Pedunculopontine and subthalamic nucleus stimulation's effect on saccades in Parkinson's disease.

Pedunculopontine and subthalamic nucleus stimulation's effect on saccades in Parkinson's disease.

World Neurosurg. 2019 Feb 21;:

Authors: Khan AN, Bronstein A, Bain P, Pavese N, Nandi D

Abstract
BACKGROUND: Recently, deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) has been explored as a target to treat the axial motor symptoms of advanced Parkinson's disease (PD). In this paper, we consider the relative effects of bilateral STN (subthalamic nucleus) and PPN DBS on both initiation and inhibition of saccades in advanced PD.
METHODS: Five patients with advanced PD performed two different oculomotor tasks whilst OFF- stimulation, with bilateral STN-DBS, bilateral PPN-DBS and simultaneous bilateral STN & PPN DBS. The first task involved visually guided saccades and the second, antisaccades. Saccadic latency, accuracy and velocity were recorded for both the visually guided and antisaccade tasks, while prosaccades were measured for the antisaccade task alone. Patients with advanced PD without DBS, age-matched healthy subjects and young healthy subjects all acted as controls (twelve each).
RESULTS: Simultaneous bilateral STN and PPN DBS produced the greatest improvement in the mean latencies, velocities and accuracies for the visually guided saccades and antisaccades compared to OFF-DBS (p < 0.001). Interestingly, bilateral STN and PPN DBS caused a significant additional improvement compared to STN DBS alone by reducing the number of prosaccades (p<0.01).
CONCLUSIONS: We know that the frontal lobe is involved in saccadic inhibition during AS tasks. Hence, our novel finding of an improvement in the antisaccadic task suggests an ascending, frontally mediated effect of PPN DBS. This implies that there may be PPN to frontal lobe connections which may partly explain the benefits of PPN DBS in axial motor function.

PMID: 30797925 [PubMed - as supplied by publisher]

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