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Singh O, Carvalho DZ, Espay AJ, Benarroch EE, Grewal SS, Pagani-Estévez GL. Spinal cord stimulation for gait impairment in Parkinson Disease: scoping review and mechanistic considerations. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:S11-S17. [PMID: 37833048 DOI: 10.1093/pm/pnad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/20/2023] [Accepted: 06/27/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE Advanced Parkinson's Disease (PD) is associated with Parkinson's Disease gait impairment (PDg), which increases the risk for falls and is often treatment-refractory. Subthalamic nucleus (STN) and globus pallidus pars interna (GPi) deep brain stimulation (DBS) often fails to improve axial symptoms like PDg. Spinal cord stimulation (SCS) has been suggested to improve PDg. SCS may benefit PDg by disrupting pathologic beta-oscillations and hypersynchrony in cortico-striatal-thalamic circuits to override excessive inhibition of brainstem locomotor regions. SCS may potentially improve locomotion by acting at any of these levels, either alone or in combination. METHODS We conducted a comprehensive literature search and scoping review, identifying 106 patients in whom SCS was evaluated for PDg. RESULTS Among the identified patients, 63% carried a pain diagnosis. Overall, the most common stimulation location was thoracic (78%), most commonly T9-T10. Burst (sub-perception) was the most common stimulation modality (59%). Prior treatment with DBS was used in 25%. Motor outcomes were assessed by the Unified Parkinson Disease Rating Scale (UPDRS) III-motor, UPDRS, the Timed Up and Go (TUG), and/or 10-/20-meter walking tests.Among these patients, 95 (90%) had PDg amelioration and improved motor outcomes. CONCLUSIONS Despite small sample sizes, patient heterogeneity, and unblinded evaluations complicating interpretations of efficacy and safety, SCS may be beneficial for at least a subset of PDg. Further research is required to clarify the role of SCS for PDg and the patients most suitable to benefit from this intervention.
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Affiliation(s)
- Omesh Singh
- Department of Physical Medicine and Rehabilitation, University of Cincinnati Medical Center, Cincinnati, OH 45219, United States
| | - Diego Z Carvalho
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States
- Center for Sleep Medicine, Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Alberto J Espay
- James J and Joan A Gardner Center for Parkinson Disease and Movement Disorders, University of Cincinnati Medical Center, Cincinnati, OH 45219, United States
| | | | - Sanjeet S Grewal
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Gabriel L Pagani-Estévez
- Interventional and Surgical Pain Management, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH 45219, United States
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Insola A, Mazzone P, Scarnati E, Restuccia D, Valeriani M. Contribution of different somatosensory afferent input to subcortical somatosensory evoked potentials in humans. Clin Neurophysiol 2021; 132:2357-2364. [PMID: 34454262 DOI: 10.1016/j.clinph.2021.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/04/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To investigate the subcortical somatosensory evoked potentials (SEPs) to electrical stimulation of either muscle or cutaneous afferents. METHODS SEPs were recorded in 6 patients suffering from Parkinson's disease (PD) who underwent electrode implantation in the pedunculopontine (PPTg) nucleus area. We compared SEPs recorded from the scalp and from the intracranial electrode contacts to electrical stimuli applied to: 1) median nerve at the wrist, 2) abductor pollicis brevis motor point, and 3) distal phalanx of the thumb. Also the high-frequency oscillations (HFOs) were analysed. RESULTS After median nerve and pure cutaneous (distant phalanx of the thumb) stimulation, a P1-N1 complex was recorded by the intracranial lead, while the scalp electrodes recorded the short-latency far-field responses (P14 and N18). On the contrary, motor point stimulation did not evoke any low-frequency component in the PPTg traces, nor the N18 potential on the scalp. HFOs were recorded to stimulation of all modalities by the PPTg electrode contacts. CONCLUSIONS Stimulus processing within the cuneate nucleus depends on modality, since only the cutaneous input activates the complex intranuclear network possibly generating the scalp N18 potential. SIGNIFICANCE Our results shed light on the subcortical processing of the somatosensory input of different modalities.
