Deep Brain Stimulation of Pedunculopontine Tegmental Nucleus: Role in Sleep Modulation in Advanced Parkinson Disease Patients—One-Year Follow-Up

Abstract

Our study suggests that PPTg-DBS plays an important role in reorganizing regular sleep in PD patients.

Participation of the pedunculopontine tegmental nucleus in arousal-demanding functions

“…All this considered, patients who underwent PPTg deep brain stimulation have been reported to improve daytime sleepiness and REM sleep [189,190], in line with the central role of the PPTg in promoting arousal and REM sleep. In addition, these patients experienced significant amelioration in cognitive functions as shown by a better performance in delayed recall, executive functions and verbal fluency paradigms.…”

Excessive Daytime Somnolence Associated with Parkinson’s Disease

“…However, unlike STN-DBS, stimulation of the PPTg improved not only nighttime sleep but also ameliorated excessive daytime sleepiness [ 32 ]. The ESS was reduced by more than 50 % with PPTg-DBS at 1-year follow up.…”

“…This improvement was seen both with PPTg stimulation only at night or on for 24 h/day. It is hypothesized that stimulation of the PPTg, which is part of the reticular activating pathway, induces a recovery of the activity of this pathway and therefore improves sleep quality and daytime alertness [ 32 ].…”

Heterogeneity of excessive daytime sleepiness in Parkinson’s disease

“…Так, при стимуляции педункулопонтинного ядра было отмечено как значительное улучшение каче-ства ночного сна, так и снижение ДС, а в сравнении с пациентами, у которых проводилась стимуляция субталамического ядра, уменьшение ДС по шкале ESS у первых было больше на 56% (р<0,05) [139]. Последующие исследования показали, что различ-ные параметры стимуляции педункулопонтинного ядра ведут к противоположным эффектам, усиливая или уменьшая ДС [140].…”