Imperial College Neuromodulation Group, Centre for Restorative Neuroscience, Division of Brain Sciences, Charing Cross Hospital Campus, London, United Kingdom.
Imperial College Neuromodulation Group, Centre for Restorative Neuroscience, Division of Brain Sciences, Charing Cross Hospital Campus, London, United Kingdom.
World Neurosurg. 2019 Jun;126:e219-e231. doi: 10.1016/j.wneu.2019.02.014. Epub 2019 Feb 22.
Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) has been explored as a target to treat axial motor symptoms of advanced Parkinson disease (PD). The aim of this study was to consider relative effects of bilateral subthalamic nucleus (STN) and PPN DBS on both initiation and inhibition of saccades in advanced PD.
Five patients with advanced PD performed 2 different oculomotor tasks off stimulation, with bilateral STN DBS, with bilateral PPN DBS, and with simultaneous bilateral STN and PPN DBS. The first task involved visually guided saccades, and the second task involved antisaccades (ASs). Saccadic latency, accuracy, and velocity were recorded for both the visually guided saccade and AS tasks, and prosaccades were measured for the AS task alone. Control subjects included patients with advanced PD without DBS, age-matched healthy subjects, and young healthy subjects (n = 12 in each group).
Simultaneous bilateral STN and PPN DBS produced the greatest improvement in mean latencies, velocities, and accuracies for visually guided saccades and ASs compared with DBS off (P < 0.001). Bilateral STN and PPN DBS caused a significant additional improvement compared with STN DBS alone by reducing the number of prosaccades (P < 0.01).
It is known that the frontal lobe is involved in saccadic inhibition during AS tasks. Hence, our novel finding of an improvement in the AS task suggests an ascending, frontally mediated effect of PPN DBS. This implies that there may be PPN-to-frontal lobe connections that may partly explain the benefits of PPN DBS in axial motor function.
深部脑刺激（DBS）的苍白球（PPN）已被探索作为一个目标，以治疗先进的帕金森病（PD）的轴向运动症状。本研究的目的是考虑双侧丘脑底核（STN）和 PPN DBS 对先进 PD 患者的扫视启动和抑制的相对影响。
5 例晚期 PD 患者在刺激下进行了 2 种不同的眼动任务，双侧 STN DBS，双侧 PPN DBS，以及双侧 STN 和 PPN DBS 同时进行。第一个任务涉及视觉引导的扫视，第二个任务涉及反扫视（AS）。记录了视觉引导扫视和 AS 任务的扫视潜伏期、准确性和速度，并单独测量了 AS 任务的前瞻性扫视。对照组包括无 DBS 的晚期 PD 患者、年龄匹配的健康受试者和年轻健康受试者（每组 12 名）。
与 DBS 关闭相比，双侧 STN 和 PPN DBS 同时刺激可显著改善视觉引导扫视和 AS 的平均潜伏期、速度和准确性（P < 0.001）。与单独的 STN DBS 相比，双侧 STN 和 PPN DBS 通过减少前瞻性扫视的数量（P < 0.01），显著改善了前瞻性扫视。
已知额叶参与反扫视任务中的扫视抑制。因此，我们发现 AS 任务得到改善，这表明 PPN DBS 具有上升的、额叶介导的效应。这意味着可能存在 PPN 到额叶的连接，这可能部分解释了 PPN DBS 在轴性运动功能中的益处。
