Targeting the pedunculopontine nucleus in Parkinson's disease: Time to go back to the drawing board.
Targeting the pedunculopontine nucleus in Parkinson's disease: Time to go back to the drawing board.
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DOI：
10.1002/mds.27540
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发表时间：
2018-12
期刊：
影响因子：
--
通讯作者：
Dauer WT
中科院分区：
文献类型：
--
作者：
Albin RL;Surmeier DJ;Tubert C;Sarter M;Müller MLTM;Bohnen NI;Dauer WT
丘脑底核或苍白球脑深部电刺激（DBS）是治疗帕金森病（PD）患者的有效方法。丘脑底核（DBS）或苍白球DBS的有效性在逻辑上导致了在其他大脑区域使用DBS来治疗缺乏足够医学治疗的PD方面的努力。步态和平衡缺陷对多巴胺替代疗法无反应是更晚期PD患者的主要问题。这些问题缺乏令人满意的医学治疗，导致人类临床实验在脚桥核（PPN）区域部署DBS，目的是减轻致残性步态和平衡问题。基本原理是PPN中的低频DBS会增加PPN神经元的关键组的活性。最近审查了PPN DBS的临床经验1。在本观点中，我们讨论了PPN DBS的科学原理，并认为我们目前对PPN、周围区域及其在运动中的潜在作用的理解并不能为PD中的传统PPN DBS提供良好的科学原理。
Subthalamic or pallidal Deep Brain Stimulation (DBS) are effective treatments for selected Parkinson disease (PD) patients. The effectiveness of subthalamic nucleus (STN) or pallidal DBS led logically to efforts to employ DBS in other brain regions to treat aspects of PD lacking adequate medical treatments. Gait and balance deficits unresponsive to dopamine replacement therapy are major problems in more advanced PD patients. The absence of satisfactory medical treatments for these problems led to human clinical experiments deploying DBS in the region of the pedunculopontine nucleus (PPN) with the goal of alleviating crippling gait and balance problems. The fundamental rationale was that low frequency DBS in the PPN would increase the activity of a critical group of PPN neurons. The clinical experience with PPN DBS was reviewed recently1. In this Viewpoint, we discuss the scientific rationale for PPN DBS and argue that our present understanding of the PPN, surrounding regions, and their potential roles in locomotion does not provide a good scientific rationale for conventional PPN DBS in PD.
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