Targeting the pedunculopontine nucleus in Parkinson's disease: Time to go back to the drawing board

ALBIN, ROGER L.; SURMEIER, D. JAMES; TUBERT, CECILIA; SARTER, MARTIN; MÜLLER, MARTIJN L.T.M.; BOHNEN, NICOLAAS I.; DAUER, WILLIAM T.

MOVEMENT DISORDERS

WILEY-LISS, DIV JOHN WILEY & SONS INC

Año: 2018 vol. 33 p. 1871 - 1875

0885-3185

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.