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VOLUME 35, ISSUE 12

DEEP BRAIN STIMULATION OF PEDUNCULOPONTINE TEGMENTAL NUCLEUS IN ADVANCED PD
Deep Brain Stimulation of Pedunculopontine Tegmental Nucleus: Role in Sleep Modulation in Advanced Parkinson Disease Patients—One-Year Follow-Up

http://dx.doi.org/10.5665/sleep.2234

Antonella Peppe, PhD1; Mariangela Pierantozzi, PhD1,2; Valentina Baiamonte, MD1; Vincenzo Moschella, MD2; Carlo Caltagirone, MD1,2; Paolo Stanzione, MD2; Alessandro Stefani, MD1,2

1I.R.C.C.S. Fondazione Santa Lucia, Rome, Italy; 2Department of Neuroscience “Tor Vergata” University, Rome, Italy



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Study Objective:

Sleep disorders are frequent non-motor symptoms in Parkinson disease (PD), probably due to multifactorial pathogeneses including disease progression, dopaminergic drugs, or concomitant illness. In recent years, the pedunculopontine tegmental (PPTg) nucleus has been considered a surgical target for deep brain stimulation (DBS) in advanced PD patients. As it is involved in controlling the sleep-wake cycle, we investigated the long-lasting effects of PPTg-DBS on the sleep of five PD patients implanted in both the PPTg and the subthalamic nucleus (STN) by rating two subjective clinical scales for sleep: the Parkinson's Disease Sleep Scale (PDSS), and the Epworth Sleepiness Scale (ESS).

Study Design:

Sleep scales were administered a week before surgery (T0), three months after DBS (T1), and one year later (T2). In this study, STN-DBS was kept constantly in ON, and three different patterns of PPTg-DBS were investigated: STN-ON (PPTg switched off); PPTg-ON (PPTg stimulated 24 h/day); PPTg-cycle (PPTg stimulated only at night).

Results:

In post-surgery follow-up, PD patients reported a marked improvement of sleep quality in all DBS conditions. In particular, stimulation of the PPTg nucleus produced not only a remarkable long-term improvement of nighttime sleep, but unlike STN-DBS, also produced significant amelioration of daytime sleepiness.

Conclusion:

Our study suggests that PPTg-DBS plays an important role in reorganizing regular sleep in PD patients.

Citation:

Peppe A; Pierantozzi M; Baiamonte V; Moschella V; Caltagirone C; Stanzione P; Stefani A. Deep brain stimulation of pedunculopontine tegmental nucleus: role in sleep modulation in advanced Parkinson disease patients—one-year follow-up. SLEEP 2012;35(12):1637-1642.

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