those whose response to STN only DBS has deteriorated over time. This combination of targets may also prove useful in extra-pyramidal disorders, such as progressive supranuclear palsy, for which treatments are currently elusive.

Projections from cortical and subcortical limbic structures to the basal ganglia are predominantly directed to the ventral striatum. The present study investigated how the expectation of external events with behavioral significance is reflected in the activity of ventral striatal neurons. A total of 420 neurons were studied in macaque monkeys performing in a delayed go-no-go task. Lights of different colors instructed the animal to do an arm-reaching movement or refrain from moving, respectively, when a trigger light was illuminated a few seconds later. Task performance was reinforced by liquid reward in both situations. A total of 60 ventral striatal neurons showed sustained increases of activity before the occurrence of individual task events. In 43 of these neurons, activations specifically preceded the delivery of reward, independent of the movement or no-movement reaction. In a series of additional tests, these activations were time locked to the subsequent reward, disappeared within a few trials when reward was omitted, and were temporally unrelated to mouth movements. Changes in the appetitive value of the reward liquid modified the magnitude of activations, suggesting a possible relationship to the hedonic properties of the expected event. Activations also occurred when reward was delivered in a predictable manner outside of any behavioral task. These data suggest that neurons in the ventral striatum are activated during states of expectation of individual environmental events that are predictable to the subject through its past experience. The prevalence of activations related to the expectation of reward suggests that ventral striatal neurons have access to central representations of reward and thereby participate in the processing of information underlying the motivational control of goal-directed behavior.

The peduncolopontine nucleus modulates locomotor activity and dysfunction in this nucleus may be responsible for the gait and postural impairments seen in Parkinson's disease and other movement disorders. We report the first surgical exploration and implantation of deep brain stimulating electrodes of the peduncolopontine nucleus area in two Parkinson's disease patients to examine the safety and the potential benefit of chronic electrical stimulation at this site. Under local anesthesia, the peduncolopontine nucleus was approached from a coronal burr hole using a trajectory that was 78-80 degrees and 62-64 degrees on the coronal and sagittal planes. Microrecordings helped to identify neurons in peduncolopontine nucleus and the adjacent substantia nigra pars reticulata. Chronic deep brain stimulating electrodes were implanted within the peduncolopontine nucleus in a manner similar to that practiced with deep brain stimulating surgery at other targets. Peduncolopontine nucleus neurons were characterized by small and broad multiunits (230 muV, 2.5 ms, 14.6 Hz). Caudal to this area, neurons firing at higher frequency, approximately 70 Hz, characteristic of nigral neuronal discharges, were encountered, followed by 2 mm of cells similar to those recorded in the dorsal peduncolopontine nucleus area. After deep brain stimulating electrodes implantation, acute intraoperative stimulation (up to 3 V) was performed with two stimulation frequencies in each session. Stimulation at 80 Hz has little discernable effect. On the other hand, stimulation at 10 Hz fostered a subjective feeling of 'well-being' and a time-locked amelioration of the clinical scores. These findings demonstrate that the stereotactic approach of peduncolopontine nucleus is safe. The target may reliably be identified by microrecordings. Low-frequency stimulation may produce acute improvements in motor function.

The sources of input and the behavioral effects of lesions and drug administration suggest that the striatum participates in motivational processes. We investigated the activity of single striatal neurons of monkeys in response to reward delivered for performing in a go-nogo task. A drop of liquid was given each time the animal correctly executed or withheld an arm movement in reaction to a visual stimulus. Of 1593 neurons, 115 showed increased activity in response to delivery of liquid reward in both go and nogo trials. Responding neurons were predominantly located in dorsal and ventromedial parts of anterior putamen, in dorsal and ventral caudate, and in nucleus accumbens. They were twice as frequent in ventral as compared to dorsal striatal areas. Responses occurred at a median latency of 337 ms and lasted for 525 ms, with insignificant differences between dorsal and ventral striatum. Reward responses differed from activity recorded in the face area of posterior putamen which varied synchronously with individual mouth movements. Responses were directly related to delivery of primary liquid reward and not to auditory stimuli associated with it. Most of them also occurred when reward was delivered outside of the task. These results demonstrate that neurons of dorsal and particularly ventral striatum are involved in processing information concerning the attribution of primary reward.

1. This study investigated neuronal activity in the striatum preceding predictable environmental events and behavioral reactions. Monkeys performed in a delayed go-nogo task that included separate time periods during which animals expected signals of behavioral significance, prepared for execution or inhibition of arm reaching movements, and expected the delivery of reward. In the task, animals were instructed by a green light cue to perform an arm reaching movement when a trigger stimulus came on approximately 3 s later (go situation). Movement was withheld after the same trigger light when the instruction cue had been red (nogo situation). Liquid reward was delivered on correct performance in both situations. 2. A total of 1,173 neurons were studied in the striatum (caudate nucleus and putamen) of 3 animals, of which 615 (52%) showed some change in activity during task performance. This report describes how the activity of 193 task-related neurons increased in advance of at least 1 component of the task, namely the instruction cue, the trigger stimulus, or the delivery of liquid reward. These neurons were found in dorsal and anterior parts of caudate and putamen and were slightly more frequent in the proximity of the internal capsule. 3. The activity of 16 neurons increased in both go and nogo trials before the onset of the instruction and subsided shortly after this signal. These activations may be related to the expectation of the instruction as the first signal in each trial. 4. The activity of 15 neurons increased between the instruction and the trigger stimulus in both go and nogo trials. These activations may be related to the expectation of the trigger stimulus independent of an arm movement. Further 56 neurons showed sustained activations only when the instruction requested a movement reaction. Activations were absent in trials in which the movement was withheld. Twenty-one of these neurons were tested with 2 different movement targets, 5 of which showed activity related to the direction of movement. These activations may be related to the preparation of movement or expectation of the specific movement triggering signal. The activity of an additional 20 neurons was unmodulated before the trigger stimulus in movement trials but increased in the interval between the no-movement instruction and the trigger stimulus for withholding the movement. These activations may be related to the preparation of movement inhibition as specific nogo reaction.(ABSTRACT TRUNCATED AT 400 WORDS)

The behavioral relationships of 396 striatum neurons with regular, tonically elevated discharge rates were studied. While monkeys performed a delayed gonogo task, neurons predominantly located in medial putamen responded with phasic depressions (n = 30) or activations (n = 5) to task-specific stimuli. Particularly effective was an instruction light preparing for movement or no-movement reactions, and an auditory signal associated with reward delivery. Stimuli triggering arm or mouth movements were less effective. The data demonstrate that these usually poorly modulated neurons display context-dependent phasic activity in specific behavioral situations.

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