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Onder H, Oguz KK, Has AC, Elibol B. Comparative analysis of freezing of gait in distinct Parkinsonism types by diffusion tensor imaging method and cognitive profiles. J Neural Transm (Vienna) 2023; 130:521-535. [PMID: 36881182 DOI: 10.1007/s00702-023-02608-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
Freezing of gait (FOG) is an episodic gait pattern that is common in advanced Parkinson's disease (PD) and other atypical parkinsonism syndromes. Recently, disturbances in the pedunculopontine nucleus (PPN) and its connections have been suggested to play a critical role in the development of FOG. In this study, we aimed to demonstrate possible disturbances in PPN and its connections by performing the diffusion tensor imaging (DTI) technique. We included 18 patients of PD with FOG [PD-FOG], 13 patients of PD without FOG [PD-nFOG] and 12 healthy subjects as well as a group of patients with progressive supranuclear palsy (PSP), an atypical parkinsonism syndrome which is very often complicated with FOG [6 PSP-FOG, 5 PSP-nFOG]. To determine the specific cognitive parameters that can be related to FOG, deliberate neurophysiological evaluations of all the individuals were performed. The comparative analyses and correlation analyses were performed to reveal the neurophysiological and DTI correlates of FOG in either group. We have found disturbances in values reflecting microstructural integrity of the bilateral superior frontal gyrus (SFG), bilateral fastigial nucleus (FN), left pre-supplementary motor area (SMA) in the PD-FOG group relative to the PD-nFOG group. The analysis of the PSP group also demonstrated disturbance in left pre-SMA values in the PSP-FOG group likewise, while negative correlations were determined between right STN, left PPN values and FOG scores. In neurophysiological assessments, lower performances for visuospatial functions were demonstrated in FOG ( +) individuals for either patient group. The disturbances in the visuospatial abilities may be a critical step for the occurrence of FOG. Together with the results of DTI analyses, it might be suggested that impairment in the connectivity of disturbed frontal areas with disordered basal ganglia, maybe the key factor for the occurrence of FOG in the PD group, whereas left PPN which is a nondopaminergic nucleus may play a more prominent role in the process of FOG in PSP. Moreover, our results support the relationship between right STN, and FOG as mentioned before, as well as introduce the importance of FN as a new structure that may be involved in FOG pathogenesis.
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Affiliation(s)
- Halil Onder
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Şehit Ömer Halisdemir Street. No: 20 Altındag, 06110, Ankara, Turkey.
| | - Kader Karli Oguz
- Department of Radiology, Hacettepe University Medical School, Ankara, Turkey
| | - Arzu Ceylan Has
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bulent Elibol
- Department of Neurology, Hacettepe University Medical School, Ankara, Turkey
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2
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Insola A, Mazzone P, Della Marca G, Capozzo A, Vitale F, Scarnati E. Pedunculopontine tegmental Nucleus-evoked prepulse inhibition of the blink reflex in Parkinson's disease. Clin Neurophysiol 2021; 132:2729-2738. [PMID: 34417108 DOI: 10.1016/j.clinph.2021.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the effects on the blink reflex (BR) of single stimuli applied to the pedunculopontine tegmental nucleus (PPTg). METHODS The BR was evoked by stimulating the supraorbital nerve (SON) in fifteen patients suffering from idiopathic Parkinson's disease (PD) who had electrodes monolaterally or bilaterally implanted in the PPTg for deep brain stimulation (DBS). Single stimuli were delivered to the PPTg through externalized electrode connection wires 3-4 days following PPTg implantation. RESULTS PPTg stimuli increased the latency and reduced duration, amplitude and area of the R2 component of the BR in comparison to the response recorded in the absence of PPTg stimulation. These effects were independent of the side of SON stimulation and were stable for interstimulus interval (ISI) between PPTg prepulse and SON stimulus from 0 to 110 ms. The PPTg-induced prepulse inhibition of the BR was bilaterally present in the brainstem. The R1 component was unaffected. CONCLUSIONS The prepulse inhibition of the R2 component may be modulated by the PPTg. SIGNIFICANCE These findings suggest that abnormalities of BR occurring in PD may be ascribed to a reduction of basal ganglia-mediated inhibition of brainstem excitability.
