Deep brain stimulation of locomotor region can help Parkinson's
21 November 2005
London, UK. The part of the brain that plays an important role in the
initiation and maintenance of walking behaviour can be safely stimulated to
improve postural stability and gait, according to a recent NeuroReport
article published by Lippincott Williams & Wilkins.
The pedunculopontine nucleus (PPN) — an integral component of the
midbrain locomotor region that plays an important role in the initiation and
maintenance of walking behaviour — can be identified and targeted
safely without major surgical risks, according to the report:
Implantation of human pedunculopontine nucleus: a safe and clinically
relevant target in Parkinson's disease.
Additionally, low frequency (20-25Hz) stimulation of this nucleus in
humans improves postural stability and gait disturbance including
"on-medication" freezing — symptoms experienced by sufferers of Parkinson's
disease in the advanced stages, reports a second NeuroReport paper published
in the same issue; Bilateral deep brain stimulation of the pedunculopontine
nucleus for Parkinson's disease.
These studies from the Dipartimento Neuroscienze, Università di Roma Tor
Vergata/IRCCS Fondazione S. Lucia, Rome, Italy and the Institute of
Neurosciences, Frenchay Hospital, Bristol, UK respectively, represent a
landmark in the treatment of Parkinson's disease.
"This research provides the first hope of alleviating the symptoms of
those Parkinsonian patients for whom currently there is no effective
treatment, even by brain stimulation — a source of great frustration
for clinicians, carers and utterly disabling for patients," say Ned
Jenkinson and Tipu Aziz, University Laboratory of Physiology, Oxford
University and Department of Neurosurgery, Radcliffe Infirmary, Oxford, UK,
where the basic research behind the current findings was carried out.
Jenkinson and Aziz continue, "In theory, even patients with multiple system
atrophy or progressive supranuclear palsy could benefit - in fact any
patient with intractable locomotive and postural akinesia."
These initial results in this area of research are encouraging. The
follow-up work of Dr. Mazzone's research team in Rome goes on to suggest
that the combined stimulation of the traditionally implanted subthalamic
nucleus plus PPN is more valuable than PPN stimulation alone. As the debate
continues, further research across larger populations of patients will help
to establish to what extent PPN is an alternative or an additive target.