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Suresh V, Dave T, Ghosh S, Jena R, Sanker V. Deep brain stimulation in Parkinson's disease: A scientometric and bibliometric analysis, trends, and research hotspots. Medicine (Baltimore) 2024; 103:e38152. [PMID: 38758903 PMCID: PMC11098246 DOI: 10.1097/md.0000000000038152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/16/2024] [Indexed: 05/19/2024] Open
Abstract
Parkinson disease (PD), a prevalent neurodegenerative ailment in the elderly, relies mainly on pharmacotherapy, yet deep brain stimulation (DBS) emerges as a vital remedy for refractory cases. This study performs a bibliometric analysis on DBS in PD, delving into research trends and study impact to offer comprehensive insights for researchers, clinicians, and policymakers, illuminating the current state and evolutionary trajectory of research in this domain. A systematic search on March 13, 2023, in the Scopus database utilized keywords like "Parkinson disease," "PD," "Parkinsonism," "Deep brain stimulation," and "DBS." The top 1000 highly cited publications on DBS in PD underwent scientometric analysis via VOS Viewer and R Studio's Bibliometrix package, covering publication characteristics, co-authorship, keyword co-occurrence, thematic clustering, and trend topics. The bibliometric analysis spanned 1984 to 2021, involving 1000 cited articles from 202 sources. The average number of citations per document were 140.9, with 31,854 references. "Movement Disorders" led in publications (n = 98), followed by "Brain" (n = 78) and "Neurology" (n = 65). The University of Oxford featured prominently. Thematic keyword clustering identified 9 core research areas, such as neuropsychological function and motor circuit electrophysiology. The shift from historical neurosurgical procedures to contemporary focuses like "beta oscillations" and "neuroethics" was evident. The bibliometric analysis emphasizes UK and US dominance, outlining 9 key research areas pivotal for reshaping Parkinson treatment. A discernible shift from invasive neurosurgery to DBS is observed. The call for personalized DBS, integration with NIBS, and exploration of innovative avenues marks the trajectory for future research.
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Affiliation(s)
- Vinay Suresh
- King George’s Medical University, Lucknow, India
| | - Tirth Dave
- Bukovinian State Medical University, Chernivtsi, Ukraine
| | | | - Rahul Jena
- Bharati Vidyapeeth Medical College, Pune, India
| | - Vivek Sanker
- Society of Brain Mapping and Therapeutics, Los Angeles, CA
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2
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Fan JM, Lee AM, Sellers KK, Woodworth K, Makhoul GS, Liu TX, Henderson C, Astudillo Maya DA, Martinez R, Zamanian H, Speidel BA, Khambhati AN, Rao VR, Sugrue LP, Scangos KW, Chang EF, Krystal AD. Intracranial electrical stimulation of corticolimbic sites modulates arousal in humans. Brain Stimul 2023; 16:1072-1082. [PMID: 37385540 PMCID: PMC10634663 DOI: 10.1016/j.brs.2023.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Humans routinely shift their sleepiness and wakefulness levels in response to emotional factors. The diversity of emotional factors that modulates sleep-wake levels suggests that the ascending arousal network may be intimately linked with networks that mediate mood. Indeed, while animal studies have identified select limbic structures that play a role in sleep-wake regulation, the breadth of corticolimbic structures that directly modulates arousal in humans remains unknown. OBJECTIVE We investigated whether select regional activation of the corticolimbic network through direct electrical stimulation can modulate sleep-wake levels in humans, as measured by subjective experience and behavior. METHODS We performed intensive inpatient stimulation mapping in two human participants with treatment resistant depression, who underwent intracranial implantation with multi-site, bilateral depth electrodes. Stimulation responses of sleep-wake levels were measured by subjective surveys (i.e. Stanford Sleepiness Scale and visual-analog scale of energy) and a behavioral arousal score. Biomarker analyses of sleep-wake levels were performed by assessing spectral power features of resting-state electrophysiology. RESULTS Our findings demonstrated three regions whereby direct stimulation modulated arousal, including the orbitofrontal cortex (OFC), subgenual cingulate (SGC), and, most robustly, ventral capsule (VC). Modulation of sleep-wake levels was frequency-specific: 100Hz OFC, SGC, and VC stimulation promoted wakefulness, whereas 1Hz OFC stimulation increased sleepiness. Sleep-wake levels were correlated with gamma activity across broad brain regions. CONCLUSIONS Our findings provide evidence for the overlapping circuitry between arousal and mood regulation in humans. Furthermore, our findings open the door to new treatment targets and the consideration of therapeutic neurostimulation for sleep-wake disorders.
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Affiliation(s)
- Joline M Fan
- Department of Neurology, University of California, San Francisco, CA, USA; Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
| | - A Moses Lee
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Kristin K Sellers
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Kai Woodworth
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Ghassan S Makhoul
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Tony X Liu
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Catherine Henderson
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Daniela A Astudillo Maya
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Rebecca Martinez
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Hashem Zamanian
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Benjamin A Speidel
- Department of Neurology, University of California, San Francisco, CA, USA; Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Ankit N Khambhati
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Vikram R Rao
- Department of Neurology, University of California, San Francisco, CA, USA; Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Leo P Sugrue
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, CA, USA
| | - Katherine W Scangos
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Edward F Chang
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Andrew D Krystal
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
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Mizrahi-Kliger AD, Feldmann LK, Kühn AA, Bergman H. Etiologies of insomnia in Parkinson's disease - Lessons from human studies and animal models. Exp Neurol 2022; 350:113976. [PMID: 35026228 DOI: 10.1016/j.expneurol.2022.113976] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/27/2021] [Accepted: 01/06/2022] [Indexed: 12/28/2022]
Abstract
Sleep disorders are integral to Parkinson's disease (PD). Insomnia, an inability to maintain stable sleep, affects most patients and is widely rated as one of the most debilitating facets of this disease. PD insomnia is often perceived as a multifactorial entity - a consequence of several of the disease symptoms, comorbidities and therapeutic strategies. Yet, this view evolved against a backdrop of a relative scarcity of works trying to directly dissect the underlying neural correlates and mechanisms in animal models. The last years have seen the emergence of a wealth of new evidence regarding the neural underpinnings of insomnia in PD. Here, we review early and recent reports from patients and animal models evaluating the etiology of PD insomnia. We start by outlining the phenomenology of PD insomnia and continue to analyze the evidence supporting insomnia as emanating from four distinct subdivisions of etiologies - the symptoms and comorbidities of the disease, the medical therapy, the degeneration of non-dopaminergic cell groups and subsequent alterations in circadian rhythms, and the degeneration of dopaminergic neurons in the brainstem and its resulting effect on the basal ganglia. Finally, we review emerging neuromodulation-based therapeutic avenues for PD insomnia.
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Affiliation(s)
- Aviv D Mizrahi-Kliger
- Department of Neurobiology, Institute of Medical Research Israel-Canada, Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem 91120, Israel.
| | - Lucia K Feldmann
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany; NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen, Berlin, Germany
| | - Hagai Bergman
- Department of Neurobiology, Institute of Medical Research Israel-Canada, Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem 91120, Israel; The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem 91904, Israel; Department of Neurosurgery, Hadassah University Hospital, Jerusalem 91120, Israel
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Baumgartner AJ, Kushida CA, Summers MO, Kern DS, Abosch A, Thompson JA. Basal Ganglia Local Field Potentials as a Potential Biomarker for Sleep Disturbance in Parkinson's Disease. Front Neurol 2021; 12:765203. [PMID: 34777232 PMCID: PMC8581299 DOI: 10.3389/fneur.2021.765203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
Abstract
Sleep disturbances, specifically decreases in total sleep time and sleep efficiency as well as increased sleep onset latency and wakefulness after sleep onset, are highly prevalent in patients with Parkinson's disease (PD). Impairment of sleep significantly and adversely impacts several comorbidities in this patient population, including cognition, mood, and quality of life. Sleep disturbances and other non-motor symptoms of PD have come to the fore as the effectiveness of advanced therapies such as deep brain stimulation (DBS) optimally manage the motor symptoms. Although some studies have suggested that DBS provides benefit for sleep disturbances in PD, the mechanisms by which this might occur, as well as the optimal stimulation parameters for treating sleep dysfunction, remain unknown. In patients treated with DBS, electrophysiologic recording from the stimulating electrode, in the form of local field potentials (LFPs), has led to the identification of several findings associated with both motor and non-motor symptoms including sleep. For example, beta frequency (13–30 Hz) oscillations are associated with worsened bradykinesia while awake and decrease during non-rapid eye movement sleep. LFP investigation of sleep has largely focused on the subthalamic nucleus (STN), though corresponding oscillatory activity has been found in the globus pallidus internus (GPi) and thalamus as well. LFPs are increasingly being recognized as a potential biomarker for sleep states in PD, which may allow for closed-loop optimization of DBS parameters to treat sleep disturbances in this population. In this review, we discuss the relationship between LFP oscillations in STN and the sleep architecture of PD patients, current trends in utilizing DBS to treat sleep disturbance, and future directions for research. In particular, we highlight the capability of novel technologies to capture and record LFP data in vivo, while patients continue therapeutic stimulation for motor symptoms. These technological advances may soon allow for real-time adaptive stimulation to treat sleep disturbances.