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Affiliation(s)
- Angelo Insola
- Unità Operativa di Neurofisiopatologia, CTO, Rome, Italy
| | - Paolo Mazzone
- Unità Operativa di Neurochirurgia funzionale e stereotassica, CTO, Rome, Italy
| | - Eugenio Scarnati
- Dipartimento di Scienze Cliniche e Biotecnologiche Applicate, Università dell'Aquila, Italy
| | - Domenico Restuccia
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimiliano Valeriani
- Divisione di Neurologia, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy; Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark.
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Chang SJ, Cajigas I, Guest JD, Noga BR, Widerström-Noga E, Haq I, Fisher L, Luca CC, Jagid JR. MR Tractography-Based Targeting and Physiological Identification of the Cuneiform Nucleus for Directional DBS in a Parkinson's Disease Patient With Levodopa-Resistant Freezing of Gait. Front Hum Neurosci 2021; 15:676755. [PMID: 34168545 PMCID: PMC8217631 DOI: 10.3389/fnhum.2021.676755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Freezing of gait (FOG) is a debilitating motor deficit in a subset of Parkinson's Disease (PD) patients that is poorly responsive to levodopa or deep brain stimulation (DBS) of established PD targets. The proposal of a DBS target in the midbrain, known as the pedunculopontine nucleus (PPN), to address FOG was based on its observed neuropathology in PD and its hypothesized involvement in locomotor control as a part of the mesencephalic locomotor region (MLR). Initial reports of PPN DBS were met with enthusiasm; however, subsequent studies reported mixed results. A closer review of the MLR basic science literature, suggests that the closely related cuneiform nucleus (CnF), dorsal to the PPN, may be a superior site to promote gait. Although suspected to have a conserved role in the control of gait in humans, deliberate stimulation of a homolog to the CnF in humans using directional DBS electrodes has not been attempted. METHODS As part of an open-label Phase 1 clinical study, one PD patient with predominantly axial symptoms and severe FOG refractory to levodopa therapy was implanted with directional DBS electrodes (Boston Science Vercise CartesiaTM) targeting the CnF bilaterally. Since the CnF is a poorly defined reticular nucleus, targeting was guided both by diffusion tensor imaging (DTI) tractography and anatomical landmarks. Intraoperative stimulation and microelectrode recordings were performed near the targets with leg EMG surface recordings in the subject. RESULTS Post-operative imaging revealed accurate targeting of both leads to the designated CnF. Intraoperative stimulation near the target at low thresholds in the awake patient evoked involuntary electromyography (EMG) oscillations in the legs with a peak power at the stimulation frequency, similar to observations with CnF DBS in animals. Oscillopsia was the primary side effect evoked at higher currents, especially when directed posterolaterally. Directional DBS could mitigate oscillopsia. CONCLUSION DTI-based targeting and intraoperative stimulation to evoke limb EMG activity may be useful methods to help target the CnF accurately and safely in patients. Long term follow-up and detailed gait testing of patients undergoing CnF stimulation will be necessary to confirm the effects on FOG. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT04218526.