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Affiliation(s)
- Angelo Insola
- Clinical Neurophysiopathology, CTO Andrea Alesini Hospital, ASL Roma 2, Via San Nemesio 21, 00145 Rome, Italy.
| | - Paolo Mazzone
- Functional and Stereotactic Neurosurgery, CTO Andrea Alesini Hospital, ASL Roma 2, Via San Nemesio 21, 00145 Rome, Italy
| | - Giacomo Della Marca
- Institute of Neurology, Catholic University, Largo A.Gemelli 8, 00168 Rome, Italy
| | - Annamaria Capozzo
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio Coppito 2, 67100 L'Aquila, Italy
| | - Flora Vitale
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio Coppito 2, 67100 L'Aquila, Italy
| | - Eugenio Scarnati
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio Coppito 2, 67100 L'Aquila, Italy
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Bertino S, Basile GA, Anastasi G, Bramanti A, Fonti B, Cavallaro F, Bruschetta D, Milardi D, Cacciola A. Anatomical Characterization of the Human Structural Connectivity between the Pedunculopontine Nucleus and Globus Pallidus via Multi-Shell Multi-Tissue Tractography. ACTA ACUST UNITED AC 2020; 56:medicina56090452. [PMID: 32906651 PMCID: PMC7557768 DOI: 10.3390/medicina56090452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/22/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022]
Abstract
Background and objectives: The internal (GPi) and external segments (GPe) of the globus pallidus represent key nodes in the basal ganglia system. Connections to and from pallidal segments are topographically organized, delineating limbic, associative and sensorimotor territories. The topography of pallidal afferent and efferent connections with brainstem structures has been poorly investigated. In this study we sought to characterize in-vivo connections between the globus pallidus and the pedunculopontine nucleus (PPN) via diffusion tractography. Materials and Methods: We employed structural and diffusion data of 100 subjects from the Human Connectome Project repository in order to reconstruct the connections between the PPN and the globus pallidus, employing higher order tractography techniques. We assessed streamline count of the reconstructed bundles and investigated spatial relations between pallidal voxels connected to the PPN and pallidal limbic, associative and sensorimotor functional territories. Results: We successfully reconstructed pallidotegmental tracts for the GPi and GPe in all subjects. The number of streamlines connecting the PPN with the GPi was greater than the number of those joining it with the GPe. PPN maps within pallidal segments exhibited a distinctive spatial organization, being localized in the ventromedial portion of the GPi and in the ventral-anterior portion in the GPe. Regarding their spatial relations with tractography-derived maps of pallidal functional territories, the highest value of percentage overlap was noticed between PPN maps and the associative territory. Conclusions: We successfully reconstructed the anatomical course of the pallidotegmental pathways and comprehensively characterized their topographical arrangement within both pallidal segments. PPM maps were localized in the ventromedial aspect of the GPi, while they occupied the anterior pole and the most ventral portion of the GPe. A better understanding of the spatial and topographical arrangement of the pallidotegmental pathways may have pathophysiological and therapeutic implications in movement disorders.
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Affiliation(s)
- Salvatore Bertino
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (G.A.B.); (G.A.); (D.M.)
- Correspondence: (S.B.); (A.C.); Tel.: +39-090-2217143 (S.B. & A.C.)
| | - Gianpaolo Antonio Basile
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (G.A.B.); (G.A.); (D.M.)
| | - Giuseppe Anastasi
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (G.A.B.); (G.A.); (D.M.)
| | - Alessia Bramanti
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (A.B.); (B.F.)
| | - Bartolo Fonti
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (A.B.); (B.F.)
| | - Filippo Cavallaro
- Physical Rehabilitation Medicine and Sport Medicine Unit, University Hospital Policlinico “G. Martino”, 98124 Messina, Italy; (F.C.); (D.B.)
| | - Daniele Bruschetta
- Physical Rehabilitation Medicine and Sport Medicine Unit, University Hospital Policlinico “G. Martino”, 98124 Messina, Italy; (F.C.); (D.B.)
| | - Demetrio Milardi
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (G.A.B.); (G.A.); (D.M.)
- Physical Rehabilitation Medicine and Sport Medicine Unit, University Hospital Policlinico “G. Martino”, 98124 Messina, Italy; (F.C.); (D.B.)
| | - Alberto Cacciola
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (G.A.B.); (G.A.); (D.M.)
- Correspondence: (S.B.); (A.C.); Tel.: +39-090-2217143 (S.B. & A.C.)
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Wright WG. Tonic Neuromuscular Processing Affects Postural Adaptation Differently in Aging and Parkinson's Disease. Front Neurol 2019; 9:1130. [PMID: 30719020 PMCID: PMC6348245 DOI: 10.3389/fneur.2018.01130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/10/2018] [Indexed: 11/13/2022] Open
Abstract
The combination of phasic and tonic neuromuscular processes are involved in the maintenance of normal upright posture. The latter is of particular importance in some pathologies, such as Parkinson's Disease (PD), which is known by one of its cardinal symptoms—tonic dysfunction (i.e., rigidity). Changes in tonic function may also occur during healthy aging. In this investigation, somatosensory input was manipulated by changing the support surface orientation for prolonged periods of quiet stance (QS). The aim was to shed light on how long-term tonic responses called postural lean after-effects are affected by aging and age-related neuropathology. Forty one participants were tested: 19 healthy young (25±5 years), 13 healthy older (63±8 years), and 9 adults with PD (63±5 years). Baseline conditions were eyes-closed QS on a stable surface or standing on an unstable, sway-referenced (SR) surface. Four experimental conditions combined two types of toes-up ramp tilt adaptation (120 s of toes-up static 7° tilt or sinusoidal 7° ± 3° tilt) with two types of post-adaptation (120 s of QS or SR). Results revealed postural after-effects during post-adaptation QS showing significant anterior COP shift for both young and older adults (p < 0.0001), but not PD (p > 0.06, n.s.). Compared to young, postural after-effects in older adults showed longer decay constants and did not return to baseline COP within the 120 s post-adaptation period (p < 0.05). Postural after-effects during SR, which appeared as toes-up surface tilt were highly significant in healthy populations (p = 0.001), but took longer to develop in PD. Younger adults showed significantly larger dorsiflexion (p < 0.01) and faster decay constants than older adults (p < 0.05). In summary, (1) postural after-effects decayed to baseline when post-tilt surface was stable but were retained and even grew larger post-adaptation in the SR surface conditions in all groups, (2) postural after-effects differed between healthy age groups, (3) PD showed less adaptation to surface changes. Differences in size and decay of after-effects between healthy and PD groups suggest tonic neuromuscular processes play a role in how adaptable postural control is to changing surface conditions and this is affected by healthy aging and basal ganglia function.