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Affiliation(s)
- Alexander J Baumgartner
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Clete A Kushida
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael O Summers
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Nebraska Medical Center, Omaha, NE, United States
| | - Drew S Kern
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States.,Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Aviva Abosch
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - John A Thompson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States.,Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States
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Yin Z, Bai Y, Guan B, Jiang Y, Wang Z, Meng F, Yang A, Zhang J. A quantitative analysis of the effect of bilateral subthalamic nucleus-deep brain stimulation on subjective and objective sleep parameters in Parkinson's disease. Sleep Med 2020; 79:195-204. [PMID: 33208282 DOI: 10.1016/j.sleep.2020.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/16/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To explore how subjective and objective sleep parameters respond to bilateral subthalamic nucleus-deep brain stimulation (STN-DBS) in patients with Parkinson's disease (PD). METHODS Thirty DBS sleep studies were included by searching PubMed, Embase, and the Cochrane Library, and only 21 prospectively designed studies, including 541 patients, were eligible for the main analysis. We evaluated sleep disturbance using 1 objective measurement, polysomnography (PSG), and 4 subjective scales, including PD Sleep Scale (PDSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and restless legs syndrome (RLS). We pooled data using the standard mean difference (SMD). The primary outcome was a change in sleep parameters 6 months postoperatively. Outcomes from <12 months to ≥12 months follow-up were compared in the subgroup analysis. Meta-regression was further conducted. RESULTS STN-DBS significantly improved all 4 subjective sleep scales in the 6-month follow-up: ESS (SMD = 0.234), PDSS (SMD = 0.724), PSQI (SMD = 1.374) and RLS (SMD = 1.086), while most PSG parameters remained unchanged, except for shortened rapid eye movement sleep latency (RSL) (SMD = 0.520). In the over-12-month follow-up, improvement persisted in PDSS but not in ESS. Dopamine drug reduction (p = 0.009) and motor improvement (p = 0.036) were correlated with ESS improvement and PDSS improvement, respectively. CONCLUSIONS Bilateral STN-DBS continuously improved subjective nocturnal sleep, while its effect on ESS lasted for only 1 year. Medication reduction and motor improvement may contribute to improved daytime sleepiness and better subjective nocturnal sleep, respectively. Except for a shortened RSL, STN-DBS did not change PSG parameters, including sleep efficiency and sleep architecture. REGISTRATION Open Science Framework: DOI 10.17605/OSF.IO/3EGRC.
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Affiliation(s)
- Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Yutong Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Boyuan Guan
- Department of Neuropsychiatry, Behavioral Neurology and Sleep Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yin Jiang
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Zhan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China.
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China.
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6
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Liu Y, Zhang L, Chen W, Ling Y, Xu M, Li Y, Yang C, Liu J, Chen L, Jiang N. Subthalamic nucleus deep brain stimulation improves sleep in Parkinson's disease patients: a retrospective study and a meta-analysis. Sleep Med 2020; 74:301-306. [DOI: 10.1016/j.sleep.2020.07.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/10/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022]
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7
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Beneficial effect of 24-month bilateral subthalamic stimulation on quality of sleep in Parkinson's disease. J Neurol 2020; 267:1830-1841. [PMID: 32152689 PMCID: PMC7293679 DOI: 10.1007/s00415-020-09743-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/27/2019] [Accepted: 02/01/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and sleep symptoms in Parkinson's disease (PD). However, the long-term effects of STN-DBS on sleep and its relationship with QoL outcome are unclear. METHODS In this prospective, observational, multicenter study including 73 PD patients undergoing bilateral STN-DBS, we examined PDSleep Scale (PDSS), PDQuestionnaire-8 (PDQ-8), Scales for Outcomes in PD-motor examination, -activities of daily living, and -complications (SCOPA-A, -B, -C), and levodopa-equivalent daily dose (LEDD) preoperatively, at 5 and 24 months follow-up. Longitudinal changes were analyzed with Friedman-tests or repeated-measures ANOVA, when parametric tests were applicable, and Bonferroni-correction for multiple comparisons. Post-hoc, visits were compared with Wilcoxon signed-rank/t-tests. The magnitude of clinical responses was investigated using effect size. RESULTS Significant beneficial effects of STN-DBS were observed for PDSS, PDQ-8, SCOPA-A, -B, and -C. All outcomes improved significantly at 5 months with subsequent decrements in gains at 24 months follow-up which were significant for PDSS, PDQ-8, and SCOPA-B. Comparing baseline and 24 months follow-up, we observed significant improvements of PDSS (small effect), SCOPA-A (moderate effect), -C, and LEDD (large effects). PDSS and PDQ-8 improvements correlated significantly at 5 and 24 months follow-up. CONCLUSIONS In this multicenter study with a 24 months follow-up, we report significant sustained improvements after bilateral STN-DBS using a PD-specific sleep scale and a significant relationship between sleep and QoL improvements. This highlights the importance of sleep in holistic assessments of DBS outcomes.
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Gay M, Belaid H, Rogers A, Pérez-García F, Roustan M, Bardinet E, François C, Karachi C. Anatomo-Functional Mapping of the Primate Mesencephalic Locomotor Region Using Stereotactic Lesions. Mov Disord 2020; 35:789-799. [PMID: 31922282 DOI: 10.1002/mds.27983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Dysfunction of the mesencephalic locomotor region has been implicated in gait disorders. However, the role of its 2 components, the pedunculopontine and the cuneiform nuclei, in locomotion is poorly understood in primates. OBJECTIVES To analyze the effect of cuneiform lesions on gait and balance in 2 monkeys and to compare them with those obtained after cholinergic pedunculopontine lesions in 4 monkeys and after lesions in both the cuneiform and pedunculopontine nuclei in 1 monkey. METHODS After each stereotactic lesion, we performed a neurological examination and gait and balance assessments with kinematic measures during a locomotor task. The 3-dimensional location of each lesion was analyzed on a common brainstem space. RESULTS After each cuneiform lesion, we observed a contralateral cervical dystonia including an increased tone in the proximal forelimb and an increase in knee angle, back curvature and walking speed. Conversely, cholinergic pedunculopontine lesions increased tail rigidity and back curvature and an imbalance of the muscle tone between the ipsi- and contralateral hindlimb with decreased knee angles. The walking speed was decreased. Moreover, pedunculopontine lesions often resulted in a longer time to waking postsurgery. CONCLUSIONS The location of the lesions and their behavioral effects revealed a somatotopic organization of muscle tone control, with the neck and forelimb represented within the cuneiform nucleus and hindlimb and tail represented within the pedunculopontine nucleus. Cuneiform lesions increased speed, whereas pedunculopontine lesions decreased it. These findings confirm the complex and specific role of the cuneiform and pedunculopontine nuclei in locomotion and suggest the role of the pedunculopontine in sleep control. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Marion Gay
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France
| | - Hayat Belaid
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France.,Department of Neurosurgery, Rothschild Foundation, Paris, France
| | - Alister Rogers
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France.,Department of Neurosurgery, Rothschild Foundation, Paris, France
| | - Fernando Pérez-García
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France.,Center of NeuroImaging Research-CENIR, Paris, France
| | - Maxime Roustan
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France
| | - Eric Bardinet
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France.,Center of NeuroImaging Research-CENIR, Paris, France
| | - Chantal François
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France
| | - Carine Karachi
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France.,AP-HP, Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France
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9
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Virmani T, Urbano FJ, Bisagno V, Garcia-Rill E. The pedunculopontine nucleus: From posture and locomotion to neuroepigenetics. AIMS Neurosci 2019; 6:219-230. [PMID: 32341978 PMCID: PMC7179357 DOI: 10.3934/neuroscience.2019.4.219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/19/2019] [Indexed: 12/04/2022] Open
Abstract
In this review, we discuss first an example of one of the symptoms of PD, freezing of gait (FOG), then we will turn to the use of deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) to treat PD, and the original studies that led to identification of the PPN as one source of locomotor control and why stimulation frequency is critical, and then describe the intrinsic properties of PPN neurons that require beta/gamma stimulation in order to fully activate all types of PPN neurons. Finally, we will describe recent findings on the proteomic and molecular consequences of gamma band activity in PPN neurons, with emphasis on the potential neuroepigenetic sequelae. These considerations will provide essential information for the appropriate refining and testing of PPN DBS as a potential therapy for PD, as well as alternative options.
