Pedunculopontine nucleus stimulation influences REM sleep in Parkinson’s disease

The impact of low-frequency stimulation of the pedunculopontine nucleus region on reaction time in parkinsonism

“…The PPN is considered a component of the ‘reticular activating system’ and may modulate states of arousal and attention 8–10. Consistent with such a role, PPN stimulation in patients with Parkinson's disease (PD) increases rapid eye movement sleep, and there is PPN-cortical coherence in the α band during wakefulness 11 12. However, the PPN is also proposed to be part of the basal ganglia and appears important to motor control 13.…”

Sleep induced by stimulation in the human pedunculopontine nucleus area

“…8,15 It is unclear why the sudden removal of a continuous low-frequency simulation resulted in immediate, short-lasting REM sleep episodes in Patient 1. However, this observation suggests that REM sleep mechanisms are continuously blocked when arousal is artificially activated.…”

Non-motor functions in parkinsonian patients implanted in the pedunculopontine nucleus: Focus on sleep and cognitive domains

“…PPN-DBS (25 Hz) promoted, in comparison with pre-surgery, a better stability and continuity of nocturnal sleep, expressed by the increase from <80% to >90% sleep efficiency, a mild reduction of Stage 1, a consistent increase of Stage 2 and a decrease of awakenings. Appealingly, these changes were associated with a relevant increase in REM sleep [11].…”

“…Moreover, the sleep structure was also objectively studied in two patients (for the first one see also Romigi et al [11]) by means of Polysomnography (PSG) recordings, which were carried out before and after surgery (STN-ON/PPN-OFF vs. PPN-ON/STN-OFF) using a dynamic 32-channel system polygraph with standard montage [28]. Post-surgery, to minimize DBS-induced artefacts during PSG, STN-DBS was delivered bipolar without a significant clinical worsening in comparison to monopolar stimulation, and the following montage was utilized: F3-C4, F4-C3 and O1-O2, according to Iranzo protocol [29].…”

“…Our patient series provided the first analytical description of the motor response produced by bilateral PPN-DBS at low frequency [10][11][12]. Actually, a recent careful revision highlighted that our stimulation target is, indeed, the caudal pontine representation of PPN, that is the nucleus tegmenti pedunculopontini (PPTg) [13] and not the PPD.…”