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Affiliation(s)
- Stephano J. Chang
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurosurgery, University of British Columbia, Vancouver, BC, Canada
| | - Iahn Cajigas
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - James D. Guest
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Brian R. Noga
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Eva Widerström-Noga
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ihtsham Haq
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Letitia Fisher
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Corneliu C. Luca
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jonathan R. Jagid
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
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Pastor J, Vega-Zelaya L. A new potential specifically marks the sensory thalamus in anaesthetised patients. Clin Neurophysiol 2019; 130:1926-1936. [DOI: 10.1016/j.clinph.2019.07.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/02/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
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5
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Bočková M, Rektor I. Impairment of brain functions in Parkinson’s disease reflected by alterations in neural connectivity in EEG studies: A viewpoint. Clin Neurophysiol 2019; 130:239-247. [DOI: 10.1016/j.clinph.2018.11.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 11/26/2022]
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Macerollo A, Brown MJ, Kilner JM, Chen R. Neurophysiological Changes Measured Using Somatosensory Evoked Potentials. Trends Neurosci 2018; 41:294-310. [DOI: 10.1016/j.tins.2018.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 01/05/2023]
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Hamani C, Lozano AM, Mazzone PAM, Moro E, Hutchison W, Silburn PA, Zrinzo L, Alam M, Goetz L, Pereira E, Rughani A, Thevathasan W, Aziz T, Bloem BR, Brown P, Chabardes S, Coyne T, Foote K, Garcia-Rill E, Hirsch EC, Okun MS, Krauss JK. Pedunculopontine Nucleus Region Deep Brain Stimulation in Parkinson Disease: Surgical Techniques, Side Effects, and Postoperative Imaging. Stereotact Funct Neurosurg 2016; 94:307-319. [PMID: 27728909 DOI: 10.1159/000449011] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/08/2016] [Indexed: 02/05/2023]
Abstract
The pedunculopontine nucleus (PPN) region has received considerable attention in clinical studies as a target for deep brain stimulation (DBS) in Parkinson disease. These studies have yielded variable results with an overall impression of improvement in falls and freezing in many but not all patients treated. We evaluated the available data on the surgical anatomy and terminology of the PPN region in a companion paper. Here we focus on issues concerning surgical technique, imaging, and early side effects of surgery. The aim of this paper was to gain more insight into the reasoning for choosing specific techniques and to discuss shortcomings of available studies. Our data demonstrate the wide range in almost all fields which were investigated. There are a number of important challenges to be resolved, such as identification of the optimal target, the choice of the surgical approach to optimize electrode placement, the impact on the outcome of specific surgical techniques, the reliability of intraoperative confirmation of the target, and methodological differences in postoperative validation of the electrode position. There is considerable variability both within and across groups, the overall experience with PPN DBS is still limited, and there is a lack of controlled trials. Despite these challenges, the procedure seems to provide benefit to selected patients and appears to be relatively safe. One important limitation in comparing studies from different centers and analyzing outcomes is the great variability in targeting and surgical techniques, as shown in our paper. The challenges we identified will be of relevance when designing future studies to better address several controversial issues. We hope that the data we accumulated may facilitate the development of surgical protocols for PPN DBS.
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Affiliation(s)
- Clement Hamani
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ont., Canada
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Insola A, Padua L, Mazzone P, Valeriani M. Low- and high-frequency subcortical SEP amplitude reduction during pure passive movement. Clin Neurophysiol 2015; 126:2366-75. [DOI: 10.1016/j.clinph.2015.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/01/2015] [Accepted: 03/04/2015] [Indexed: 12/15/2022]
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Lau B, Welter ML, Belaid H, Fernandez Vidal S, Bardinet E, Grabli D, Karachi C. The integrative role of the pedunculopontine nucleus in human gait. Brain 2015; 138:1284-96. [PMID: 25765327 DOI: 10.1093/brain/awv047] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/06/2015] [Indexed: 01/20/2023] Open
Abstract
The brainstem pedunculopontine nucleus has a likely, although unclear, role in gait control, and is a potential deep brain stimulation target for treating resistant gait disorders. These disorders are a major therapeutic challenge for the ageing population, especially in Parkinson's disease where gait and balance disorders can become resistant to both dopaminergic medication and subthalamic nucleus stimulation. Here, we present electrophysiological evidence that the pedunculopontine and subthalamic nuclei are involved in distinct aspects of gait using a locomotor imagery task in 14 patients with Parkinson's disease undergoing surgery for the implantation of pedunculopontine or subthalamic nuclei deep brain stimulation electrodes. We performed electrophysiological recordings in two phases, once during surgery, and again several days after surgery in a subset of patients. The majority of pedunculopontine nucleus neurons (57%) recorded intrasurgically exhibited changes in activity related to different task components, with 29% modulated during visual stimulation, 41% modulated during voluntary hand movement, and 49% modulated during imaginary gait. Pedunculopontine nucleus local field potentials recorded post-surgically were modulated in the beta and gamma bands during visual and motor events, and we observed alpha and beta band synchronization that was sustained for the duration of imaginary gait and spatially localized within the pedunculopontine nucleus. In contrast, significantly fewer subthalamic nucleus neurons (27%) recorded intrasurgically were modulated during the locomotor imagery, with most increasing or decreasing activity phasically during the hand movement that initiated or terminated imaginary gait. Our data support the hypothesis that the pedunculopontine nucleus influences gait control in manners extending beyond simply driving pattern generation. In contrast, the subthalamic nucleus seems to control movement execution that is not likely to be gait-specific. These data highlight the crucial role of these two nuclei in motor control and shed light on the complex functions of the lateral mesencephalus in humans.
