7. 0T ultrahigh-field MRI directly visualized the pedunculopontine nucleus in Parkinson's disease patients

OBJECTIVES: The pedunculopontine nucleus (PPN) is considered a promising new target for neurostimulation in Parkinson's disease (PD) patients with postural instability and gait disturbance that is refractory to other treatment modalities. However, the PPN is typically difficult to visualize with magnetic resonance imaging (MRI) at clinical field strengths, which greatly limits the PPN as a viable surgical target for deep brain stimulation (DBS). Thus, the aim of this study is to directly visualize the PPN based on 7.0T ultrahigh-field MRI. METHODS: Five PD patients were enrolled and scanned using the MP2RAGE sequence on a 7.0T ultrahigh-field MRI scanner. Then, the MP2RAGE sequences were imported into a commercially available navigation system. The coordinates of the directly localized PPN poles were recorded in the navigation system relative to the anterior commissure-posterior commissure plane. RESULTS: Our results indicated that the PPN presented intermediate signal intensity in the 7.0T ultrahigh-field MR images in comparison with the surrounding structure, such as the hypo-intensity of the periaqueductal gray and the hyperintensity of the neighboring white matter tracts, in PD patients. The mean coordinates for the rostral and caudal poles of PPN were 6.50 mm and 7.20 mm lateral, 1.58 mm and 2.21 mm posterior, and 8.89 mm and 13.83 mm relative to the posterior commissure. CONCLUSION: Our findings provide, for the first time, direct visualization of the PPN using the MP2RAGE sequence on a 7.0T ultrahigh-field MRI, which may improve the accuracy of stereotactic targeting of the PPN and improve the outcomes in patients undergoing DBS.

Utilidad de la estimulación continua del núcleo pedunculopontino para el tratamiento de la enfermedad de Parkinson / Utility Continuous Stimulation of Pedunculopontine Nucleus for treating Parkinson's Disease

El núcleo pedunculopontmo contiene gran cantidad de conexiones que modulan la actividad motora en los humanos; por este motivo, se ha planteado que su estimulación profunda tendría beneficios significativos en el tratamiento de la enfermedad de Parkinson. Con una carga orgánica y social significativa, la enfermedad de Parkinson reúne una serie de signos y síntomas, principalmente motores, que afectan significativamente la calidad de vida de los pacientes que la padecen. Actualmente, se encuentran dentro de un área de investigación con gran potencial para dar manejo a los síntomas de esta enfermedad, y se desconoce si su estimulación cerebral profunda podría orientar futuras intervenciones con resultados óptimos. Por esta razón, la revisión busca esclarecer la utilidad de este procedimiento; sin embargo, es bastante controvertido y su evidencia escasa, además de que es difícil centrarse únicamente en un núcleo para resolver los problemas relacionados con dicha enfermedad.

The pendunculopontine nucleus contains many connections responsible or modulate motor activity. It has been suggested that deep stimulation would have significant benefits in the treatment of Parldnson's disease, intervention that could improve the patient5s quality of life and generare a positive impact in public health due Parkmson's disease has important organic and social burden. There is a growmg area of research in this fíeld, however is still uncertain if deep brain stimulation could guide future interventíons with optimal results. For this reason, we pretend to darify the existing knowledge of this procedure, nevertheless, it is quite controversial, we consider that it is difficult to focusing on a unique nucleus to solve the problems associated with this disease.

Deep Brain Stimulation of the Subthalamic and Pedunculopontine Nucleus in a Patient with Parkinson's Disease

Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) is a novel therapy developed to treat Parkinson's disease. We report a patient who underwent bilateral DBS of the PPN and subthalamic nucleus (STN). He suffered from freezing of gait (FOG), bradykinesia, rigidity and mild tremors. The patient underwent bilateral DBS of the PPN and STN. We compared the benefits of PPN-DBS and STN-DBS using motor and gait subscores. The PPN-DBS provided modest improvements in the gait disorder and freezing episodes, while the STN-DBS failed to improve the dominant problems. This special case suggests that PPN-DBS may have a unique role in ameliorating the locomotor symptoms and has the potential to provide improvement in FOG.