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Affiliation(s)
- T Virmani
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Slot 847, Little Rock, AR 72205, USA.,Department of Neurology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - F J Urbano
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Slot 847, Little Rock, AR 72205, USA.,Instituto Nacional de Investigaciones Farmacologicas, Argentina
| | - V Bisagno
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Slot 847, Little Rock, AR 72205, USA.,Universidad de Buenos Aires, Buenos Aires, Argentina
| | - E Garcia-Rill
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Slot 847, Little Rock, AR 72205, USA
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10
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Choi JH, Kim HJ, Lee JY, Yoo D, Im JH, Paek SH, Jeon B. Long-term effects of bilateral subthalamic nucleus stimulation on sleep in patients with Parkinson's disease. PLoS One 2019; 14:e0221219. [PMID: 31454366 PMCID: PMC6711522 DOI: 10.1371/journal.pone.0221219] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 08/01/2019] [Indexed: 12/20/2022] Open
Abstract
Objectives Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been reported to have a positive effect on sleep-wake disturbance in Parkinson's disease (PD). We aimed to investigate the long-term effects of STN DBS on sleep in patients with PD. Methods Sixty-one patients with PD who had undergone bilateral STN DBS were followed for 3 years with assessments including the Parkinson’s disease sleep scale (PDSS), Epworth sleepiness scale (ESS), total sleep hours per day, Unified PD Rating Scale part I-III, Hoehn & Yahr stage, levodopa equivalent dose, quality of life measure, and depression scale measured preoperatively and at 6 months after postoperatively, and annually thereafter. Results Among the 61 patients at baseline, 46 patients completed the last follow-up assessment. The total PDSS score significantly improved after STN DBS from baseline up to 3 years after STN DBS (79.0±30, 100.0±23.3, 98.8±23.0, 97.1±29.6, and 93.3±28.0 at baseline, 6, 12, 24, and 36 months, respectively, p = 0.006 for the change over time). Among the eight PDSS domains, the domains for overall quality of a night’s sleep, sleep onset and maintenance insomnia, and nocturnal motor symptoms showed significant improvement after STN DBS (p = 0.036, 0.029, and < 0.001, respectively, for the change over time). The total sleep hours per day were increased, but the total ESS score did not show significant change after STN DBS (p = 0.001 and 0.055, respectively, for the change over time). Changes in the total PDSS were associated with changes in the depression and motivation items in the Unified PD Rating Scale part I, depression scale, and quality of life measure, but those variables at baseline were not predictive of changes in the total PDSS after STN DBS. Conclusion In the largest systematic long-term follow-up study, the improvement in subjective sleep quality after bilateral STN DBS was sustained in PD patients. Improved nocturnal sleep and nocturnal motor symptoms were correlated with an improved mood and quality of life. However, STN DBS did not reduce excessive daytime sleepiness despite reductions in antiparkinsonian medications.
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Grants
- Travel Grant: Korea Research-Based Pharmaceutical Industry Association, Korean Pharmaceutical Manufacturers Association, Seoul National University Hospital (The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript)
- Research Grant: Seoul National University College of Medicine, Seoul National University Hospital, Sinyang Cultural Foundation, Peptron, Abbvie Korea (The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript)
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Affiliation(s)
- Ji-Hyun Choi
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Joon Kim
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dallah Yoo
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Hee Im
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Ha Paek
- Department of Neurosurgery and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- * E-mail: (BJ); (SHP)
| | - Beomseok Jeon
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- * E-mail: (BJ); (SHP)
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11
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Vitale F, Capozzo A, Mazzone P, Scarnati E. Neurophysiology of the pedunculopontine tegmental nucleus. Neurobiol Dis 2019. [DOI: 10.1016/j.nbd.2018.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Tubert C, Galtieri D, Surmeier DJ. The pedunclopontine nucleus and Parkinson's disease. Neurobiol Dis 2019; 128:3-8. [PMID: 30171892 PMCID: PMC6546542 DOI: 10.1016/j.nbd.2018.08.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/22/2018] [Accepted: 08/26/2018] [Indexed: 01/08/2023] Open
Abstract
In the last decade, scientific and clinical interest in the pedunculopontine nucleus (PPN) has grown dramatically. This growth is largely a consequence of experimental work demonstrating its connection to the control of gait and of clinical work implicating PPN pathology in levodopa-insensitive gait symptoms of Parkinson's disease (PD). In addition, the development of optogenetic and chemogenetic approaches has made experimental analysis of PPN circuitry and function more tractable. In this brief review, recent findings in the field linking PPN to the basal ganglia and PD are summarized; in addition, an attempt is made to identify key gaps in our understanding and challenges this field faces in moving forward.
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Affiliation(s)
- Cecilia Tubert
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Daniel Galtieri
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - D James Surmeier
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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13
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Structure and function of the mesencephalic locomotor region in normal and parkinsonian primates. CURRENT OPINION IN PHYSIOLOGY 2019. [DOI: 10.1016/j.cophys.2019.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Update on the clinical application of deep brain stimulation in sleep dysfunction of Parkinson's disease. Acta Neurol Belg 2018; 118:351-359. [PMID: 29987555 DOI: 10.1007/s13760-018-0971-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 07/02/2018] [Indexed: 12/19/2022]
Abstract
Sleep dysfunctions, including rapid eye movement sleep behavior disorder, sleep fragmentation, excessive daytime sleepiness and various other dysfunctions, can seriously affect quality of life in patients with Parkinson's disease (PD). Emerging evidence suggests that deep brain stimulation (DBS) exerts a substantial effect when used to treat sleep dysfunctions, which are common nonmotor symptoms experienced by patients with PD. However, far less is known about the specific mechanisms underlying the effects of DBS on sleep processes and the factors that potentially influence these effects. These issues therefore need to be further clarified. Intriguingly, a number of recent studies have evaluated the effects of applying DBS to various brain targets on sleep in patients with PD. Deeper research into the efficacy of applying DBS to each brain target may help determine which region should be targeted during surgery in PD patients. Furthermore, compared with pharmacological therapy, DBS had more beneficial effects on sleep symptoms, and appropriate management involving the joint application of dopamine replacement therapy and DBS might accelerate the effects of treatment. Here, we review the potential roles DBS may play and provide clinical guidance for the use of DBS in treating sleep dysfunctions in PD patients.
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15
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Sharma VD, Sengupta S, Chitnis S, Amara AW. Deep Brain Stimulation and Sleep-Wake Disturbances in Parkinson Disease: A Review. Front Neurol 2018; 9:697. [PMID: 30210429 PMCID: PMC6119706 DOI: 10.3389/fneur.2018.00697] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/02/2018] [Indexed: 12/02/2022] Open
Abstract
Sleep-wake disturbances are common non-motor manifestations in Parkinson Disease (PD). Complex pathophysiological changes secondary to neurodegeneration in combination with motor symptoms and dopaminergic medications contribute to development of sleep-wake disturbances. The management of sleep complaints in PD is important as this symptom can affect daily activities and impair quality of life. Deep brain stimulation (DBS) is an effective adjunctive therapy for management of motor symptoms in PD. However, its effect on non-motor symptoms including sleep-wake disturbances is not widely understood. In this article, we reviewed studies assessing the effect of DBS at various therapeutic targets on sleep-wake disturbances. Of the studies examining the role of DBS in sleep-wake disturbances, the effect of subthalamic nucleus stimulation is most widely studied and has shown improvement in sleep quality, sleep efficiency, and sleep duration. Although, studies investigating changes in sleep with stimulation of thalamus, globus pallidus interna, and pedunculopontine nucleus are limited, they support the potential for modulation of sleep-wake centers with DBS at these sites. The mechanism by which DBS at different anatomical targets affects sleep-wake disturbances in PD is unclear and may involves multiple factors, including improved motor symptoms, medication adjustment, and direct modulation of sleep-wake centers.