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Affiliation(s)
- W Geoffrey Wright
- Neuromotor Sciences Program, College of Public Health, Temple University, Philadelphia, PA, United States
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5
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Di Giovanni G, Chagraoui A, Puginier E, Galati S, De Deurwaerdère P. Reciprocal interaction between monoaminergic systems and the pedunculopontine nucleus: Implication in the mechanism of L-DOPA. Neurobiol Dis 2018; 128:9-18. [PMID: 30149181 DOI: 10.1016/j.nbd.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/19/2018] [Accepted: 08/23/2018] [Indexed: 01/31/2023] Open
Abstract
The pedunculopontine nucleus (PPN) is part of the mesencephalic locomotor region (MLR) and has been involved in the control of gait, posture, locomotion, sleep, and arousal. It likely participates in some motor and non-motor symptoms of Parkinson's disease and is regularly proposed as a surgical target to ameliorate gait, posture and sleep disorders in Parkinsonian patients. The PPN overlaps with the monoaminergic systems including dopamine, serotonin and noradrenaline in the modulation of the above-mentioned functions. All these systems are involved in Parkinson's disease and the mechanism of the anti-Parkinsonian agents, mostly L-DOPA. This suggests that PPN interacts with monoaminergic neurons and vice versa. Some evidence indicates that the PPN sends cholinergic, glutamatergic and even gabaergic inputs to mesencephalic dopaminergic cells, with the data regarding serotonergic or noradrenergic cells being less well known. Similarly, the control exerted by the PPN on dopaminergic neurons, is multiple and complex, and more extensively explored than the other monoaminergic systems. The data on the influence of monoaminergic systems on PPN neuron activity are rather scarce. While there is evidence that the PPN influences the therapeutic response of L-DOPA, it is still difficult to discerne the reciprocal action of the PPN and monoaminergic systems in this action. Additional data are required to better understand the functional organization of monoaminergic inputs to the MLR including the PPN to get a clearer picture of their interaction.
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Affiliation(s)
- Giuseppe Di Giovanni
- Department of Physiology & Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta; Neuroscience Division, School of Biosciences, Cardiff University, Cardiff, UK.
| | - Abdeslam Chagraoui
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France; Department of Medical Biochemistry, Rouen University Hospital, Rouen, France
| | - Emilie Puginier
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France; Department of Medical Biochemistry, Rouen University Hospital, Rouen, France
| | - Salvatore Galati
- Parkinson and movement Disorders Center Neurocenter of Southern Switzerland, Ospedale Civico di Lugano, Lugano, Switzerland
| | - Philippe De Deurwaerdère
- Centre National de la Recherche Scientifique (Unité Mixte de Recherche 5287), 146 rue Léo Saignat, B.P.281, F-33000 Bordeaux Cedex, France.
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6
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Rodrigues NB, Mithani K, Meng Y, Lipsman N, Hamani C. The Emerging Role of Tractography in Deep Brain Stimulation: Basic Principles and Current Applications. Brain Sci 2018; 8:brainsci8020023. [PMID: 29382119 PMCID: PMC5836042 DOI: 10.3390/brainsci8020023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 12/30/2022] Open
Abstract
Diffusion tensor imaging (DTI) is an MRI-based technique that delineates white matter tracts in the brain by tracking the diffusion of water in neural tissue. This methodology, known as “tractography”, has been extensively applied in clinical neuroscience to explore nervous system architecture and diseases. More recently, tractography has been used to assist with neurosurgical targeting in functional neurosurgery. This review provides an overview of DTI principles, and discusses current applications of tractography for improving and helping develop novel deep brain stimulation (DBS) targets.
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Affiliation(s)
- Nelson B Rodrigues
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada.
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Karim Mithani
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada.
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
| | - Ying Meng
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada.
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Nir Lipsman
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada.
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
| | - Clement Hamani
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada.
