Pedunculopontine and Subthalamic Nucleus Stimulation Effect on Saccades in Parkinson Disease
Pedunculopontine and Subthalamic Nucleus Stimulation Effect on Saccades in Parkinson Disease
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DOI：
10.1016/j.wneu.2019.02.014
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发表时间：
2019-06-01
影响因子：
2
通讯作者：
Nandi, Dipankar
中科院分区：
文献类型：
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作者：
Khan, Amad Naseer;Bronstein, Adolfo;Nandi, Dipankar
背景：桥脚核（PPN）的深部脑刺激（DBS）已被探索作为治疗晚期帕金森病（PD）轴向运动症状的目标。本研究的目的是考虑双侧丘脑底核 (STN) 和 PPN DBS 对晚期 PD 眼跳的启动和抑制的相对影响。 方法：5 名晚期 PD 患者在刺激后执行 2 种不同的动眼神经任务，即双侧 STN DBS、双侧 PPN DBS 以及同时双侧 STN 和 PPN DBS。第一个任务涉及视觉引导眼跳，第二个任务涉及反眼跳（AS）。记录视觉引导扫视和 AS 任务的扫视潜伏期、准确性和速度，并单独测量 AS 任务的扫视延迟。对照受试者包括未接受 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 n = 12）。 结果：与关闭 DBS 相比，同时双侧 STN 和 PPN DBS 在视觉引导眼跳和 AS 的平均延迟、速度和准确性方面产生了最大的改善（P < 0.001）。与单独的 STN DBS 相比，双侧 STN 和 PPN DBS 通过减少眼跳数量产生了显着的额外改善 (P < 0.01)。 结论：众所周知，额叶参与 AS 任务期间的眼跳抑制。因此，我们关于 AS 任务改善的新发现表明 PPN DBS 具有上升的、额部介导的作用。这意味着可能存在 PPN 与额叶的连接，这可以部分解释 PPN DBS 在轴向运动功能中的好处。
BACKGROUND: 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.METHODS: 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).RESULTS: 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).CONCLUSIONS: 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.