Deep Brain Stimulation of the Pedunculopontine Nucleus Area in Parkinson Disease MRI-Based Anatomoclinical Correlations and Optimal Target

Laurent Goetz 1, 2 Manik Bhattacharjee 1 Murielle U. Ferraye 1 Valerie Fraix 1, 3 Carina Maineri 3, 4 Daniela Nosko 1, 5 Albert J. Fenoy 3, 6 Brigitte Piallat 1 Napoleon Torres 3, 7 Alexandre Krainik 1, 3 Eric Seigneuret 1, 3 Olivier David 1 Martin Parent 2 Andre Parent 2 Pierre Pollak 1, 8 Alim-Louis Benabid 8, 7 Bettina Debu 1 Stephan Chabardes 1, 8, 7
1 GIN - Grenoble Institut des Neurosciences
2 Laval University [Québec]
3 CHU Grenoble
4 Italian Hospital of Buenos Aires
5 Örebro University Hospital [Örebro, Sweden]
6 UTHealth - The University of Texas Health Science Center at Houston
7 CEA-LETI - Laboratoire d'Electronique et des Technologies de l'Information
8 CHU Grenoble
Abstract : BACKGROUND Experimental studies led to testing of deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) as a new therapy to treat freezing of gait (FOG) in Parkinson disease (PD). Despite promising initial results fueling a growing interest toward that approach, several clinical studies reported heterogeneity in patient responses. Variation in the position of electrode contacts within the rostral brainstem likely contributes to such heterogeneity. OBJECTIVE To provide anatomoclinical correlations of the effect of DBS of the caudal mesencephalic reticular formation (cMRF) including the PPN to treat FOG by comparing the normalized positions of the active contacts among a series of 11 patients at 1- and 2-yr follow-up and to provide an optimal target through an open-label study. METHODS We defined a brainstem normalized coordinate system in relation to the pontomesencephalic junction. Clinical evaluations were based on a composite score using objective motor measurements and questionnaires allowing classification of patients as "bad responders" (2 patients), "mild responders" (1 patient) and "good responders" (6 patients). Two patients, whose long-term evaluation could not be completed, were excluded from the analysis. RESULTS Most effective DBS electrode contacts to treat FOG in PD patients were located in the posterior part of the cMRF (encompassing the posterior PPN and cuneiform nucleus) at the level of the pontomesencephalic junction. CONCLUSION In the present exploratory study, we performed an anatomoclinical analysis using a new coordinate system adapted to the brainstem in 9 patients who underwent PPN area DBS. We propose an optimal DBS target that allows a safe and efficient electrode implantation in the cMRF.
Keywords : Pedunculopontine nucleus Deep brain stimulation Parkinson disease Freezing of gait Cuneiform nucleus Mesencephalic reticular formation Mesencephalic locomotor region
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Journal articles
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https://hal-cea.archives-ouvertes.fr/cea-02186436
Contributor : Marianne Leriche <>
Submitted on : Wednesday, July 17, 2019 - 12:20:57 PM
Last modification on : Thursday, August 22, 2019 - 4:26:01 PM

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Laurent Goetz, Manik Bhattacharjee, Murielle U. Ferraye, Valerie Fraix, Carina Maineri, et al.. Deep Brain Stimulation of the Pedunculopontine Nucleus Area in Parkinson Disease MRI-Based Anatomoclinical Correlations and Optimal Target. Neurosurgery, Lippincott, Williams & Wilkins, 2019, 84 (2), pp.506-517. ⟨10.1093/neuros/nyy151⟩. ⟨cea-02186436⟩

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