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
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Jha A, Litvak V, Taulu S, Thevathasan W, Hyam JA, Foltynie T, Limousin P, Bogdanovic M, Zrinzo L, Green AL, Aziz TZ, Friston K, Brown P. Functional Connectivity of the Pedunculopontine Nucleus and Surrounding Region in Parkinson's Disease. Cereb Cortex 2016; 27:54-67. [PMID: 28316456 PMCID: PMC5357066 DOI: 10.1093/cercor/bhw340] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Deep brain stimulation of the pedunculopontine nucleus and surrounding region (PPNR) is a novel treatment strategy for gait freezing in Parkinson's disease (PD). However, clinical results have been variable, in part because of the paucity of functional information that might help guide selection of the optimal surgical target. In this study, we use simultaneous magnetoencephalography and local field recordings from the PPNR in seven PD patients, to characterize functional connectivity with distant brain areas at rest. The PPNR was preferentially coupled to brainstem and cingulate regions in the alpha frequency (8-12 Hz) band and to the medial motor strip and neighboring areas in the beta (18-33 Hz) band. The distribution of coupling also depended on the vertical distance of the electrode from the pontomesencephalic line: most effects being greatest in the middle PPNR, which may correspond to the caudal pars dissipata of the pedunculopontine nucleus. These observations confirm the crucial position of the PPNR as a functional node between cortical areas such as the cingulate/ medial motor strip and other brainstem nuclei, particularly in the dorsal pons. In particular they suggest a special role for the middle PPNR as this has the greatest functional connectivity with other brain regions.
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Affiliation(s)
- Ashwani Jha
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Wellcome Trust Centre for Neuroimaging, 12 Queen Square, London, UK
| | - Vladimir Litvak
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK.,Wellcome Trust Centre for Neuroimaging, 12 Queen Square, London, UK
| | - Samu Taulu
- I-LABS MEG Brain Imaging Center, University of Washington, Seattle, WA, USA.,Department of Physics, University of Washington, Seattle, WA, USA
| | - Wesley Thevathasan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jonathan A Hyam
- Unit of Functional Neurosurgery, UCL Institute of Neurology, Queen Square, London, UK
| | - Tom Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK.,Unit of Functional Neurosurgery, UCL Institute of Neurology, Queen Square, London, UK
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK.,Unit of Functional Neurosurgery, UCL Institute of Neurology, Queen Square, London, UK
| | - Marko Bogdanovic
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK.,Unit of Functional Neurosurgery, UCL Institute of Neurology, Queen Square, London, UK
| | - Alexander L Green
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Tipu Z Aziz
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Karl Friston
- Wellcome Trust Centre for Neuroimaging, 12 Queen Square, London, UK
| | - Peter Brown
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK
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Mazzone P, Vilela Filho O, Viselli F, Insola A, Sposato S, Vitale F, Scarnati E. Our first decade of experience in deep brain stimulation of the brainstem: elucidating the mechanism of action of stimulation of the ventrolateral pontine tegmentum. J Neural Transm (Vienna) 2016; 123:751-767. [DOI: 10.1007/s00702-016-1518-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 01/28/2016] [Indexed: 12/19/2022]
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9
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Lim JS, Shin SA, Lee JY, Nam H, Lee JY, Kim YK. Neural substrates of rapid eye movement sleep behavior disorder in Parkinson's disease. Parkinsonism Relat Disord 2015; 23:31-6. [PMID: 26678512 DOI: 10.1016/j.parkreldis.2015.11.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/13/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate neural substrates of symptomatic rapid eye movement sleep behavior disorder (RBD) in Parkinson's disease (PD) by analyzing brain changes based on both hypothesis-free and hypothesis-driven neuroimaging analyses. METHODS A total of 63 subjects (14 PDRBD-, 24 PDRBD+, and 25 age-matched healthy controls = HC) were enrolled in this study. RBD was defined by RBD screening questionnaire with video-polysomnographic confirmation. All subjects underwent volumetric and diffusion tensor imaging. The whole brain gray- and white-matter changes were analyzed and the central ascending cholinergic pathway involving the pedunculopontine nucleus and thalamus was compared with a region-of-interest analysis and probabilistic tractography. RESULTS The PDRBD+ group showed decreased gray matter volume of the left posterior cingulate and hippocampus compared to the PDRBD- and additional gray matter decrease in the left precuneus, cuneus, medial frontal gyrus, postcentral gyrus and both inferior parietal lobule compared to the HC group (uncorrected p < 0.001, k = 50). There were no significant differences in white matter changes between the PDRBD- and PDRBD+ groups both by fractional anisotropy and mean diffusivities. However, both PD groups showed widespread changes by fractional anisotropy reductions and mean diffusivity increments compared to HC (p < 0.05 corrected). There were no significant differences in tract-based spatial statistics and the normalized tract volumes as well as the diffusion indices of both the thalamus and pedunculopontine nuclei among the study groups. CONCLUSIONS The appearance of RBD in PD may be related to regional gray matter changes in the left posterior cingulate and hippocampus but not localized to the brainstem.
