Implantation of human pedunculopontine nucleus: A safe and clinically relevant target in Parkinson's disease

Paolo Mazzone, Andres Lozano, Paolo Stanzione, Salvatore Galati, Eugenio Scarnati, Antonella Peppe, Alessandro Stefani

Research output: Contribution to journalArticlepeer-review

Abstract

The peduncolopontine nucleus modulates locomotor activity and dysfunction in this nucleus may be responsible for the gait and postural impairments seen in Parkinson's disease and other movement disorders. We report the first surgical exploration and implantation of deep brain stimulating electrodes of the peduncolopontine nucleus area in two Parkinson's disease patients to examine the safety and the potential benefit of chronic electrical stimulation at this site. Under local anesthesia, the peduncolopontine nucleus was approached from a coronal burr hole using a trajectory that was 78-80° and 62-64° on the coronal and sagittal planes. Microrecordings helped to identify neurons in peduncolopontine nucleus and the adjacent substantia nigra pars reticulata. Chronic deep brain stimulating electrodes were implanted within the peduncolopontine nucleus in a manner similar to that practiced with deep brain stimulating surgery at other targets. Peduncolopontine nucleus neurons were characterized by small and broad multiunits (230 μV, 2.5 ms, 14.6 Hz). Caudal to this area, neurons firing at higher frequency, approximately 70 Hz, characteristic of nigral neuronal discharges, were encountered, followed by 2 mm of cells similar to those recorded in the dorsal peduncolopontine nucleus area. After deep brain stimulating electrodes implantation, acute intraoperative stimulation (up to 3 V) was performed with two stimulation frequencies in each session. Stimulation at 80 Hz has little discernable effect. On the other hand, stimulation at 10 Hz fostered a subjective feeling of 'well-being' and a time-locked amelioration of the clinical scores. These findings demonstrate that the stereotactic approach of peduncolopontine nucleus is safe. The target may reliably be identified by microrecordings. Low-frequency stimulation may produce acute improvements in motor function.

Original languageEnglish
Pages (from-to)1877-1881
Number of pages5
JournalNeuroReport
Volume16
Issue number17
DOIs
Publication statusPublished - Nov 28 2005

Keywords

  • Deep brain stimulation
  • Intraoperatory microrecordings
  • Parkinson's disease
  • Peduncolopontine nucleus
  • Subthalamic nucleus

ASJC Scopus subject areas

  • Neuroscience(all)

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