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Affiliation(s)
- Vibhash D Sharma
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Samarpita Sengupta
- Department of Neurology, University of Southwestern Medical Center, Dallas, TX, United States
| | - Shilpa Chitnis
- Department of Neurology, University of Southwestern Medical Center, Dallas, TX, United States
| | - Amy W Amara
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
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16
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O'Dowd S, Galna B, Morris R, Lawson RA, McDonald C, Yarnall AJ, Burn DJ, Rochester L, Anderson KN. Poor Sleep Quality and Progression of Gait Impairment in an Incident Parkinson's Disease Cohort. JOURNAL OF PARKINSONS DISEASE 2018; 7:465-470. [PMID: 28671141 DOI: 10.3233/jpd-161062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abnormal sleep may associate with cognitive decline in Parkinson's disease (PD). Furthermore, sleep dysfunction may associate with worse motor outcome. We hypothesised that PD patients with poor quality sleep would have greater progression in gait dysfunction, due to structural and functional overlap in networks subserving sleep and gait regulation. 12 PD patients and 12 age-matched controls completed longitudinal follow-up over 36 months. Poor sleep efficiency and greater sleep fragmentation correlated significantly with progression of step-width variability, a gait characteristic mediated by postural control, providing evidence that poor sleep in PD is associated with a more rapid deterioration in gait.
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Affiliation(s)
- Seán O'Dowd
- Institute of Neuroscience, Institute for Ageing, Newcastle University, UK
| | - Brook Galna
- Institute of Neuroscience, Institute for Ageing, Newcastle University, UK.,School of Biomedical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Rosie Morris
- Institute of Neuroscience, Institute for Ageing, Newcastle University, UK
| | - Rachael A Lawson
- Institute of Neuroscience, Institute for Ageing, Newcastle University, UK
| | - Claire McDonald
- Institute of Neuroscience, Institute for Ageing, Newcastle University, UK
| | - Alison J Yarnall
- Institute of Neuroscience, Institute for Ageing, Newcastle University, UK
| | - David J Burn
- Institute of Neuroscience, Institute for Ageing, Newcastle University, UK
| | - Lynn Rochester
- Institute of Neuroscience, Institute for Ageing, Newcastle University, UK
| | - Kirstie N Anderson
- Newcastle Regional Sleep Service, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Freeman Road, Newcastle upon Tyne, UK
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17
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Bargiotas P, Eugster L, Oberholzer M, Debove I, Lachenmayer ML, Mathis J, Pollo C, Schüpbach WMM, Bassetti CL. Sleep-wake functions and quality of life in patients with subthalamic deep brain stimulation for Parkinson's disease. PLoS One 2017; 12:e0190027. [PMID: 29253029 PMCID: PMC5734707 DOI: 10.1371/journal.pone.0190027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Sleep-wake disturbances (SWD) are frequent in Parkinson's disease (PD). The effect of deep brain stimulation (DBS) on SWD is poorly known. In this study we examined the subjective and objective sleep-wake profile and the quality of life (QoL) of PD patients in the context of subthalamic DBS. PATIENTS AND METHODS We retrospectively analyzed data from PD patients and candidates for DBS in the nucleus suthalamicus (STN). Pre-DBS, sleep-wake assessments included subjective and objective (polysomnography, vigilance tests and actigraphy) measures. Post-DBS, subjective measures were collected. QoL was assessed using the Parkinson's Disease Questionnaire (PDQ-39) and the RAND SF-36-item Health Survey (RAND SF-36). RESULTS Data from 74 PD patients (62% male, mean age 62.2 years, SD = 8.9) with a mean UPDRS-III (OFF) of 34.2 (SD = 14.8) and 11.8 (SD = 4.5) years under PD treatment were analyzed. Pre-DBS, daytime sleepiness, apathy, fatigue and depressive symptoms were present in 49%, 34%, 38% and 25% of patients respectively but not always as co-occurring symptoms. Sleep-wake disturbances were significantly correlated with QoL scores. One year after STN DBS, motor signs, QoL and sleepiness improved but apathy worsened. Changes in QoL were associated with changes in sleepiness and apathy but baseline sleep-wake functions were not predictive of STN DBS outcome. CONCLUSION In PD patients presenting for STN DBS, subjective and objective sleep-wake disturbances are common and have a negative impact on QoL before and after neurosurgery. Given the current preliminary evidence, prospective observational studies assessing subjective and objective sleep-wake variables prior to and after DBS are needed.
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Affiliation(s)
- Panagiotis Bargiotas
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- * E-mail:
| | - Lukas Eugster
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Michael Oberholzer
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Ines Debove
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - M. Lenard Lachenmayer
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Johannes Mathis
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Claudio Pollo
- Department of Neurosurgery, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - W. M. Michael Schüpbach
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Claudio L. Bassetti
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
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18
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Silkis IG. Hypothetical neurochemical mechanisms of paradoxical sleep deficiency in Alzheimer’s disease. NEUROCHEM J+ 2017. [DOI: 10.1134/s181971241702012x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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19
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Loddo G, Calandra-Buonaura G, Sambati L, Giannini G, Cecere A, Cortelli P, Provini F. The Treatment of Sleep Disorders in Parkinson's Disease: From Research to Clinical Practice. Front Neurol 2017; 8:42. [PMID: 28261151 PMCID: PMC5311042 DOI: 10.3389/fneur.2017.00042] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 01/30/2017] [Indexed: 12/29/2022] Open
Abstract
Sleep disorders (SDs) are one of the most frequent non-motor symptoms of Parkinson’s disease (PD), usually increasing in frequency over the course of the disease and disability progression. SDs include nocturnal and diurnal manifestations such as insomnia, REM sleep behavior disorder, and excessive daytime sleepiness. The causes of SDs in PD are numerous, including the neurodegeneration process itself, which can disrupt the networks regulating the sleep–wake cycle and deplete a large number of cerebral amines possibly playing a role in the initiation and maintenance of sleep. Despite the significant prevalence of SDs in PD patients, few clinical trials on SDs treatment have been conducted. Our aim is to critically review the principal therapeutic options for the most common SDs in PD. The appropriate diagnosis and treatment of SDs in PD can lead to the consolidation of nocturnal sleep, the enhancement of daytime alertness, and the amelioration of the quality of life of the patients.
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Affiliation(s)
- Giuseppe Loddo
- Department of Biomedical and Neuromotor Sciences, University of Bologna , Bologna , Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Bellaria Hospital, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Luisa Sambati
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Bellaria Hospital, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Giulia Giannini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Bellaria Hospital, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Annagrazia Cecere
- Bellaria Hospital, IRCCS Institute of Neurological Sciences of Bologna , Bologna , Italy
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Bellaria Hospital, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Bellaria Hospital, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
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20
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Role of the pedunculopontine nucleus in controlling gait and sleep in normal and parkinsonian monkeys. J Neural Transm (Vienna) 2017; 125:471-483. [PMID: 28084536 DOI: 10.1007/s00702-017-1678-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/07/2017] [Indexed: 12/20/2022]
Abstract
Patients with Parkinson's disease (PD) develop cardinal motor symptoms, including akinesia, rigidity, and tremor, that are alleviated by dopaminergic medication and/or subthalamic deep brain stimulation. Over the time course of the disease, gait and balance disorders worsen and become resistant to pharmacological and surgical treatments. These disorders generate debilitating motor symptoms leading to increased dependency, morbidity, and mortality. PD patients also experience sleep disturbance that raise the question of a common physiological basis. An extensive experimental and clinical body of work has highlighted the crucial role of the pedunculopontine nucleus (PPN) in the control of gait and sleep, and its potential major role in PD. Here, we summarise our investigations in the monkey PPN in the normal and parkinsonian states. We first examined the anatomy and connectivity of the PPN and the cuneiform nucleus which both belong to the mesencephalic locomotor region. Second, we conducted experiments to demonstrate the specific effects of PPN cholinergic lesions on locomotion in the normal and parkinsonian monkey. Third, we aimed to understand how PPN cholinergic lesions impair sleep in parkinsonian monkeys. Our final goal was to develop a novel model of advanced PD with gait and sleep disorders. We believe that this monkey model, even if it does not attempt to reproduce the exact human disease with all its complexities, represents a good biomedical model to characterise locomotion and sleep in the context of PD.
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21
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Efficacy and Safety of Pedunculopontine Nuclei (PPN) Deep Brain Stimulation in the Treatment of Gait Disorders: A Meta-Analysis of Clinical Studies. Can J Neurol Sci 2016; 43:120-6. [PMID: 26786642 DOI: 10.1017/cjn.2015.318] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pedunculopontine nucleus (PPN) has complex reciprocal connections with basal ganglia, especially with internal globus pallidus and substantia nigra, and it has been postulated that PPN stimulation may improve gait instability and freezing of gait. In this meta-analysis, we will assess the evidence for PPN deep brain stimulation in treatment of gait and motor abnormalities especially focusing on Parkinson disease patients. METHODS PubMed and Scopus electronic databases were searched for related studies published before February 2014. Medline (1966-2014), Embase (1974-2010), CINAHL, Web of Science, Scopus bibliographic, and Google Scholar databases (1960-2014) were also searched for studies investigating effect of PPN deep brain stimulation in treatment of postural and postural instability and total of ten studies met the inclusion criteria for this analysis. RESULTS Our findings showed a significant improvement in postural instability (p<0.001) and motor symptoms of Parkinson disease on and off medications (p<0.05), but failed to show improvement in freezing of gait. CONCLUSIONS Despite significant improvement in postural instability observed in included studies, evidence from current literature is not sufficient to generalize these findings to the majority of patients.