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Affiliation(s)
- Jae-Sung Lim
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, Republic of Korea; College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Seong A Shin
- Department of Biomedical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, Republic of Korea; College of Medicine, Seoul National University, Seoul, Republic of Korea.
| | - Hyunwoo Nam
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, Republic of Korea; College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry and Behavioral Science, Seoul National University Boramae Hospital, Seoul, Republic of Korea; College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea; College of Medicine, Seoul National University, Seoul, Republic of Korea.
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Chomiak T, Pereira FV, Clark TW, Cihal A, Hu B. Concurrent arm swing-stepping (CASS) can reveal gait start hesitation in Parkinson's patients with low self-efficacy and fear of falling. Aging Clin Exp Res 2015; 27:457-63. [PMID: 25577232 DOI: 10.1007/s40520-014-0313-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 12/30/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Movement incoordination, freezing of gait, fear of falling, low self-efficacy, and multi-tasking can all contribute to falls in Parkinson's disease. How these multi-factorial risks interact in individual patients remain poorly understood. METHODS Concurrent arm swing-stepping is a simple motor test in which subjects are first asked to swing their arms before being instructed to initiate the secondary task of leg stepping-in-place. We postulated that in patients with multiple fall risks, sensorimotor impairments in upper- and lower-limb movement control can render concurrent arm swing-stepping a demanding dual task, thereby triggering gait hesitation. A total of 31 subjects with Parkinson's disease were enrolled in the study. RESULTS It was found that concurrent arm swing-stepping induced hesitation primarily in Parkinson's disease patients with low fall-related self-efficacy and a fear of falling. By contrast, concurrent arm swing-stepping led to limb incoordination in both patients and in healthy elderly controls. The calculated specificity and sensitivity of the concurrent arm swing-stepping test was 100 and 42 % for hesitation and 12 and 77 % for incoordination. CONCLUSION These results suggest that the concurrent arm swing-stepping test can be used in conjunction with conventional psychometric assessments to facilitate multi-factorial assessment of potential fall risk.
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Affiliation(s)
- Taylor Chomiak
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 1AC60 HRIC, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada,
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11
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Abstract
Background:In Parkinson's disease (PD) cell loss in the substantia nigra is known to result in motor symptoms; however widespread pathological changes occur and may be associated with non-motor symptoms such as cognitive impairment. Diffusion tensor imaging is a quantitative imaging method sensitive to the micro-structure of white matter tracts.Objective:To measure fractional anisotropy (FA) and mean diffusivity (MD) values in the corpus callosum and cingulum pathways, defined by diffusion tensor tractography, in patients with PD, PD with dementia (PDD) and controls and to determine if these measures correlate with Mini-Mental Status Examination (MMSE) scores in parkinsonian patients.Methods:Patients with PD (17 Males [M], 12 Females [F]), mild PDD (5 M, 1F) and controls (8 M, 7F) underwent cognitive testing and MRI scans. The corpus callosum was divided into four regions and the cingulum into two regions bilaterally to define tracts using the program DTIstudio (Johns Hopkins University) using the fiber assignment by continuous tracking algorithm. Volumetric MRI scans were used to measure white and gray matter volumes.Results:Groups did not differ in age or education. There were no overall FA or MD differences between groups in either the corpus callosum or cingulum pathways. In PD subjects the MMSE score correlated with MD within the corpus callosum. These findings were independent of age, sex and total white matter volume.Conclusions:The data suggest that the corpus callosum or its cortical connections are associated with cognitive impairment in PD patients.
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Ferraye MU, Debû B, Heil L, Carpenter M, Bloem BR, Toni I. Using motor imagery to study the neural substrates of dynamic balance. PLoS One 2014; 9:e91183. [PMID: 24663383 PMCID: PMC3963848 DOI: 10.1371/journal.pone.0091183] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 02/10/2014] [Indexed: 01/05/2023] Open
Abstract
This study examines the cerebral structures involved in dynamic balance using a motor imagery (MI) protocol. We recorded cerebral activity with functional magnetic resonance imaging while subjects imagined swaying on a balance board along the sagittal plane to point a laser at target pairs of different sizes (small, large). We used a matched visual imagery (VI) control task and recorded imagery durations during scanning. MI and VI durations were differentially influenced by the sway accuracy requirement, indicating that MI of balance is sensitive to the increased motor control necessary to point at a smaller target. Compared to VI, MI of dynamic balance recruited additional cortical and subcortical portions of the motor system, including frontal cortex, basal ganglia, cerebellum and mesencephalic locomotor region, the latter showing increased effective connectivity with the supplementary motor area. The regions involved in MI of dynamic balance were spatially distinct but contiguous to those involved in MI of gait (Bakker et al., 2008; Snijders et al., 2011; Crémers et al., 2012), in a pattern consistent with existing somatotopic maps of the trunk (for balance) and legs (for gait). These findings validate a novel, quantitative approach for studying the neural control of balance in humans. This approach extends previous reports on MI of static stance (Jahn et al., 2004, 2008), and opens the way for studying gait and balance impairments in patients with neurodegenerative disorders.
