Pedunculopontine nucleus: An integrative view with implications on Deep Brain Stimulation

Nowacki, Andreas; Galati, Salvatore; Ai-Schlaeppi, Janine; Bassetti, Claudio; Kaelin, Alain; Pollo, Claudio

doi:10.1016/j.nbd.2018.08.015

Cited by 28 publications

(28 citation statements)

References 172 publications

(238 reference statements)

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“…The clinical effects of STN-DBS has been suggested to result from modulations of the connectivity within the cortico-striato-thalamo-cortical loop 44 and of basal ganglia circuits that also affect sleep physiology 45 . Furthermore, the pedunculopontine nucleus and globus pallidus externa are both connected to STN [46][47][48] and are important in sleep regulation. Studies have shown that DBS in these areas increases REM sleep 46,49 .…”

Section: Discussionmentioning

confidence: 99%

Subthalamic deep brain stimulation improves sleep and excessive sweating in Parkinson’s disease

Bjerknes

Skogseid

Hauge

et al. 2020

npj Parkinsons Dis.

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Parkinson’s disease (PD) is a complex multisystem disorder with motor and non-motor symptoms (NMS). NMS may have an even greater impact on quality of life than motor symptoms. Subthalamic nucleus deep brain stimulation (STN-DBS) has been shown to improve motor fluctuations and quality of life, whereas the effects on different NMS have been less examined. Sleep disturbances and autonomic dysfunction are among the most prevalent NMS. We here report the efficacy of STN-DBS on sleep disturbances and autonomic dysfunction. In the parent trial, 60 patients were included in a single-center randomized prospective study, with MDS-UPDRS III and PDQ-39 as primary endpoints at 12 months of STN-DBS. Preplanned assessments at baseline and postoperatively at 3 and 12 months also included Parkinson’s Disease Sleep Scale (PDSS); Scopa-Aut; and MDS-UPDRS I, II, and IV. We found that STN-DBS had a significant and lasting positive effect on overall sleep quality, nocturnal motor symptoms and restlessness, and daytime dozing. Several aspects of autonomic dysfunction were also improved at 3 months postoperatively, although at 12 months only thermoregulation (sudomotor symptoms) remained significantly improved. We could not identify preoperative factors that predicted improvement in PDSS or Scopa-Aut. There was a close relationship between improved autonomic symptoms and improved quality of life after 1 year. NMS and especially sleep and autonomic dysfunction deserve more focus to improve patient outcomes further.

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Section: Discussionmentioning

confidence: 99%

Subthalamic deep brain stimulation improves sleep and excessive sweating in Parkinson’s disease

Bjerknes

Skogseid

Hauge

et al. 2020

npj Parkinsons Dis.

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“…The PPN plays an important role in balance function, as it is an important part of MLR and has a close relationship with balance function [10,11]. Some scholars have shown that stimulation of the PPN can alter motor behavior [12].…”

Section: Plos Onementioning

confidence: 99%

Effect of Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) on balance performance in Parkinson's disease

Liang

et al. 2020

PLoS ONE

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To study the effect of STN-DBS on balance performance of Parkinson's disease. Method 16 idiopathic PD patients treated with bilateral STN-DBS (DBS Group) and 20 PD patients treated with Levodopa (Medicine group) were included in the study. Clinical material including Levodopa Equivalent Daily Dose (LEDD, mg/day), life quality (PDQ-39) were collected. For DBS group and Medicine group, The motor disability (Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale , MDS-UPDRSIII) and balance performance (MDS-UPDRS 3.12, Berg Balance Scale BBS) and the Limits of Stability (LoS) (target acquisition percentage, trunk swing angle standard deviation, time) in state of Med-Off/Med-On at preoperation, postoperation, 6 months postoperation and 12 months postoperation were evaluated. Repeated ANOVA was used to analyze the effect of STN-DBS on balance performance. Result The Clinical material (age, gender, duration, LEDD preoperation, PDQ39), motor disability (Med-on/Med-Off), balance performance (Med-on/Med-Off) and LoS preoperation had no differences in DBS-group and Medical-group (P>0.05). During the follow up, LEDD, PDQ39, Motor disability (MDS-UPDRSIII), balance performance (MDS-UPDRS 3.12, BBS) in Medicine-group had no significant changes in both Med-Off and Med-On. For DBS-group, immediately improvement of motor disability (MDS-UPDRSIII), LoS (target acquisition percentage, trunk swing angle standard deviation, time) and LEDD were observed postoperation (P<0.05); PDQ39, balance performance (MDS-UPDRS 3.12, BBS) began to improve at 6 months and 12 months postoperation. Repeated ANOVA showed that DBS could significantly improve the motor disability, balance performance and LoS in PD.

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“…DBS is the standard of surgical care for Parkinson’s Disease (PD) where electrodes are chronically implanted into the subthalamic nucleus and often extending into the mesencephalic substantia nigra [ 27 , 28 ]. The pedunculopontine nucleus is another brainstem target being evaluated for implanted neuromodulation systems to improve postural and gait instability in PD [ 29 ]. It is important to note that DBS and IMT are starkly different in neurological indication, operational parameters and hardware design.…”

Section: Discussionmentioning

confidence: 99%

Diffuse intrinsic pontine glioma cells are vulnerable to low intensity electric fields delivered by intratumoral modulation therapy

Deweyert

Iredale

et al. 2019

J Neurooncol

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Introduction Diffuse intrinsic pontine glioma (DIPG) is a high fatality pediatric brain cancer without effective treatment. The field of electrotherapeutics offers new potential for other forms of glioma but the efficacy of this strategy has not been reported for DIPG. This pilot study evaluated the susceptibility of patient-derived DIPG cells to low intensity electric fields delivered using a developing technology called intratumoral modulation therapy (IMT). Methods DIPG cells from autopsy specimens were treated with a custom-designed, in vitro IMT system. Computer-generated electric field simulation was performed to quantify IMT amplitude and distribution using continuous, low intensity, intermediate frequency stimulation parameters. Treatment groups included sham, IMT, temozolomide (TMZ) chemotherapy and radiation therapy (RT). The impact of single and multi-modality therapy was compared using spectrophotometric and flow cytometry viability analyses. Results DIPG cells exhibited robust, consistent susceptibility to IMT fields that significantly reduced cell viability compared to untreated control levels. The ratio of viable:non-viable DIPG cells transformed from ~ 6:1 in sham-treated to ~ 1.5:1 in IMT-treated conditions. The impact of IMT was similar to that of dual modality TMZ–RT therapy and the addition of IMT to this treatment combination dramatically reduced DIPG cell viability to ~ 20% of control values. Conclusions This proof-of-concept study provides a novel demonstration of marked DIPG cell susceptibility to low intensity electric fields delivered using IMT. The potent impact as a monotherapy and when integrated into multi-modality treatment platforms justifies further investigations into the potential of IMT as a critically needed biomedical innovation for DIPG.

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Pedunculopontine nucleus: An integrative view with implications on Deep Brain Stimulation

Cited by 28 publications

References 172 publications

Subthalamic deep brain stimulation improves sleep and excessive sweating in Parkinson’s disease

Subthalamic deep brain stimulation improves sleep and excessive sweating in Parkinson’s disease

Effect of Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) on balance performance in Parkinson's disease

Diffuse intrinsic pontine glioma cells are vulnerable to low intensity electric fields delivered by intratumoral modulation therapy

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