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22
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Deep brain stimulation and sleep-wake functions in Parkinson's disease: A systematic review. Parkinsonism Relat Disord 2016; 32:12-19. [PMID: 27605426 DOI: 10.1016/j.parkreldis.2016.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/19/2016] [Accepted: 08/05/2016] [Indexed: 01/27/2023]
Abstract
Sleep-wake disturbances (SWD) are common nonmotor symptoms (NMS) and have a great impact on quality of life of patients with Parkinson's disease (PD). Deep brain stimulation (DBS) is an established treatment in PD. While the beneficial effects of DBS on cardinal PD motor symptoms are indisputable, the data for several NMS, including sleep-wake functions, are limited and often controversial. Our primary objective was to review the literature on the impact of DBS on sleep-wake functions in patients with PD. A systematic review of articles, published in PubMed between January 1st, 2000 and December 31st, 2015 was performed to identify studies addressing the evolution of sleep-wake functions after DBS in patients with PD. Only 38 of 208 studies, involving a total of 1443 subjects, met the inclusion criteria. Most of them reported a positive effect of subthalamic DBS on sleep quality and consequently on quality of life. Seven studies used polysomnography to objectively assess sleep parameters. The data concerning subthalamic DBS and wake functions are controversial and studies using objective, laboratory-based measures for the assessment of wake functions are lacking. Very few studies assessed the impact of other DBS targets (e.g. pallidal stimulation) on SWD. Further prospective observational DBS studies assessing subjectively and objectively specific sleep-wake parameters in patients with PD are needed.
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23
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Goetz L, Piallat B, Bhattacharjee M, Mathieu H, David O, Chabardès S. The primate pedunculopontine nucleus region: towards a dual role in locomotion and waking state. J Neural Transm (Vienna) 2016; 123:667-678. [PMID: 27216823 DOI: 10.1007/s00702-016-1577-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
The mesencephalic reticular formation (MRF) mainly composed by the pedunculopontine and the cuneiform nuclei is involved in the control of several fundamental brain functions such as locomotion, rapid eye movement sleep and waking state. On the one hand, the role of MRF neurons in locomotion has been investigated for decades in different animal models, including in behaving nonhuman primate (NHP) using extracellular recordings. On the other hand, MRF neurons involved in the control of waking state have been consistently shown to constitute the cholinergic component of the reticular ascending system. However, a dual control of the locomotion and waking state by the same groups of neurons in NHP has never been demonstrated in NHP. Here, using microelectrode recordings in behaving NHP, we recorded 38 neurons in the MRF that were followed during transition between wakefulness (TWS) and sleep, i.e., until the emergence of sleep episodes characterized by typical cortical slow wave activity (SWA). We found that the MRF neurons, mainly located in the pedunculopontine nucleus region, modulated their activity during TWS with a decrease in firing rate during SWA. Of interest, we could follow some MRF neurons from locomotion to SWA and found that they also modulated their firing rate during locomotion and TWS. These new findings confirm the role of MRF neurons in both functions. They suggest that the MRF is an integration center that potentially allows to fine tune waking state and locomotor signals in order to establish an efficient locomotion.
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Affiliation(s)
- Laurent Goetz
- University of Grenoble Alpes, 38000, Grenoble, France.,INSERM, U1216, Grenoble Institut des Neurosciences, 38000, Grenoble, France
| | - Brigitte Piallat
- University of Grenoble Alpes, 38000, Grenoble, France.,INSERM, U1216, Grenoble Institut des Neurosciences, 38000, Grenoble, France
| | - Manik Bhattacharjee
- University of Grenoble Alpes, 38000, Grenoble, France.,INSERM, U1216, Grenoble Institut des Neurosciences, 38000, Grenoble, France
| | - Hervé Mathieu
- University of Grenoble Alpes, 38000, Grenoble, France.,INSERM, U1216, Grenoble Institut des Neurosciences, 38000, Grenoble, France.,Unité Mixte de Service IRMaGe, Grenoble Alpes Hospital, 38000, Grenoble, France.,Unité Mixte de Service 3552, CNRS, 38000, Grenoble, France
| | - Olivier David
- University of Grenoble Alpes, 38000, Grenoble, France.,INSERM, U1216, Grenoble Institut des Neurosciences, 38000, Grenoble, France
| | - Stéphan Chabardès
- University of Grenoble Alpes, 38000, Grenoble, France. .,INSERM, U1216, Grenoble Institut des Neurosciences, 38000, Grenoble, France. .,Clinique de neurochirurgie Pôle PALCROS, CHU Grenoble Alpes, 38000, Grenoble, France.
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24
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Strumpf H, Noesselt T, Schoenfeld MA, Voges J, Panther P, Kaufmann J, Heinze HJ, Hopf JM. Deep Brain Stimulation of the Pedunculopontine Tegmental Nucleus (PPN) Influences Visual Contrast Sensitivity in Human Observers. PLoS One 2016; 11:e0155206. [PMID: 27167979 PMCID: PMC4864298 DOI: 10.1371/journal.pone.0155206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/26/2016] [Indexed: 01/24/2023] Open
Abstract
The parapontine nucleus of the thalamus (PPN) is a neuromodulatory midbrain structure with widespread connectivity to cortical and subcortical motor structures, as well as the spinal cord. The PPN also projects to the thalamus, including visual relay nuclei like the LGN and the pulvinar. Moreover, there is intense connectivity with sensory structures of the tegmentum in particular with the superior colliculus (SC). Given the existence and abundance of projections to visual sensory structures, it is likely that activity in the PPN has some modulatory influence on visual sensory selection. Here we address this possibility by measuring the visual discrimination performance (luminance contrast thresholds) in a group of patients with Parkinson’s Disease (PD) treated with deep-brain stimulation (DBS) of the PPN to control gait and postural motor deficits. In each patient we measured the luminance-contrast threshold of being able to discriminate an orientation-target (Gabor-grating) as a function of stimulation frequency (high 60Hz, low 8/10, no stimulation). Thresholds were determined using a standard staircase-protocol that is based on parameter estimation by sequential testing (PEST). We observed that under low frequency stimulation thresholds increased relative to no and high frequency stimulation in five out of six patients, suggesting that DBS of the PPN has a frequency-dependent impact on visual selection processes at a rather elementary perceptual level.
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Affiliation(s)
| | - Toemme Noesselt
- Institute for Biological Psychology, Otto-von-Guericke University, Magdeburg, Germany
| | - Mircea Ariel Schoenfeld
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Clinic for Neurology, Otto-von-Guericke University, Magdeburg, Germany
- Kliniken Schmieder, Allensbach, Germany
| | - Jürgen Voges
- Clinic for Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Patricia Panther
- Clinic for Stereotactic Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Joern Kaufmann
- Clinic for Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Clinic for Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Jens-Max Hopf
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Clinic for Neurology, Otto-von-Guericke University, Magdeburg, Germany
- * E-mail:
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25
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Gummadavelli A, Kundishora AJ, Willie JT, Andrews JP, Gerrard JL, Spencer DD, Blumenfeld H. Neurostimulation to improve level of consciousness in patients with epilepsy. Neurosurg Focus 2016; 38:E10. [PMID: 26030698 DOI: 10.3171/2015.3.focus1535] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
When drug-resistant epilepsy is poorly localized or surgical resection is contraindicated, current neurostimulation strategies such as deep brain stimulation and vagal nerve stimulation can palliate the frequency or severity of seizures. However, despite medical and neuromodulatory therapy, a significant proportion of patients continue to experience disabling seizures that impair awareness, causing disability and risking injury or sudden unexplained death. We propose a novel strategy in which neuromodulation is used not only to reduce seizures but also to ameliorate impaired consciousness when the patient is in the ictal and postictal states. Improving or preventing alterations in level of consciousness may have an effect on morbidity (e.g., accidents, drownings, falls), risk for death, and quality of life. Recent studies may have elucidated underlying networks and mechanisms of impaired consciousness and yield potential novel targets for neuromodulation. The feasibility, benefits, and pitfalls of potential deep brain stimulation targets are illustrated in human and animal studies involving minimally conscious/vegetative states, movement disorders, depth of anesthesia, sleep-wake regulation, and epilepsy. We review evidence that viable therapeutic targets for impaired consciousness associated with seizures may be provided by key nodes of the consciousness system in the brainstem reticular activating system, hypothalamus, basal ganglia, thalamus, and basal forebrain.