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Affiliation(s)
- Murielle Ursulla Ferraye
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Bettina Debû
- Grenoble Institut des Neurosciences, INSERM U838, Université de Grenoble, Grenoble, France
| | - Lieke Heil
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Mark Carpenter
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Bastiaan Roelof Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Ivan Toni
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, the Netherlands
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Müller MLTM, Albin RL, Kotagal V, Koeppe RA, Scott PJH, Frey KA, Bohnen NI. Thalamic cholinergic innervation and postural sensory integration function in Parkinson's disease. ACTA ACUST UNITED AC 2013; 136:3282-9. [PMID: 24056537 DOI: 10.1093/brain/awt247] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The pathophysiology of postural instability in Parkinson's disease remains poorly understood. Normal postural function depends in part on the ability of the postural control system to integrate visual, proprioceptive, and vestibular sensory information. Degeneration of cholinergic neurons in the brainstem pedunculopontine nucleus complex and their thalamic efferent terminals has been implicated in postural control deficits in Parkinson's disease. Our aim was to investigate the relationship of cholinergic terminal loss in thalamus and cortex, and nigrostriatal dopaminergic denervation, on postural sensory integration function in Parkinson's disease. We studied 124 subjects with Parkinson's disease (32 female/92 male; 65.5 ± 7.4 years old; 6.0 ± 4.2 years motor disease duration; modified Hoehn and Yahr mean stage 2.4 ± 0.5) and 25 control subjects (10 female/15 male, 66.8 ± 10.1 years old). All subjects underwent (11)C-dihydrotetrabenazine vesicular monoaminergic transporter type 2 and (11)C-methylpiperidin-4-yl propionate acetylcholinesterase positron emission tomography and the sensory organization test balance platform protocol. Measures of dopaminergic and cholinergic terminal integrity were obtained, i.e. striatal vesicular monoaminergic transporter type 2 binding (distribution volume ratio) and thalamic and cortical acetylcholinesterase hydrolysis rate per minute (k3), respectively. Total centre of pressure excursion (speed), a measure of total sway, and sway variability were determined for individual sensory organization test conditions. Based on normative data, principal component analysis was performed to reduce postural sensory organization functions to robust factors for regression analysis with the dopaminergic and cholinergic terminal data. Factor analysis demonstrated two factors with eigenvalues >2 that explained 52.2% of the variance, mainly reflecting postural sway during sensory organization test Conditions 1-3 and 5, respectively. Regression analysis of the Conditions 1-3 postural sway-related factor [R(2)adj = 0.123, F(5,109) = 4.2, P = 0.002] showed that decreased thalamic cholinergic innervation was associated with increased centre of pressure sway speed (β = -0.389, t = -3.4, P = 0.001) while controlling for covariate effects of cognitive capacity and parkinsonian motor impairments. There was no significant effect of cortical cholinergic terminal deficits or striatal dopaminergic terminal deficits. This effect could only be found for the subjects with Parkinson's disease. We conclude that postural sensory integration function of subjects with Parkinson's disease is modulated by pedunculopontine nucleus-thalamic but not cortical cholinergic innervation. Impaired integrity of pedunculopontine nucleus cholinergic neurons and their thalamic efferents play a role in postural control in patients with Parkinson's disease, possibly by participating in integration of multimodal sensory input information.
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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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García-Gomar MG, Concha L, Alcauter S, Abraham JS, Carrillo-Ruiz JD, Farfan GC, Campos FV. Probabilistic tractography of the posterior subthalamic area in Parkinson’s disease patients. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jbise.2013.63a048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sudhyadhom A, McGregor K, Okun MS, Foote KD, Trinastic J, Crosson B, Bova FJ. Delineation of motor and somatosensory thalamic subregions utilizing probabilistic diffusion tractography and electrophysiology. J Magn Reson Imaging 2012; 37:600-9. [PMID: 23060259 DOI: 10.1002/jmri.23861] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 09/05/2012] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To employ and compare probabilistic diffusion tractography (PDT) for the explicit localization of connections from the thalamus to somatosensory cortex (S1) and primary motor cortex (M1) / supplementary motor area (SMA) with microelectrode electrophysiology in patients undergoing deep brain stimulation (DBS) surgery. MATERIALS AND METHODS These tractography-derived connections were used to categorize voxels in the thalamus as corresponding to sensory or motor physiology. A novel model (referred to in this work as the "mixture" model) to delineate PDT-based thalamic functional subregions by thresholding fiber intensities, ie, connectivity-defined regions (CDR), was devised. Regions created using this classification method were compared with the most commonly used model (referred to in this work as the "separation" or "winner takes all" model) for defining CDRs. RESULTS Electrophysiology data corresponded better for S1 CDRs created using the mixture model for both sensory and motor cells. Separation model CDRs showed poor correspondence against electrophysiology, with few sensory cells corresponding to the S1 separation model CDR. CONCLUSION Mixture model-based CDRs may offer a significant improvement in delineation of functional subregions of subcortical structures.
