Abstract
Background: In advanced Parkinson’s disease, the pedunculopontine nucleus region is thought to be abnormally inhibited by gamma-aminobutyric acid (GABA) ergic inputs from the over-active globus pallidus internus. Recent attempts to boost pedunculopontine nucleus function through deep brain stimulation are promising, but suffer from the incomplete understanding of the physiology of the pedunculopontine nucleus region. Methods: Local field potentials of the pedunculopontine nucleus region and the globus pallidus internus were recorded and quantitatively analyzed in a patient with Parkinson’s disease. In particular, we compared the local field potentials from the pedunculopontine nucleus region at rest and during deep brain stimulation of the globus pallidus internus. Results: At rest, the spectrum of local field potentials in the globus pallidus internus was mainly characterized by delta-theta and beta frequency activity whereas the spectrum of the pedunculopontine nucleus region was dominated by activity only in the delta and theta band. High-frequency deep brain stimulation of the globus pallidus internus led to increased theta activity in the pedunculopontine nucleus region and enabled information exchange between the left and right pedunculopontine nuclei. Therefore, Conclusions: When applying deep brain stimulation in the globus pallidus internus, its modulatory effect on pedunculopontine nucleus physiology should be taken into account.
Highlights
Akinetic axial symptoms such as postural instability and gait disorders (PIGD) are among the most disabling features of Parkinson’s disease (PD) and significantly affect quality of life [1].Brain Sci. 2018, 8, 117; doi:10.3390/brainsci8070117 www.mdpi.com/journal/brainsciBrain Sci. 2018, 8, 117Initial PIGD often respond to levodopa and deep brain stimulation (DBS) of the subthalamic nucleus or the globus pallidus internus (GPi)
In PD with PIGD, pathologically increased GPi-activity is supposed to cause an over-inhibition of the pedunculopontine nucleus (PPN) region via GABAergic projections and current therapies attempt to augment the PPN region activity through low frequency DBS [12,13,14]
In the PPN region, the local field potentials (LFPs) spectrum was mainly concentrated around the delta (1.5 . . . 3.0 Hz) and theta frequencies (3.5 . . . 8.0 Hz)
Summary
Initial PIGD often respond to levodopa and deep brain stimulation (DBS) of the subthalamic nucleus or the globus pallidus internus (GPi). Since these strategies eventually become less effective during the course of the disease [2], low-frequency DBS of the pedunculopontine nucleus (PPN) region has been suggested [3]. Methods: Local field potentials of the pedunculopontine nucleus region and the globus pallidus internus were recorded and quantitatively analyzed in a patient with Parkinson’s disease. We compared the local field potentials from the pedunculopontine nucleus region at rest and during deep brain stimulation of the globus pallidus internus. Conclusions: When applying deep brain stimulation in the globus pallidus internus, its modulatory effect on pedunculopontine nucleus physiology should be taken into account
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