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Affiliation(s)
| | | | - Jon T Willie
- 2Departments of Neurosurgery and Neurology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Hal Blumenfeld
- Departments of 1Neurosurgery.,3Neurology, and.,4Neurobiology, Yale University School of Medicine, New Haven, Connecticut; and
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Garcia-Rill E, Virmani T, Hyde J, D’Onofrio S, Mahaffey S. Arousal and the control of perception and movement. CURRENT TRENDS IN NEUROLOGY 2016; 10:53-64. [PMID: 28690375 PMCID: PMC5501251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Recent discoveries on the nature of the activity generated by the reticular activating system (RAS) suggest that arousal is much more involved in perception and movement than previously thought. The RAS is not simply an amorphous, unspecific region but rather a distinct group of nuclei with specific cell and transmitter types that control waking and modulate such processes as perception and movement. Thus, disturbances in the RAS will affect a number of neurological disorders. The discovery of gamma band activity in the RAS determined that high threshold calcium channels are responsible for generating gamma band activity in the RAS. Results showing that waking is mediated by CaMKII modulation of P/Q-type channels and REM sleep is modulated by cAMP/PK modulation of N-type channels points to different intracellular pathways influencing each state. Few studies address these important breakthroughs. Novel findings also show that the same primate RAS neurons exhibiting activity in relation to arousal are also involved in locomotion. Moreover, deep brain stimulation of this region, specifically the pedunculopontine nucleus (PPN DBS), in Parkinson's disease has salutary effects on movement, sleep, and cognition. Gamma oscillations appear to participate in sensory perception, problem solving, and memory, and coherence at these frequencies may occur at cortical or thalamocortical levels. However, rather than participating in the temporal binding of sensory events, gamma band activity generated in the RAS may help stabilize coherence related to arousal, providing a stable activation state during waking, and relay such activation to the cortex. Continuous sensory input will thus induce gamma band activity in the RAS to participate in the processes of preconscious awareness, and provide the essential stream of information for the formulation of many of our perceptions and actions. Such a role has received little attention but promises to help understand and treat a number of neurological disorders.
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Affiliation(s)
- E. Garcia-Rill
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR
| | - T. Virmani
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - J.R. Hyde
- Department of Psychiatry and Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA
| | - S. D’Onofrio
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR
| | - S. Mahaffey
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR
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Babkina OV, Poluektov MG, Levin OS. Heterogeneity of excessive daytime sleepiness in Parkinson’s disease. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:60-70. [DOI: 10.17116/jnevro20161166260-70] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Garcia-Rill E, Luster B, D’Onofrio S, Mahaffey S, Bisagno V, Urbano FJ. Pedunculopontine arousal system physiology - Deep brain stimulation (DBS). Sleep Sci 2015; 8:153-61. [PMID: 26779322 PMCID: PMC4688589 DOI: 10.1016/j.slsci.2015.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/03/2015] [Accepted: 09/05/2015] [Indexed: 12/19/2022] Open
Abstract
This review describes the wake/sleep symptoms present in Parkinson׳s disease, and the role of the pedunculopontine nucleus in these symptoms. The physiology of PPN cells is important not only because it is a major element of the reticular activating system, but also because it is a novel target for deep brain stimulation in the treatment of gait and postural deficits in Parkinson׳s disease. A greater understanding of the physiology of the target nuclei within the brainstem and basal ganglia, amassed over the past decades, has enabled increasingly better patient outcomes from deep brain stimulation for movement disorders.
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Key Words
- Basal forebrain
- Calcium channels
- DBS, deep brain stimulation
- EEG, electroencephalogram
- Gamma band activity
- LC, locus coeruleus
- Lateral hypothalamus
- Orexin
- PD, Parkinson׳s disease
- PGO, ponto-geniculo-occipital
- PPN, pedunculopontine nucleus
- RAS, reticular activating system
- REM, rapid eye movement
- SN, substantia nigra
- STN, subthalamic nucleus
- SubCD, subcoeruleus nucleus dorsalis
- Tuberomammillary
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Affiliation(s)
- Edgar Garcia-Rill
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brennon Luster
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stasia D’Onofrio
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Susan Mahaffey
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Veronica Bisagno
- IFIBYNE-CONICET and ININFA-CONICET, University of Buenos Aires, Argentina
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Takakusaki K, Chiba R, Nozu T, Okumura T. Brainstem control of locomotion and muscle tone with special reference to the role of the mesopontine tegmentum and medullary reticulospinal systems. J Neural Transm (Vienna) 2015; 123:695-729. [PMID: 26497023 PMCID: PMC4919383 DOI: 10.1007/s00702-015-1475-4] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/13/2015] [Indexed: 01/12/2023]
Abstract
The lateral part of the mesopontine tegmentum contains functionally important structures involved in the control of posture and gait. Specifically, the mesencephalic locomotor region, which may consist of the cuneiform nucleus and pedunculopontine tegmental nucleus (PPN), occupies the interest with respect to the pathophysiology of posture-gait disorders. The purpose of this article is to review the mechanisms involved in the control of postural muscle tone and locomotion by the mesopontine tegmentum and the pontomedullary reticulospinal system. To make interpretation and discussion more robust, the above issue is considered largely based on our findings in the experiments using decerebrate cat preparations in addition to the results in animal experimentations and clinical investigations in other laboratories. Our investigations revealed the presence of functional topographical organizations with respect to the regulation of postural muscle tone and locomotion in both the mesopontine tegmentum and the pontomedullary reticulospinal system. These organizations were modified by neurotransmitter systems, particularly the cholinergic PPN projection to the pontine reticular formation. Because efferents from the forebrain structures as well as the cerebellum converge to the mesencephalic and pontomedullary reticular formation, changes in these organizations may be involved in the appropriate regulation of posture-gait synergy depending on the behavioral context. On the other hand, abnormal signals from the higher motor centers may produce dysfunction of the mesencephalic-reticulospinal system. Here we highlight the significance of elucidating the mechanisms of the mesencephalic-reticulospinal control of posture and locomotion so that thorough understanding of the pathophysiological mechanisms of posture-gait disorders can be made.
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Affiliation(s)
- Kaoru Takakusaki
- Research Center for Brain Function and Medical Engineering, Asahikawa Medical University, Midorigaoka-Higashi 2-1, 1-1, Asahikawa, 078-8511, Japan.
| | - Ryosuke Chiba
- Research Center for Brain Function and Medical Engineering, Asahikawa Medical University, Midorigaoka-Higashi 2-1, 1-1, Asahikawa, 078-8511, Japan
| | - Tsukasa Nozu
- Department of Regional Medicine and Education, Asahikawa Medical University, Asahikawa, Japan
| | - Toshikatsu Okumura
- Department of General Medicine, Asahikawa Medical University, Asahikawa, Japan
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Why do patients with Parkinson's disease fall? A cross-sectional analysis of possible causes of falls. NPJ PARKINSONS DISEASE 2015; 1:15011. [PMID: 28409181 PMCID: PMC5388183 DOI: 10.1038/npjparkd.2015.11] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Falls in Parkinson’s disease (PD) are associated with significant injury, disability, hospitalization, and reduced quality of life. Aims: To identify modifiable medical causes of falls in a cohort of PD patients. Methods: Eighty seven PD patients were interviewed and examined using validated scales assessing motor and nonmotor aspects of PD, comorbidities and medication use. The frequency of falls in the last month was the primary outcome measure. Falls were hypothesized to be associated with increasing age, advanced motor severity, particularly axial features (e.g., freezing and postural instability), and dyskinesia. Nonmotor features hypothesized to be associated with falls included; cognitive impairment, psychosis, sleep disorders, cardiovascular dysfunction, and ophthalmological and medical comorbidities. Results: Fallers had longer disease duration, higher Levodopa-equivalent doses, greater ‘On’ time with dyskinesia (all P<0.005), and higher scores on some Movement Disorder Society-Unified Parkinson’s Disease Rating Scale items, particularly axial scores. However, patients with falls did not differ from non-fallers in age or overall motor UPDRS scores. Severity of psychosis, executive cognitive impairment, autonomic (particularly cardiovascular) dysfunction and sleep disturbances (particularly REM sleep behavioral disorder) were significantly associated with falls (all P<0.005). Fallers more frequently reported use of antidepressants (both tricyclics and SSRIs) and neuroleptics (P<0.001), but not hypnotics. There was no difference in medical comorbidities, ophthalmological assessments, fatigue, and apathy scores between the groups. In logistic regression analysis, cardiovascular dysfunction, antidepressant use, and REM sleep behavioral disorder were significantly associated with falls. Conclusions: The causes of falls in PD are multifactorial and extend beyond motor impairment and dyskinesia; addressing these in patients already treated with dopaminergic medications has the potential to improve this important complication of PD.