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Affiliation(s)
- Atchar Sudhyadhom
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610-0265, USA.
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Vercruysse S, Spildooren J, Heremans E, Vandenbossche J, Wenderoth N, Swinnen SP, Vandenberghe W, Nieuwboer A. Abnormalities and Cue Dependence of Rhythmical Upper-Limb Movements in Parkinson Patients With Freezing of Gait. Neurorehabil Neural Repair 2012; 26:636-45. [DOI: 10.1177/1545968311431964] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Freezing of gait (FOG) is a significant clinical problem in Parkinson disease (PD). Similar freezing-like episodes occur during finger movements, but little is known about ongoing motor problems during repetitive hand movements. Objective. To investigate if the regulation of bimanual movements is impaired in those with FOG and if withdrawal of an auditory cue amplifies this problem. Methods. A total of 23 PD patients (11 with and 12 without FOG) and 11 controls (CTRLs) performed repetitive finger movements, either externally paced or following cue withdrawal. Movement frequency, amplitude, and coordination pattern were manipulated. The stability and accuracy of movement were evaluated after exclusion of freezing trials. Results. With auditory pacing present, movement performance was comparable between groups. Following cue withdrawal, motor control deteriorated in those with FOG, resulting in smaller and less stable amplitudes, hastened and more variable frequency, and decreased coordination stability. Conversely, the performance of those without FOG remained mostly similar to that of CTRLs. Conclusions. Compared with those without FOG, those with FOG show greater continuous dyscontrol of bimanual movements, similar to the continuous timing and scaling difficulties during locomotion. Those with FOG also benefit from auditory cueing during upper-limb movements, but these are highly cue dependent. This implies that internal timekeeping functions are more disturbed in those with FOG, who may require rehabilitation strategies for repetitive upper-extremity tasks that include cueing and imagery.
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Smith Y, Wichmann T, Factor SA, DeLong MR. Parkinson's disease therapeutics: new developments and challenges since the introduction of levodopa. Neuropsychopharmacology 2012; 37:213-46. [PMID: 21956442 PMCID: PMC3238085 DOI: 10.1038/npp.2011.212] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 12/13/2022]
Abstract
The demonstration that dopamine loss is the key pathological feature of Parkinson's disease (PD), and the subsequent introduction of levodopa have revolutionalized the field of PD therapeutics. This review will discuss the significant progress that has been made in the development of new pharmacological and surgical tools to treat PD motor symptoms since this major breakthrough in the 1960s. However, we will also highlight some of the challenges the field of PD therapeutics has been struggling with during the past decades. The lack of neuroprotective therapies and the limited treatment strategies for the nonmotor symptoms of the disease (ie, cognitive impairments, autonomic dysfunctions, psychiatric disorders, etc.) are among the most pressing issues to be addressed in the years to come. It appears that the combination of early PD nonmotor symptoms with imaging of the nigrostriatal dopaminergic system offers a promising path toward the identification of PD biomarkers, which, once characterized, will set the stage for efficient use of neuroprotective agents that could slow down and alter the course of the disease.
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Affiliation(s)
- Yoland Smith
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30322, USA.
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Youn J, Cho JW, Lee WY, Kim GM, Kim ST, Kim HT. Diffusion tensor imaging of freezing of gait in patients with white matter changes. Mov Disord 2011; 27:760-4. [PMID: 22162037 DOI: 10.1002/mds.24034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 09/19/2011] [Accepted: 10/23/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Freezing of gait is a common and disabling symptom of parkinsonism. However, the corresponding anatomic structures have yet to be clearly elucidated. METHODS We performed diffusion tensor imaging on 40 subjects with white matter changes. We compared apparent diffusion coefficient values and fraction anisotropy values of 7 candidate anatomic structures between 14 patients with freezing of gait (freezing of gait group) and 26 without freezing of gait (control group). RESULTS Fraction anisotropy values of the bilateral pedunculopontine nucleus, bilateral superior premotor cortex, right orbitofrontal area, and left supplement motor area were significantly lower in the freezing of gait group than in the control group. In contrast, there were no significant differences in apparent diffusion coefficient values between freezing of gait and control groups. CONCLUSIONS Our findings suggest that the bilateral pedunculopontine nucleus, bilateral superior premotor cortex, right orbitofrontal area, and left supplement motor area are closely related to freezing of gait.