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Affiliation(s)
- Brian Lau
- 1 Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, F-75013, Paris, France
| | - Marie-Laure Welter
- 1 Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, F-75013, Paris, France 2 Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013 Paris, France
| | - Hayat Belaid
- 2 Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013 Paris, France
| | - Sara Fernandez Vidal
- 1 Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, F-75013, Paris, France 3 Centre de Neuroimagerie de Recherche, Institut du Cerveau et de la Moelle épinière, F-75013, Paris, France
| | - Eric Bardinet
- 1 Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, F-75013, Paris, France 3 Centre de Neuroimagerie de Recherche, Institut du Cerveau et de la Moelle épinière, F-75013, Paris, France
| | - David Grabli
- 1 Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, F-75013, Paris, France 2 Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013 Paris, France
| | - Carine Karachi
- 1 Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, F-75013, Paris, France 2 Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013 Paris, France
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Servello D, Zekaj E, Saleh C, Menghetti C, Porta M. Long-term follow-up of deep brain stimulation of peduncolopontine nucleus in progressive supranuclear palsy: Report of three cases. Surg Neurol Int 2014; 5:S416-20. [PMID: 25289173 PMCID: PMC4173638 DOI: 10.4103/2152-7806.140208] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 04/04/2014] [Indexed: 11/23/2022] Open
Abstract
Background: Progressive supranuclear palsy (PSP) is a neurodegenerative disease due to mitochondrial dysfunction. The PSP syndrome presents generally with gait disorder, Parkinsonism, ophthalmoparesis and cognitive alteration. Few reports exist on deep brain stimulation (DBS) in patients with atypical Parkinsonism. The aim of our study was to evaluate further the potential role of DBS in PSP. Case Description: We report three patients with PSP with long-term follow up undergoing DBS. Two patients had right peripedunculopontine nucleus (PPN) stimulation and one patient had simultaneous right PPN and bilateral globus pallidus internus DBS. DBS of the PPN alone or combined with globus pallidus internus (GPi) determined an improvement in gait and a reduction in falls sustained over time. Combined target stimulation (GPi-PPN) was correlated with better clinical outcome than single target (PPN) DBS for PSP. Conclusions: Although few data on DBS for PSP exist, reported clinical results are encouraging. DBS might be considered as an alternative therapeutic option for patients with PSP presenting with relevant gait imbalance and frequent falls, who fail to respond to pharmacological treatment. Larger cohorts with longer follow-ups are needed to evaluate more exhaustively the efficacy of DBS in PSP.
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Affiliation(s)
- Domenico Servello
- Departments of Neurosurgery and Neurology, IRCCS Galeazzi, Milan, Italy
| | - Edvin Zekaj
- Departments of Neurosurgery and Neurology, IRCCS Galeazzi, Milan, Italy
| | - Christian Saleh
- Departments of Neurosurgery and Neurology, IRCCS Galeazzi, Milan, Italy
| | - Claudia Menghetti
- Departments of Neurosurgery and Neurology, IRCCS Galeazzi, Milan, Italy
| | - Mauro Porta
- Departments of Neurosurgery and Neurology, IRCCS Galeazzi, Milan, Italy
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Insola A, Padua L, Mazzone P, Scarnati E, Valeriani M. Low and high-frequency somatosensory evoked potentials recorded from the human pedunculopontine nucleus. Clin Neurophysiol 2014; 125:1859-69. [DOI: 10.1016/j.clinph.2013.12.112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 12/04/2013] [Accepted: 12/20/2013] [Indexed: 10/25/2022]
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12
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Mazzone P, Insola A, Valeriani M, Caliandro P, Sposato S, Scarnati E. Uncertainty, misunderstanding and the pedunculopontine nucleus: the exhumation of an already buried dispute. Acta Neurochir (Wien) 2012; 154:1527-9; author reply 1531-3. [PMID: 22588336 DOI: 10.1007/s00701-012-1364-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 04/18/2012] [Indexed: 11/28/2022]
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13
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Insola A, Valeriani M, Mazzone P. Targeting the Pedunculopontine Nucleus. Oper Neurosurg (Hagerstown) 2012; 71:96-103. [DOI: 10.1227/neu.0b013e318249c726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Pedunculopontine tegmental nucleus (PPTg) deep brain stimulation (DBS) has been used in patients with Parkinson disease.
