rCBF changes associated with PPN stimulation in a patient with Parkinson's disease: A PET study

Authors

  • Antonio P. Strafella MD, PhD,

    Corresponding author
    1. Movement Disorders Center, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
    2. PET Imaging Centre, Center of Addiction Mental Health, University of Toronto, Toronto, Ontario, Canada
    • Toronto Western Hospital and Research Institute, Movement Disorders Centre, University of Toronto, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada

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  • Andres M. Lozano MD, PhD,

    1. Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Benedicte Ballanger PhD,

    1. PET Imaging Centre, Center of Addiction Mental Health, University of Toronto, Toronto, Ontario, Canada
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  • Yu-Yan Poon RN,

    1. Movement Disorders Center, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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  • Anthony E. Lang MD,

    1. Movement Disorders Center, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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  • Elena Moro MD, PhD

    1. Movement Disorders Center, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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Abstract

Gait disturbances and akinesia are disabling symptoms in advanced Parkinson's disease (PD). The pedunculopontine nucleus (PPN) is involved in locomotion, control of posture, and behavioral states [i.e. wakefulness, rapid eye movement (REM) sleep]. Some reports have suggested that modulation of the activity of the PPN with deep brain stimulation (DBS) may be beneficial in the treatment of gait dysfunction and akinesia. To gain some insights on effects of PPN-DBS in the human brain, we used [15O] H2O positron emission tomography (PET) to measure changes in regional cerebral blood flow (rCBF) at rest during Off and On stimulation in an advanced PD patient with unilateral PPN-DBS. PPN-DBS increased rCBF in different subcortical areas most notably the thalamus, bilaterally. Double-blinded clinical evaluation revealed an improvement in motor function by ∼20%. The PET changes provide for the first time evidence in the human brain that PPN-DBS may be able to influence and modify rCBF of closely connected subcortical structures. Given the importance of the PPN in locomotion, control of posture, and behavioral states, DBS may have significant implication for more complicated forms of movement disorders where deterioration of gait, postural instability, and REM sleep behavior disorders are very disabling. © 2008 Movement Disorder Society

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