Núcleo pedúnculo pontino, y su relación con la fisiopatología de la enfermedad de Parkinson / Core pontine peduncle, and its relationship to the pathophysiology of Parkinson’s disease

El núcleo pedúnculopóntico (NPP) se encuentra localizado en el tegmento pontomesencefálico en su región dorsolateral.Este núcleo es un complejo de neuronas colinérgicas y nocolinérgicas que por su situación anatómica y sus numerosas conexiones con estructuras como los ganglios de la base, juega un papel importante en la produccióny la modulación del movimiento, aspecto que lo involucra en la fisiopatología de la Enfermedad de Parkinson.Estudios post-mortem en pacientes que padecieron enfermedad de Parkinson, mostraron una significativa degeneración del NPP. También se han explicado las manifestaciones clínicas de la Enfermedad del Parkinson, desde la disfunción del núcleo, y se ha propuesto la estimulación cerebral profunda del mismo como parte de la terapia de la Enfermedad de Parkinson. Este artículo de revisión, pretende explorar el papel fisiopatológico y funcional del NPP.

The pedunculopontine nucleus (PPN) is located in the dorsolateral region of the pontomesencephalic tegmentum.This nucleus is a neuronal complex; it has cholinergic and non-cholinergic neurons. Its situation and anatomical connections with many structures such as the basal ganglia give it an important role in the production and modulation of the movement. This nucleus can be implicated in the physiopathology of Parkinson’s disease (PD). Inpost mortem researches in human brains of patients suffering from Parkinson’s disease, a significant degeneration of the PPN was found. We have also explained the clinical manifestations of Parkinson’s disease, since dysfunction of the pedunculopontine nucleus, and we have analyzed the deep brain stimulation of the nucleus as part of the therapy of PD.

Effect of High-Frequency Stimulation in the Pedunculopontine Nucleus on Neuronal Activity and Neurotransmitters in the Globus Pallidus Internus of Rats / 天津医药

Objective To study the effect of high frequency stimulation (HFS) in pedunculopontine nucleus (PPN) on the neuronal activities of globus pallidus internus (Gpi) in Parkinson’s disease (PD) model rats, and the mechanisms there-of. Methods Seventy male Sprague-Dawley rats were divided into two groups, control group (n=30) and PD model group (n=40). PD rat model was established by the injection of 6-OHDA into substantia nigra pars compacta (SNc) on the right side of the brain with stereotactic technique. Electrophysiological recordings were made in anaesthetized rats to investigate the ef-fects of HFS-PPN on the firing rate of the GPi neurons. Brain microdialysis combined with high-performance liquid chroma-tography was applied to detect glutamate (Glu) andγ-aminobutyric acid (GABA) levels in GPi. Results HFS-PPN caused an excitatory reaction of the majority of neurons recorded in the GPi in PD model group and control group. The mean firing rate of GPi excited neurons was significantly increased (P﹤0.01). The levels of Glu were reduced under HFS-PPN and the levels of GABA were not affected (P>0.05).Conclusion HFS-PPN heightened the electrical activity of GPi neurons and re-duced the level of Glu. These excitatory effects were probably realized by PPN-GPi direct path or other indirect path.

El núcleo pedunuulopontino y su relación con la fisiopatología de la enfermedad de parkinson / The Pedunculopontine Nucleus and its Relationship to the Pathophysiology of Parkinson's Disease

Varias décadas de investigaciones neuropatológicas e imagenológicas han proporcionado suficientes evidencias acerca de las alteraciones en la neurotransmisión colinérgica que acompañan a la disfunción dopaminérgica en la enfermedad de Parkinson (EP). El núcleo pedunculopontino tegmental laterodorsal (NPP) representa una de las fuentes principales de proyecciones colinérgicas en el cerebro y a su vez es el origen de la única proyección colinérgica que recibe la substantia nigra pars compacta (SNpc). Actualmente el estudio de la participación del NPP en la fisiopatología de la EP toma en cuenta dos vertientes: el impacto de la pérdida temprana de la influencia excitatoria pontina sobre la SNpc asociado a la degeneración temprana del NPP y la estimulación a baja frecuencia del NPP como tratamiento quirúrgico beneficioso para los signos axiales de la EP. El NPP ha emergido como una estructura esencial en la comprensión de la fisiopatología de la EP dado sus relaciones con los núcleos de los ganglios basales, el tálamo, la corteza motora y la médula espinal. La degeneración de algunas de sus poblaciones neuronales en etapas presintomáticas de la EP ha sugerido una relación causa-efecto entre este hallazgo y la muerte de las células dopaminérgicas nigrales. Por otra parte la estimulación del NPP tiene resultados favorables sobre los trastornos posturales y de la marcha, los cuales se presentan en etapas tardías de la EP y son refractarios a otros tratamientos farmacológicos y quirúrgicos.