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Garcia-Rill E, Hyde J, Kezunovic N, Urbano FJ, Petersen E. The physiology of the pedunculopontine nucleus: implications for deep brain stimulation. J Neural Transm (Vienna) 2015; 122:225-35. [PMID: 24880787 PMCID: PMC4484763 DOI: 10.1007/s00702-014-1243-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 05/09/2014] [Indexed: 01/07/2023]
Abstract
This brief review resolves a number of persistent conflicts regarding the location and characteristics of the mesencephalic locomotor region, which has in the past been described as not locomotion-specific and is more likely the pedunculopontine nucleus (PPN). The parameters of stimulation used to elicit changes in posture and locomotion we now know are ideally suited to match the intrinsic membrane properties of PPN neurons. The physiology of these cells is important not only because it is a major element of the reticular activating system, but also because it is a novel target for the treatment of gait and postural deficits in Parkinson's disease (PD). The discussion explains many of the effects reported following deep brain stimulation (DBS) of the PPN by different groups and provides guidelines for the determination of long-term assessment and effects of PPN DBS. A greater understanding of the physiology of the target nuclei within the brainstem and basal ganglia, amassed over the past decades, has enabled increasingly better patient outcomes from DBS for movement disorders. Despite these improvements, there remains a great opportunity for further understanding of the mechanisms through which DBS has its effects and for further development of appropriate technology to effect these treatments. We review the scientific basis for one of the newest targets, the PPN, in the treatment of PD and other movement disorders, and address the needs for further investigation.
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Affiliation(s)
- E Garcia-Rill
- Department of Neurobiology and Developmental Sciences, Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Slot 847, 4301 West Markham St, Little Rock, AR, 72205, USA,
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Okoshi Y, Tanuma N, Miyata R, Hayashi M. Melatonin alterations and brain acetylcholine lesions in sleep disorders in Cockayne syndrome. Brain Dev 2014; 36:907-13. [PMID: 24503446 DOI: 10.1016/j.braindev.2014.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/01/2014] [Accepted: 01/14/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cockayne syndrome (CS) is a genetic disorder caused by deficient nucleotide excision repair. Patients with CS exhibit progeroid features, developmental delay, and various neurological disorders; they are also known to suffer from sleep problems, which have never been investigated in detail. OBJECTIVE The aim of this study is to investigate the pathogenesis of sleep disorders in patients with CS. METHODS We performed a questionnaire survey of the families of patients with CS, enzyme-linked immunosorbent analyses of the melatonin metabolite, 6-sulphatoxymelatonin (6-SM), in the patients' urine, and immunohistochemistry in the hypothalamus, the basal nucleus of Meynert (NbM), and the pedunculopontine tegmental nucleus (PPN) in four autopsy cases. RESULTS Sleep-wakefulness rhythms were disturbed in patients with CS, and these disturbances seemed to be related to a reduced urinary excretion of 6-SM. In addition, although the hypothalamic nuclei were comparatively preserved, acetylcholine neurons (AchNs) were severely decreased in the NbM and PPN. CONCLUSIONS AchNs modulate both arousal and rapid eye movement sleep, and selective lesions of AchNs in the PPN and/or NbM in combination with disturbed melatonin metabolism might be involved in the sleep disorders in CS.
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Affiliation(s)
- Yumi Okoshi
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; Department of Pediatrics, Hokkaido University Graduate School of Medicine, Hokkaido, Japan; Department of Pediatrics, Tokyo Metropolitan Fuchu Medical Center for the Disabled, Tokyo, Japan
| | - Naoyuki Tanuma
- Department of Pediatrics, Tokyo Metropolitan Fuchu Medical Center for the Disabled, Tokyo, Japan
| | - Rie Miyata
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Masaharu Hayashi
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
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Dos Santos AB, Barreto GE, Kohlmeier KA. Treatment of sleeping disorders should be considered in clinical management of Parkinson's disease. Front Aging Neurosci 2014; 6:273. [PMID: 25346687 PMCID: PMC4191244 DOI: 10.3389/fnagi.2014.00273] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/20/2014] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - George E Barreto
- Departmento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana Bogotá DC, Colombia
| | - Kristi A Kohlmeier
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences University of Copenhagen, Denmark
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34
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Jaseja H. Deep-brain stimulation in intractable epilepsy: pedunculopontine nucleus versus thalamic nuclei: a perspective. World Neurosurg 2014; 82:e568-9. [PMID: 24834872 DOI: 10.1016/j.wneu.2014.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 05/09/2014] [Indexed: 02/05/2023]
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Sleep disorders in Parkinsonian macaques: effects of L-dopa treatment and pedunculopontine nucleus lesion. J Neurosci 2014; 34:9124-33. [PMID: 24990932 DOI: 10.1523/jneurosci.0181-14.2014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Patients with Parkinson's disease (PD) display significant sleep disturbances and daytime sleepiness. Dopaminergic treatment dramatically improves PD motor symptoms, but its action on sleep remains controversial, suggesting a causal role of nondopaminergic lesions in these symptoms. Because the pedunculopontine nucleus (PPN) regulates sleep and arousal, and in view of the loss of its cholinergic neurons in PD, the PPN could be involved in these sleep disorders. The aims of this study were as follows: (1) to characterize sleep disorders in a monkey model of PD; (2) to investigate whether l-dopa treatment alleviates sleep disorders; and (3) to determine whether a cholinergic PPN lesion would add specific sleep alterations. To this end, long-term continuous electroencephalographic monitoring of vigilance states was performed in macaques, using an implanted miniaturized telemetry device. 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine treatment induced sleep disorders that comprised sleep episodes during daytime and sleep fragmentation and a reduction of sleep efficiency at nighttime. It also induced a reduction in time spent in rapid eye movement (REM) sleep and slow-wave sleep and an increase in muscle tone during REM and non-REM sleep episodes and in the number of awakenings and movements. l-Dopa treatment resulted in a partial but significant improvement of almost all sleep parameters. PPN lesion induced a transient decrease in REM sleep and in slow-wave sleep followed by a slight improvement of sleep quality. Our data demonstrate the efficacy of l-dopa treatment in improving sleep disorders in parkinsonian monkeys, and that adding a cholinergic PPN lesion improves sleep quality after transient sleep impairment.
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Kutscher SJ, Farshidpanah S, Claassen DO. Sleep dysfunction and its management in Parkinson's disease. Curr Treat Options Neurol 2014; 16:304. [PMID: 24930678 DOI: 10.1007/s11940-014-0304-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OPINION STATEMENT Sleep disorders are among the most common non-motor symptoms in Parkinson's Disease (PD). In some cases, symptoms can precede a diagnosis of PD by many years, but otherwise they are commonly encountered during the clinical care of patients. Unfortunately, sleep problems are under-recognized and subsequently inadequately addressed. In our experience, when properly addressed, physicians and patients are quickly aware of the often-debilitating nature of sleep dysfunction. This does not mean that solutions are easily attainable. Sleep in PD is held in a delicate balance, influenced by the disease process, medications, co-morbid symptoms, and a variety of other factors. For this reason, management of sleep in PD often requires an inter-disciplinary approach. Physicians should have an intimate knowledge of the many sleep problems apparent in PD, as well as appreciate the challenge presented by diverse therapeutic options that can both ameliorate and aggravate symptoms.