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Affiliation(s)
- Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Tykocki T, Mandat T, Nauman P. Pedunculopontine nucleus deep brain stimulation in Parkinson's disease. Arch Med Sci 2011; 7:555-64. [PMID: 22291786 PMCID: PMC3258764 DOI: 10.5114/aoms.2011.24119] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 03/10/2011] [Accepted: 04/14/2011] [Indexed: 11/17/2022] Open
Abstract
Postural instability and gait difficulty (PIGD) are commonly observed in advanced Parkinson's disease. The neuronal mechanism of PIGD is not fully understood. Dysfunction of the pedunculopontine nucleus (PPN) might be a possible cause of these symptoms. The autopsy studies of subjects with PIGD revealed a neurodegenerative process involving mainly PPN cholinergic neurons. The PPN participates in the locomotion processes by initiation, modulation and execution of stereotyped patterns of movement. The standard neurosurgical treatment of PD is subthalamic deep brain stimulation (STN DBS). Clinical results revealed low efficiency of STN DBS on PIGD. Preliminary results of simultaneous PPN and STN DBS are very promising. Only a few reports have been published until now; a significant improvement of PIGD was observed in both ON and OFF L-dopa states.
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Affiliation(s)
- Tomasz Tykocki
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tomasz Mandat
- Department of Neurosurgery, Maria Skłodowska-Curie Memorial Oncology Centre, Warsaw, Poland
| | - Paweł Nauman
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
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Abstract
Parkinson's disease (PD) may involve sudden unintended arrests in gait or failure to initiate gait, known as gait freezing. Deep brain stimulation of the pedunculopontine nucleus (PPN) has been found to be an effective therapy for this phenomenon. In this study, we characterized the connectivity of the PPN freezing of gait (FOG) patients, compared with non-FOG PD and healthy controls using diffusion tensor imaging techniques. Differences in PPN connectivity profiles of the study groups were shown in the cerebellum and pons. The PPN showed connectivity with the cerebellum in controls and non-FOG PD. FOG patients showed absence of cerebellar connectivity, and increased visibility of the decussation of corticopontine fibres in the anterior pons. The findings suggest that corticopontine projections, which cross at the pons are increased in gait freezing, highlighting the importance and role of corticopontine-cerebellar pathways in the pathophysiology of this phenomenon.
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Yeo SS, Ahn SH, Choi BY, Chang CH, Lee J, Jang SH. Contribution of the Pedunculopontine Nucleus on Walking in Stroke Patients. Eur Neurol 2011; 65:332-7. [DOI: 10.1159/000324152] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 01/05/2011] [Indexed: 11/19/2022]
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Yeo SS, Kim SH, Ahn YH, Son SM, Jang SH. Anatomical location of the pedunculopontine nucleus in the human brain: diffusion tensor imaging study. Stereotact Funct Neurosurg 2011; 89:152-6. [PMID: 21494066 DOI: 10.1159/000324890] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 02/07/2011] [Indexed: 11/19/2022]
Abstract
We investigated the anatomical location of the pedunculopontine nucleus (PPN) in the human brain using diffusion tensor imaging. Forty normal healthy subjects were recruited. To confirm the boundary of the PPN, we analyzed the superior cerebellar peduncle and medial lemniscus using DTI-Studio software. We identified the PPN on red green blue (RGB) images, and defined four points of the PPN and four boundaries of the midbrain: point a - the most anterior point, point b - the most posterior point, point c - the most medial point, point d - the most lateral point; anterior boundary - the line of the most posterior point of the interpeduncular fossa, posterior boundary - the line of the upper part of the inferior colliculus, lateral boundary - the line of the most lateral point of the midbrain, medial boundary - the line of the midline of the midbrain. Points a and b were located at an average of 20.19 and 30.52% from the anterior boundary, respectively. By contrast, points c and d were located at an average of 22.50 and 41.65% from the medial boundary, respectively. We believe that the methodology and data of this study would be helpful in research and procedures on the PPN.
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Affiliation(s)
- Sang Seok Yeo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea
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Mazzone P, Sposato S, Insola A, Scarnati E. The deep brain stimulation of the pedunculopontine tegmental nucleus: towards a new stereotactic neurosurgery. J Neural Transm (Vienna) 2011; 118:1431-51. [DOI: 10.1007/s00702-011-0593-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
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The pedunculopontine nucleus as a target for deep brain stimulation. J Neural Transm (Vienna) 2010; 118:1461-8. [PMID: 21194002 DOI: 10.1007/s00702-010-0547-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
Abstract
The pedunculopontine nucleus (PPN) is a brain stem locomotive center that is also involved in the processing of sensory and behavioral information. The PPN has been recently proposed as a potential target for the treatment of axial symptoms in Parkinson's disease (PD). To date, results of the first series of PD patients treated with PPN deep brain stimulation (DBS) have shown promising results. In this article, we review some of the basic aspects of the PPN as a target and the outcome of the recently published clinical trials.
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Massey L, Yousry T. Anatomy of the Substantia Nigra and Subthalamic Nucleus on MR Imaging. Neuroimaging Clin N Am 2010; 20:7-27. [DOI: 10.1016/j.nic.2009.10.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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