Journal ArticleDOI
The Deep Brain Stimulation of the Pedunculopontine Tegmental Nucleus
TLDR
The data suggest a promising outcome for simultaneous implantations of different basal ganglia nuclei in Parkinsonian and in progressive supranuclear palsy patients as well.Abstract:
Objective. The aim of the present study was to describe the surgical and clinical outcomes of the implantation and stimulation of the pedunculopontine tegmental nucleus in humans. Materials and Methods. Fourteen patients affected by movement disorders (12 Parkinson's disease and 2 progressive supranuclear palsy) underwent surgery for bilateral or monolateral implantation of stimulating electrodes in the pedunculopontine tegmental nucleus. The correct placement of electrodes was established and verified by combining angio-CT scans with magnetic resonance imaging. Intraoperative and postoperative evaluations were made to assess the clinical effectiveness of stimulation according to different Unified Parkinson's Disease Rating Scale items and neurophysiologic parameters. Results. No major complications occurred following the insertion of electrodes into the pedunculopontine tegmental nucleus. Neuroimaging showed that the electrode contacts were always correctly placed below the ponto-mesencephalic line. Stimulation of the pedunculopontine tegmental nucleus improved gait, posture, and speech, and modulated reflexes integrated at spinal or pontine levels. Conclusions. The surgical targeting of the pedunculopontine tegmental nucleus requires a careful adaptation of the traditional stereotactic approaches owing to the high variability of brainstem anatomy from one patient to another. The insertion of the leads in the pedunculopontine tegmental nucleus as well as their activation did not appear to induce serious adverse effects. The correct positioning of stimulating electrodes in pontine structures such as the pedunculopontine nucleus may be ascertained not only through neuroimaging techniques but also through clinical neurophysiology. The evolution of the surgical planning that we have developed emphasizes the limited value of single-unit recordings to identify the pedunculopontine tegmental nucleus and highlights the opportunities offered by functional evaluations of neurophysiologic parameters. As far as the clinical efficacy is concerned, our data suggest a promising outcome for simultaneous implantations of different basal ganglia nuclei in Parkinsonian and in progressive supranuclear palsy patients as well.read more
Citations
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Journal ArticleDOI
Atlas of the Human Brainstem
Journal ArticleDOI
The pedunculopontine nucleus area: critical evaluation of interspecies differences relevant for its use as a target for deep brain stimulation.
TL;DR: An overview of anatomy and connectivity of the pedunculopontine nucleus area in rats, cats, non-human primates and humans is given and the behavioural changes after chemical or electrical manipulation are reported on.
Journal ArticleDOI
Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?
Thomas Wichmann,Mahlon R. DeLong +1 more
TL;DR: This review considers anatomical and functional concepts of the basal ganglia relevant to the understanding of DBS mechanisms, as well as the current understanding of the pathophysiology of two of the most commonly DBS-treated conditions, Parkinson’s disease and dystonia.
BookDOI
Protein aggregation and fibrillogenesis in cerebral and systemic amyloid disease
TL;DR: This work describes the development of fibrillogenesis and neurotoxicity by amyloid-beta (Abeta) and other disease-related peptides/proteins by plant extracts and herbal compounds and models the Polyglutamine Aggregation Pathway in Huntington's Disease from Basic Studies to Clinical Applications.
References
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Journal ArticleDOI
Electrical Stimulation of the Subthalamic Nucleus in Advanced Parkinson's Disease
Patricia Limousin,Paul Krack,Pierre Pollak,Abdelhamid Benazzouz,Claire Ardouin,Dominique Hoffmann,Alim-Louis Benabid +6 more
TL;DR: Electrical stimulation of the subthalamic nucleus is an effective treatment for advanced Parkinson's disease and the severity of symptoms off medication decreases, and the dose of levodopa can be reduced with consequent reduction in dyskinesias.
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Atlas for Stereotaxy of the Human Brain
TL;DR: Anatomical Abbreviations: Table for the Thalamus, Synonyma table for the Hypothalamus, and Microscopic Series with fixed Overlays for Anatomic Explanations.
Journal ArticleDOI
Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up
M.C. Rodríguez-Oroz,Jose A. Obeso,Anthony E. Lang,J. L. Houeto,Pierre Pollak,Stig Rehncrona,Jaume Kulisevsky,Alberto Albanese,Jens Volkmann,Marwan Hariz,Niall Quinn,Johannes D. Speelman,Jorge Guridi,I Zamarbide,Alexandre Gironell,Joan Molet,Berta Pascual-Sedano,Bernard Pidoux,A M Bonnet,Yves Agid,Jing Xie,Alim-Louis Benabid,Andres M. Lozano,Jean A. Saint-Cyr,Luigi Romito,Maria Fiorella Contarino,Massimo Scerrati,Valérie Fraix,N. Van Blercom +28 more
TL;DR: This first multicentre study assessing the long-term efficacy of either STN or GPi stimulation shows a significant and substantial clinically important therapeutic benefit for at least 3-4 years in a large cohort of patients with severe Parkinson's disease.
Journal ArticleDOI
The pedunculopontine nucleus and Parkinson's disease
TL;DR: The anatomical connections and physiological attributes of the pedunculopontine nucleus are highlighted to discuss how the function of these connections may be altered in the parkinsonian state and to speculate how present and potential future therapy directed to the PPN might improve akinesia and gait difficulties in parkinsonia patients.
Journal ArticleDOI
Bilateral deep brain stimulation of the pedunculopontine and subthalamic nuclei in severe Parkinson's disease
Alessandro Stefani,Andres M. Lozano,Antonella Peppe,Paolo Stanzione,Salvatore Galati,Domenicantonio Tropepi,Mariangela Pierantozzi,Livia Brusa,Eugenio Scarnati,Paolo Mazzone +9 more
TL;DR: Findings indicate that, in patients with advanced Parkinson's disease, PPN-DBS associated with standard STN- DBS may be useful in improving gait and in optimizing the dopamine-mediated ON-state, particularly in those whose response to STN only DBS has deteriorated over time.
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