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Affiliation(s)
- Scott J Kutscher
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue South, A-0118 Medical Center North, Nashville, TN, 37232, USA,
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37
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Sleep/wake problems in Parkinson’s disease: pathophysiology and clinicopathologic correlations. J Neural Transm (Vienna) 2014; 121 Suppl 1:S3-13. [DOI: 10.1007/s00702-014-1239-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/06/2014] [Indexed: 11/25/2022]
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Blanco L, Ros CM, Tarragón E, Fernández-Villalba E, Herrero MT. Functional role of Barrington's nucleus in the micturition reflex: relevance in the surgical treatment of Parkinson's disease. Neuroscience 2014; 266:150-61. [PMID: 24568730 DOI: 10.1016/j.neuroscience.2014.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/31/2014] [Accepted: 02/01/2014] [Indexed: 01/23/2023]
Abstract
The pontine micturition center or Barrington's nucleus (BN) - besides regulating micturition - co-regulates the activity of other pelvic viscera such as the colon and genitals. At present, this issue is gaining particular importance due to: (i) recent findings of α-synuclein in BN, (ii) known urinary dysfunction in parkinsonian patients (part of the so-called non-motor symptoms), other patients with dementia and as in very old individuals; and (iii) its proximity to the pedunculopontine nucleus, a surgical target in deep brain stimulation for Parkinson's disease (PD). The structural and functional organization of the micturition reflex comprises a coordinating action of somatic motor activity with both divisions of the autonomic nervous system, modulated by trunk encephalic and cortical centers that involve the BN as locus coeruleus and periaqueductal gray matter, among other trunk encephalic structures. The involvement of dopaminergic activity (physiologic inhibition of the micturition reflex mediated by dopaminergic D1 activity) that diminishes in Parkinsonism and leads to overactivity of the micturition reflex is also well known. In this review, the integrating role of the BN in the context of vesical and gastrointestinal behavior is revisited, and the principal morpho-functional findings that associate dysfunction with the urinary disorders that appear during the pre-motor stages of PD are summarized.
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Affiliation(s)
- L Blanco
- Clinical and Experimental Neuroscience, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), School of Medicine, University of Murcia, Campus de Espinardo, 30071 Murcia, Spain; International Center of Neurological Restoration, Department of Experimental Neurophysiology, Avenue 25 #15805, 11300 Havana, Cuba
| | - C M Ros
- Clinical and Experimental Neuroscience, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), School of Medicine, University of Murcia, Campus de Espinardo, 30071 Murcia, Spain; Department of Medicine, School of Health Sciences, University Jaime I, Campus del Riu Sec, 12071 Castellón de la Plana, Spain
| | - E Tarragón
- Department of Medicine, School of Health Sciences, University Jaime I, Campus del Riu Sec, 12071 Castellón de la Plana, Spain
| | - E Fernández-Villalba
- Clinical and Experimental Neuroscience, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), School of Medicine, University of Murcia, Campus de Espinardo, 30071 Murcia, Spain
| | - M T Herrero
- Clinical and Experimental Neuroscience, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), School of Medicine, University of Murcia, Campus de Espinardo, 30071 Murcia, Spain; Department of Medicine, School of Health Sciences, University Jaime I, Campus del Riu Sec, 12071 Castellón de la Plana, Spain.
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Castrioto A, Moro E. New targets for deep brain stimulation treatment of Parkinson's disease. Expert Rev Neurother 2013; 13:1319-28. [PMID: 24215284 DOI: 10.1586/14737175.2013.859987] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the globus pallidus pars interna (GPi) has been shown to be an effective treatment for patients with Parkinson's disease. Strong clinical evidence supports the improvement of motor and non-motor complications and quality of life, with some data suggesting that GPi DBS might be less effective than STN DBS. However, neither STN nor GPi stimulation provides a satisfactory control of non-dopaminergic symptoms, such as gait and balance impairment and cognitive decline, which are frequent and disabling symptoms in advanced Parkinson's disease patients. Therefore, several efforts have been made to discover alternative and new targets to overcome these current DBS limitations. Among these new targets, the stimulation of the pedunculopontine nucleus has initially appeared encouraging. However, findings from different double-blind trials have mitigated the enthusiasm. A multi-target strategy aimed at improving symptoms with different pathogenetic mechanisms might be a promising approach in the next years.
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Affiliation(s)
- Anna Castrioto
- Movement Disorders Centre, Department of Psychiatry and Neurology, CHU de Grenoble - CS10217, 38043 Grenoble Cedex 09, France
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40
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Karas PJ, Mikell CB, Christian E, Liker MA, Sheth SA. Deep brain stimulation: a mechanistic and clinical update. Neurosurg Focus 2013; 35:E1. [DOI: 10.3171/2013.9.focus13383] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Deep brain stimulation (DBS), the practice of placing electrodes deep into the brain to stimulate subcortical structures with electrical current, has been increasing as a neurosurgical procedure over the past 15 years. Originally a treatment for essential tremor, DBS is now used and under investigation across a wide spectrum of neurological and psychiatric disorders. In addition to applying electrical stimulation for clinical symptomatic relief, the electrodes implanted can also be used to record local electrical activity in the brain, making DBS a useful research tool. Human single-neuron recordings and local field potentials are now often recorded intraoperatively as electrodes are implanted. Thus, the increasing scope of DBS clinical applications is being matched by an increase in investigational use, leading to a rapidly evolving understanding of cortical and subcortical neurocircuitry. In this review, the authors discuss recent innovations in the clinical use of DBS, both in approved indications as well as in indications under investigation. Deep brain stimulation as an investigational tool is also reviewed, paying special attention to evolving models of basal ganglia and cortical function in health and disease. Finally, the authors look to the future across several indications, highlighting gaps in knowledge and possible future directions of DBS treatment.
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Affiliation(s)
- Patrick J. Karas
- 1Department of Neurosurgery, The Neurological Institute, Columbia University Medical Center, New York, New York; and
| | - Charles B. Mikell
- 1Department of Neurosurgery, The Neurological Institute, Columbia University Medical Center, New York, New York; and
| | - Eisha Christian
- 2Department of Neurosurgery, Keck Hospital of the University of Southern California, Los Angeles, California
| | - Mark A. Liker
- 2Department of Neurosurgery, Keck Hospital of the University of Southern California, Los Angeles, California
| | - Sameer A. Sheth
- 1Department of Neurosurgery, The Neurological Institute, Columbia University Medical Center, New York, New York; and
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Smedemark-Margulies N, Trapani JG. Tools, methods, and applications for optophysiology in neuroscience. Front Mol Neurosci 2013; 6:18. [PMID: 23882179 PMCID: PMC3713398 DOI: 10.3389/fnmol.2013.00018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 06/27/2013] [Indexed: 11/13/2022] Open
Abstract
The advent of optogenetics and genetically encoded photosensors has provided neuroscience researchers with a wealth of new tools and methods for examining and manipulating neuronal function in vivo. There exists now a wide range of experimentally validated protein tools capable of modifying cellular function, including light-gated ion channels, recombinant light-gated G protein-coupled receptors, and even neurotransmitter receptors modified with tethered photo-switchable ligands. A large number of genetically encoded protein sensors have also been developed to optically track cellular activity in real time, including membrane-voltage-sensitive fluorophores and fluorescent calcium and pH indicators. The development of techniques for controlled expression of these proteins has also increased their utility by allowing the study of specific populations of cells. Additionally, recent advances in optics technology have enabled both activation and observation of target proteins with high spatiotemporal fidelity. In combination, these methods have great potential in the study of neural circuits and networks, behavior, animal models of disease, as well as in high-throughput ex vivo studies. This review collects some of these new tools and methods and surveys several current and future applications of the evolving field of optophysiology.
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Stefani A, Peppe A, Galati S, Bassi MS, D'Angelo V, Pierantozzi M. The serendipity case of the pedunculopontine nucleus low-frequency brain stimulation: chasing a gait response, finding sleep, and cognition improvement. Front Neurol 2013; 4:68. [PMID: 23761781 PMCID: PMC3672779 DOI: 10.3389/fneur.2013.00068] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 05/22/2013] [Indexed: 11/22/2022] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an efficacious therapy for Parkinson’s disease (PD) but its effects on non-motor facets may be detrimental. The low-frequency stimulation (LFS) of the pedunculopontine nucleus (PPN or the nucleus tegmenti pedunculopontini – PPTg-) opened new perspectives. In our hands, PPTg-LFS revealed a modest influence on gait but increased sleep quality and degree of attentiveness. At odds with potential adverse events following STN-DBS, executive functions, under PPTg-ON, ameliorated. A recent study comparing both targets found that only PPTg-LFS improved night-time sleep and daytime sleepiness. Chances are that different neurosurgical groups influence either the PPN sub-portion identified as pars dissipata (more interconnected with GPi/STN) or the caudal PPN region known as pars compacta, preferentially targeting intralaminar and associative nucleus of the thalamus. Yet, the wide electrical field delivered affects a plethora of en passant circuits, and a fine distinction on the specific pathways involved is elusive. This review explores our angle of vision, by which PPTg-LFS activates cholinergic and glutamatergic ascending fibers, influencing non-motor behaviors.
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Affiliation(s)
- Alessandro Stefani
- Department of Neuroscience, "Tor Vergata" University , Rome , Italy ; IRCCS, Fondazione Santa Lucia , Rome , Italy
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