Several decades of neuropathologic and imagenologic investigations have provided sufficient evidences about alterations in cholinergic neurotransmission that go together with the dopaminergic dysfunction in Parkinson s disease (PD). The laterodorsal tegmental pedunculopontine nucleus (PPN) represents one of the main sources of cholinergic projections into the brain and at the same time the origin of the only cholinergic projection that substantia nigra pars compacta (SNpc) receives. At present, the study of the PPN participation as part of the physiopathology of PD has two notions: the impact of the lack of pontine excitatory influence on SNpc, associated to the early degeneration of PPN as well as the low frequency stimulation in the PPN as a beneficial surgical treatment for the axial symptoms of PD. PPN has emerged as an essential structure in the comprehension of PD physiopathology, given by its relation with the basal ganglia nuclei, thalamus, motor cortex and the spinal cord. The degeneration of some of its neuronal populations in PD pre symptomatic steps, has suggested a cause- and-effect relation on this finding and the death of nigral dopaminergic cells. On the other hand, PPN stimulation has favorable results on postural and gait disorders, which present themselves in late PD stages and are refractory to other pharmacological and surgical treatments.

Efecto de la adiinistración intracerebral de mk801 y (-) nicotina en las conceentraciones extracelulares de glu y gaba en el núcleo pedunculopontino de ratas / Effect of the Mk801 and (-) Nicotine Intracerebral Administration on Glu and Gaba Extracellular Concentration in the Pedunculopontine Nucleus from Rats

Aunque la manipulación farmacológica de los sistemas glutamatérgico y colinérgico se ha tratado en modelos experimentales de enfermedad de Parkinson (EP), pocos autores han realizado estudios de esta temática a nivel del núcleo pedunculopontino (NPP). El presente trabajo aborda los cambios en las concentraciones extracelulares (CE) de glutamato (Glu) y ácido δ-amino butírico (GABA) en el NPP de ratas hemiparkinsonizadas por inyección de 6-hidroxidopamina (6-OHDA) y sometidas a infusión local de MK-801 (10 µmol/L) o (-) nicotina (10 mM). La infusión se realizó mediante microdiálisis cerebral y la determinación de CE de neurotransmisores se realizó a través de cromatografía líquida de alta resolución acoplada a detección de fluorescencia. La infusión de MK-801 en el NPP produjo disminución significativa de CE de Glu (p< 0,01) y de GABA (p < 0,01) en ratas hemiparkinsonizadas y controles. La infusión de (-) nicotina mostró un incremento significativo de CE de Glu (p < 0,001) y GABA (p< 0,001) en el NPP de ratas hemiparkinsonizadas y controles. El bloqueo local de receptores NMDA por MK-801 facilita la interacción de Glu con sus receptores metabotrópicos que participan en mecanismos de inhibición presináptica y bloquean la liberación de neurotransmisores. Mientras que la infusión de nicotina en el NPP suma los efectos de activación de los receptores nicotínicos a los cambios conocidos en la neurotransmisión glutamatérgica y gabaérgica en el NPP en parkinsonismo. La infusión de fármacos glutamatérgicos y colinérgicos en el NPP, impone un reajuste a la neurotransmisión a este nivel que se añade a los cambios neuroquímicos asociados a denervación dopaminérgica.

