Deep brain stimulation of globus pallidus interna, subthalamic nucleus, and pedunculopontine nucleus for Parkinson's disease: Which target?

Resting-state networks link invasive and noninvasive brain stimulation across diverse psychiatric and neurological diseases

“…For example, there is some evidence that TMS to M1 may predict the effect of surgically implanted epidural electrical stimulation (150). One could imagine stimulating cortical patterns reflecting the STN versus the GPi to indicate which nucleus should be targeted in a given patient with Parkinson's disease (151). Even more valuable could be stimulating patterns associated with different experimental DBS targets to determine which DBS site should be pursued in a clinical trial.…”

Neural Circuit Modulation During Deep Brain Stimulation at the Subthalamic Nucleus for Parkinson's Disease: What Have We Learned from Neuroimaging Studies?

“…Interest in the GPi within the context of Parkinson's disease arises from many sources, including the therapeutic effects exerted from lesioning (pallidotomy) or DBS at this target (Follett and Torres-Russotto, 2012;Obeso et al, 2001;Pizzolato and Mandat, 2012;Rouaud et al, 2010). In classical models of Parkinson's disease, loss of striatal dopamine is predicted to result in hyperactivity within the GPi with consequent over-inhibition of thalamocortical motor relays (Obeso et al, 2008b;Wichmann et al, 2011).…”

“…However, it should be noted in this context that although high-frequency stimulation is most commonly applied, at some targets, low frequencies may be beneficial for treating movement disorders. Indeed, DBS at the pedunculopontine nucleus (PPN; a brainstem nuclei intimately connected with the basal ganglia and cerebellum) may alleviate parkinsonian symptoms of postural instability or freezing of gait, with therapeutic outcomes occurring at low frequencies (e.g., 35 Hz) (Follett and Torres-Russotto, 2012;Thevathasan et al, 2011). A small number of imaging studies have examined regional neural modulation by lowfrequency PPN-DBS (Ceravolo et al, 2011;Schweder et al, 2010;Stefani et al, 2010).…”

Interactive effects of GPI stimulation and levodopa on postural control in Parkinson's disease

“…High frequency deep brain stimulation of the globus pallidus internus (GPI-DBS) has been shown to elicit significant anti-parkinsonian effects superior to best medical therapy reducing tremor, bradykinesia and rigidity, and suppressing levodopa-induced dyskinesias [4][5][6][7][8].…”