Cerebral blood flow changes induced by pedunculopontine nucleus stimulation in patients with advanced Parkinson's disease: A [15O] H2O PET study
Identifieur interne : 002035 ( Main/Curation ); précédent : 002034; suivant : 002036Cerebral blood flow changes induced by pedunculopontine nucleus stimulation in patients with advanced Parkinson's disease: A [15O] H2O PET study
Auteurs : Benedicte Ballanger [Canada] ; Andres M. Lozano [Canada] ; Elena Moro [Canada] ; Thilo Van Eimeren [Canada] ; Clement Hamani [Canada] ; Robert Chen [Canada] ; Roberto Cilia [Canada] ; Sylvain Houle [Canada] ; Yu Yan Poon [Canada] ; Anthony E. Lang [Canada] ; Antonio P. Strafella [Canada]Source :
- Human Brain Mapping [ 1065-9471 ] ; 2009-12.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
- KwdEn :
- Advanced stage, Aged, Blood flow, Brain Mapping, Cerebrovascular Circulation (physiology), Deep Brain Stimulation (methods), Deep brain stimulation, Electrodes, Implanted, Emission tomography, Encephalon, Human, Humans, Image Interpretation, Computer-Assisted, Locomotion, Male, Midbrain, Motor Skills (physiology), Nervous system diseases, Oxygen Radioisotopes, Parkinson Disease (diagnostic imaging), Parkinson Disease (physiopathology), Parkinson Disease (therapy), Parkinson disease, Parkinsonism, Pedunculopontine Tegmental Nucleus (blood supply), Pedunculopontine Tegmental Nucleus (diagnostic imaging), Pedunculopontine Tegmental Nucleus (physiopathology), Pedunculopontine nucleus, Positron emission tomography, Positron-Emission Tomography, Radiodiagnosis, Radiopharmaceuticals, deep brain stimulation, imaging, locomotion, midbrain.
- MESH :
- chemical : Oxygen Radioisotopes, Radiopharmaceuticals.
- blood supply : Pedunculopontine Tegmental Nucleus.
- diagnostic imaging : Parkinson Disease, Pedunculopontine Tegmental Nucleus.
- methods : Deep Brain Stimulation.
- physiology : Cerebrovascular Circulation, Motor Skills.
- physiopathology : Parkinson Disease, Pedunculopontine Tegmental Nucleus.
- therapy : Parkinson Disease.
- Aged, Brain Mapping, Electrodes, Implanted, Humans, Image Interpretation, Computer-Assisted, Male, Positron-Emission Tomography.
Abstract
Patients with advanced Parkinson's disease (PD) develop disabling axial symptoms, including gait disturbances, freezing and postural instability poorly responsive to levodopa replacement therapy. The pedunculopontine nucleus (PPN) is involved in locomotion, control of posture, and behavioral states [i.e. wakefulness, rapid eye movement sleep]. Recent reports suggested that PPN modulation with deep brain stimulation (DBS) may be beneficial in the treatment of axial symptoms. However, the mechanisms underlying these effects are still unknown. We used [15O] H2O PET to investigate regional cerebral blood flow in three patients with advanced PD who underwent a new experimental surgical procedure with implantation of unilateral PPN‐DBS. Patients were studied Off‐medication with stimulator Off and On, both at rest and during a self‐paced alternating motor task of the lower limbs. We used SPM2 for imaging data analysis, threshold P < 0.05 corrected at the cluster level. Stimulation induced significant regional cerebral blood flow increment in subcortical regions such as the thalamus (P < 0.006), cerebellum (P < 0.001), and midbrain region (P < 0.001) as well as different cortical areas involving medial sensorimotor cortex extending into caudal supplementary motor area (BA 4/6; P < 0.001). PPN‐DBS in advanced PD resulted in blood flow and presumably neuronal activity changes in subcortical and cortical areas involved in balance and motor control, including the mesencephalic locomotor region (e.g. PPN) and closely interconnected structures within the cerebello‐(rubro)‐thalamo‐cortical circuit. Whether these findings are associated with the DBS‐PPN clinical effect remains to be proven. However, they suggest that PPN modulation may induce functional changes in neural networks associated with the control of lower limb movements. Hum Brain Mapp, 2009. © 2009 Wiley‐Liss, Inc.