Although the pharmacological manipulation of the glutamatergic and cholinergic systems have been studied in animal models of Parkinson´s disease (PD), only some authors have done work on this topic at the pedunculopontine nucleus (PPN). The present work studied the changes in glutamate (Glu) and δ-aminobutyric acid (GABA) extracellular concentrations (EC) in the PPN from hemiparkinsonian rats by 6hydroxydopamine injection. The rats were locally perfused by MK-801 (10 µmol/L) or (-) nicotine (10 mM) solutions by cerebral microdyalisis. The biochemical studies were carried out through high performance liquid chromatography coupled to fluorescence detection. MK-801 infusion induced a significant decrease of Glu (p< 0.01) and GABA (p< 0.01) EC in PPN. On the other hand (-) nicotine infusion induced a significant increase of Glu (p< 0.001) and GABA (p< 0.001) EC in PPN from hemiparkinsonian rats. The local blockade of NMDA receptors by MK-801 infusion facilitates the interaction between Glu and their metabotropic receptors that take part in presynaptic inhibition mechanisms and interfere with neurotransmitters release. Meanwhile, the nicotine infusion sums the effects of nicotinic receptor activation with the glutamatergic and gabaergic neurotransmission changes produced in the PPN in the parkinsonian condition. The cholinergic and glutamergic drug infusion in PPN impose a new adjustment to the neurotransmition at this level that is added to the neurochemical changes associated to dopaminergic denervation.

The altered expression of M_2 muscarinic receptor in the neurons of the pedunculopontine nucleus in 6-hydrodopamine unilaterally lesioned rats and its significance / 西安交通大学学报(医学版)

Objective To investigate the altered expression of muscarinic receptor 2 (M_2 receptor) in the pedunculopontine nucleus (PPN) of Parkinson's disease (PD) model rat by immunocytochemical technique and explore the role of M_2 receptor in etiopathogenesis and pathophysiological changes of PD. Methods Sixteen healthy SD rats were divided randomly into two groups. Rat monoclonal antibody against the M_2 receptor was used. Then we used positive cell counting and optical density as indicators to analyze the altered expression of M_2 receptor in PPN of PD model rats. Results The counting of M_2 receptor positive cells in the PPN was not obviously changed in normal rats and the unlesioned side of PD rats (P>0.05), whereas a significant decrease was observed when compared to that in normal rats and the lesioned side of PD rats, respectively (P<0.05). However, the positive intensity in the three groups did not differ significantly. Conclusion The results indicate that there was a degenerative death or receptor loss of M_2 receptor positive cells in the lesioned PPN of PD rats. The expression intensity of M_2 receptor positive cells without degenrative death or receptor loss was not affected. It was also found that the factor affecting the change of M_2 receptor positive cells in the PPN involved only one side.

The pedunculopontine nucleus: its role in the genesis of movement disorders

The pedunculopontine nucleus (PPN) is located in the dorso-lateral part of the ponto-mesencephalic tegmentum. The PPN is composed of two groups of neurons: one containing acetylcholine, and the other containing non-cholinergic neurotransmitters (GABA, glutamate). The PPN is connected reciprocally with the limbic system, the basal ganglia nuclei (globus pallidus, substantia nigra, subthalamic nucleus), and the brainstem reticular formation. The caudally directed corticolimbic-ventral striatal-ventral pallidal-PPN-pontomedullary reticular nuclei-spinal cord pathway seems to be involved in the initiation, acceleration, deceleration, and termination of locomotion. This pathway is under the control of the deep cerebellar and basal ganglia nuclei at the level of the PPN, particularly via potent inputs from the medial globus pallidus, substantia nigra pars reticulata and subthalamic nucleus. The PPN sends profuse ascending cholinergic efferent fibers to almost all the thalamic nuclei, to mediate phasic events in rapid-eye-movement sleep. Experimental evidence suggests that the PPN, along with other brain stem nuclei, is also involved in anti-nociception and startle reactions. In idiopathic Parkinson's disease (IPD) and parkinson plus syndrome, overactive pallidal and nigral inhibitory inputs to the PPN may cause sequential occurrences of PPN hypofunction, decreased excitatory PPN input to the substantia nigra, and aggravation of striatal dopamine deficiency. In addition, neuronal loss in the PPN itself may cause dopamine-r esistant parkinsonian deficits, including gait disorders, postural instability and sleep disturbances. In patients with IPD, such deficits may improve after posteroventral pallidotomy, but not after thalamotomy. One of the possible explanations for such differences is that dopamine-resistant parkinsonian deficits are mediated to the PPN by the descending pallido-PPN inhibitory fibers, which leave the pallido-thalamic pathways before they reach the thalamic targets.