OBJECTIVE:
To verify the position of the DBS lead within the pons during PPTg targeting.
METHODS:
In 10 Parkinson disease patients undergoing electrode implantation in the PPTg, somatosensory evoked potentials were recorded after median nerve stimulation from the 4 DBS electrode contacts and from 2 scalp leads placed in the frontal and parietal regions.
RESULTS:
The DBS electrode recorded a P16 potential (latency at contact 0, 16.33 ± 0.76 ms). There was a P16 latency shift of 0.18 ± 0.07 ms from contact 0 (lower) to contact 3 (upper). The scalp electrodes recorded the P14 far-field response (latency, 15.44 ± 0.63 ms) and the cortical N20 potential (latency, 21.58 ± 1.42 ms). The P16 potentials recorded by the intracranial electrode contacts are generated by the volley traveling along the medial lemniscus, whereas the scalp P14 potential represents a far-field response generated at the Obex level. Considering that the distance between the electrode contacts 0 and 3 is 6 mm, the distance of the electrode contact 0 from the Obex (ΔObex) was calculated by the equation: ΔObex = 6 × Δlatency P14- PPTg0/Δlatency PPTg0-PPTg3. The Obex-to-brainstem electrode distance obtained by the neurophysiological method confirmed that the electrode was located within the pons in all patients. Moreover, this distance was very similar to that issued from the individual brain magnetic resonance imaging.
CONCLUSION:
Somatosensory evoked potentials may be a helpful tool for calculating the macroelectrode position within the pons during PPTg targeting.
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Affiliation(s)
- Angelo Insola
- Unità Operativa di Neurofisiopatologia, CTO, Rome, Italy
| | - Massimiliano Valeriani
- Divisione di Neurologia, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
- Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Paolo Mazzone
- Unità Operativa di Neurochirurgia Funzionale e Stereotassica, CTO, Rome, Italy
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Yeh IJ, Tsang EW, Hamani C, Moro E, Mazzella F, Poon YY, Lozano AM, Chen R. Reply: Where are the somatosensory evoked potentials recorded from DBS leads implanted in the human pedunculopontine tegmental nucleus generated? Mov Disord 2011. [DOI: 10.1002/mds.23597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Profice P, Mazzone P, Pilato F, Dileone M, Insola A, Ranieri F, Di Lazzaro V. Neurophysiological evaluation of the pedunculopontine nucleus in humans. J Neural Transm (Vienna) 2011; 118:1423-9. [PMID: 21479864 DOI: 10.1007/s00702-011-0644-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 03/28/2011] [Indexed: 12/19/2022]
Abstract
The pedunculopontine nucleus (PPTg) is constituted by a heterogeneous cluster of neurons located in caudal mesencephalic tegmentum which projects to the thalamus to trigger thalamocortical rhythms and the brainstem to modulate muscle tone and locomotion. It has been investigated as potential deep brain stimulation (DBS) target for treating Parkinson's disease (PD) symptoms. Neurophysiological studies conducted in humans using DBS electrodes for exploring functional properties of PPTg in vivo, reviewed in this paper, demonstrated that the functional connections between PPTg and cortex, basal ganglia, brainstem network involved in sleep/wake control, and spinal cord can be explored in vivo and provided useful insights about the physiology of this nucleus and pathophysiology of PD.
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Affiliation(s)
- P Profice
- Institute of Neurology, Università Cattolica, L.go A. Gemelli 8, 00168, Rome, Italy
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Mazzone P, Sposato S, Insola A, Scarnati E. The deep brain stimulation of the pedunculopontine tegmental nucleus: towards a new stereotactic neurosurgery. J Neural Transm (Vienna) 2011; 118:1431-51. [DOI: 10.1007/s00702-011-0593-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
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