Deep brain stimulation of locomotor region can help Parkinson's sufferers

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.

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