Abstract
Background and purposeDeep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) reduces the number of falls in patients with Parkinson's disease (PD). It was hypothesized that enhanced sensory processing contributes to this PPN‐mediated gait improvement.MethodsFour PD patients (and eight matched controls) with implanted bilateral PPN and subthalamic nucleus DBS electrodes were assessed on postural (with/without vision) and vestibular perceptual threshold tasks.ResultsPedunculopontine nucleus ON stimulation (compared to OFF) lowered vestibular perceptual thresholds but there was a disproportionate increase in the normal sway increase on going from light to dark.ConclusionsThe disproportionate increased sway with PPN stimulation in the dark may paradoxically improve balance function since mechanoreceptor signals rapidly adapt to continuous pressure stimulation from postural akinesia. Additionally, the PPN‐mediated vestibular signal enhancement also improves the monitoring of postural sway. Overall, PPN stimulation may improve sensory feedback and hence balance performance.
Highlights
Parkinson’s disease (PD) standard medical (L-DOPA) and surgical therapy [subthalamic nucleus (STN) deep brain stimulation (DBS)] are effective in reducing patients’ bradykinesia, rigidity and rest tremor but are less successful in controlling postural dysfunction [1]
When pedunculopontine nucleus (PPN) stimulation is ON compared to OFF, patients swayed disproportionately more with eyes closed (EC), but there was little change in sway with eyes open (EO) when PPN was ON or OFF
It was hypothesized that PPN DBS improves postural control in PD patients by enhancing sensory processing
Summary
Parkinson’s disease (PD) standard medical (L-DOPA) and surgical therapy [subthalamic nucleus (STN) deep brain stimulation (DBS)] are effective in reducing patients’ bradykinesia, rigidity and rest tremor but are less successful in controlling postural dysfunction [1]. Recent data suggest that pedunculopontine nucleus (PPN) DBS may improve balance function in PD [2]. Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) reduces the number of falls in patients with Parkinson’s disease (PD). It was hypothesized that enhanced sensory processing contributes to this PPN-mediated gait improvement. Methods: Four PD patients (and eight matched controls) with implanted bilateral PPN and subthalamic nucleus DBS electrodes were assessed on postural (with/without vision) and vestibular perceptual threshold tasks. Conclusions: The disproportionate increased sway with PPN stimulation in the dark may paradoxically improve balance function since mechanoreceptor signals rapidly adapt to continuous pressure stimulation from postural akinesia. The PPN-mediated vestibular signal enhancement improves the monitoring of postural sway. PPN stimulation may improve sensory feedback and balance performance
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