Url:
DOI: 10.1002/hbm.20815
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<term>Aged</term>
<term>Blood flow</term>
<term>Brain Mapping</term>
<term>Cerebrovascular Circulation (physiology)</term>
<term>Deep Brain Stimulation (methods)</term>
<term>Deep brain stimulation</term>
<term>Electrodes, Implanted</term>
<term>Emission tomography</term>
<term>Encephalon</term>
<term>Human</term>
<term>Humans</term>
<term>Image Interpretation, Computer-Assisted</term>
<term>Locomotion</term>
<term>Male</term>
<term>Midbrain</term>
<term>Motor Skills (physiology)</term>
<term>Nervous system diseases</term>
<term>Oxygen Radioisotopes</term>
<term>Parkinson Disease (diagnostic imaging)</term>
<term>Parkinson Disease (physiopathology)</term>
<term>Parkinson Disease (therapy)</term>
<term>Parkinson disease</term>
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<term>Pedunculopontine Tegmental Nucleus (blood supply)</term>
<term>Pedunculopontine Tegmental Nucleus (diagnostic imaging)</term>
<term>Pedunculopontine Tegmental Nucleus (physiopathology)</term>
<term>Pedunculopontine nucleus</term>
<term>Positron emission tomography</term>
<term>Positron-Emission Tomography</term>
<term>Radiodiagnosis</term>
<term>Radiopharmaceuticals</term>
<term>deep brain stimulation</term>
<term>imaging</term>
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</keywords>
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<term>Motor Skills</term>
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<term>Brain Mapping</term>
<term>Electrodes, Implanted</term>
<term>Humans</term>
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<term>Parkinsonisme</term>
<term>Pathologie du système nerveux</term>
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<term>Stade avancé</term>
<term>Stimulation cérébrale profonde</term>
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<front><div type="abstract" xml:lang="en">Patients with advanced Parkinson's disease (PD) develop disabling axial symptoms, including gait disturbances, freezing and postural instability poorly responsive to levodopa replacement therapy. The pedunculopontine nucleus (PPN) is involved in locomotion, control of posture, and behavioral states [i.e. wakefulness, rapid eye movement sleep]. Recent reports suggested that PPN modulation with deep brain stimulation (DBS) may be beneficial in the treatment of axial symptoms. However, the mechanisms underlying these effects are still unknown. We used [15O] H2O PET to investigate regional cerebral blood flow in three patients with advanced PD who underwent a new experimental surgical procedure with implantation of unilateral PPN‐DBS. Patients were studied Off‐medication with stimulator Off and On, both at rest and during a self‐paced alternating motor task of the lower limbs. We used SPM2 for imaging data analysis, threshold P < 0.05 corrected at the cluster level. Stimulation induced significant regional cerebral blood flow increment in subcortical regions such as the thalamus (P < 0.006), cerebellum (P < 0.001), and midbrain region (P < 0.001) as well as different cortical areas involving medial sensorimotor cortex extending into caudal supplementary motor area (BA 4/6; P < 0.001). PPN‐DBS in advanced PD resulted in blood flow and presumably neuronal activity changes in subcortical and cortical areas involved in balance and motor control, including the mesencephalic locomotor region (e.g. PPN) and closely interconnected structures within the cerebello‐(rubro)‐thalamo‐cortical circuit. Whether these findings are associated with the DBS‐PPN clinical effect remains to be proven. However, they suggest that PPN modulation may induce functional changes in neural networks associated with the control of lower limb movements. Hum Brain Mapp, 2009. © 2009 Wiley‐Liss, Inc.</div>
</front>
</TEI>
<double idat="1065-9471:2009:Ballanger B:cerebral:blood:flow"><INIST><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Cerebral Blood Flow Changes Induced by Pedunculopontine Nucleus Stimulation in Patients With Advanced Parkinson's Disease: A [<sup>15</sup>
O] H<sub>2</sub>
O PET Study</title>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Cerebral Blood Flow Changes Induced by Pedunculopontine Nucleus Stimulation in Patients With Advanced Parkinson's Disease: A [<sup>15</sup>
O] H<sub>2</sub>
O PET Study</title>
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<author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name>
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<series><title level="j" type="main">Human brain mapping</title>
<title level="j" type="abbreviated">Hum. brain mapp.</title>
<idno type="ISSN">1065-9471</idno>
<imprint><date when="2009">2009</date>
</imprint>
</series>
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</sourceDesc>
<seriesStmt><title level="j" type="main">Human brain mapping</title>
<title level="j" type="abbreviated">Hum. brain mapp.</title>
<idno type="ISSN">1065-9471</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Advanced stage</term>
<term>Blood flow</term>
<term>Deep brain stimulation</term>
<term>Emission tomography</term>
<term>Encephalon</term>
<term>Human</term>
<term>Locomotion</term>
<term>Midbrain</term>
<term>Nervous system diseases</term>
<term>Parkinson disease</term>
<term>Parkinsonism</term>
<term>Pedunculopontine nucleus</term>
<term>Positron emission tomography</term>
<term>Radiodiagnosis</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Maladie de Parkinson</term>
<term>Parkinsonisme</term>
<term>Pathologie du système nerveux</term>
<term>Encéphale</term>
<term>Débit sanguin</term>
<term>Homme</term>
<term>Stade avancé</term>
<term>Tomoscintigraphie</term>
<term>Tomographie par émission de positons</term>
<term>Mésencéphale</term>
<term>Locomotion</term>
<term>Radiodiagnostic</term>
<term>Noyau pédonculopontin</term>
<term>Stimulation cérébrale profonde</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term>
</keywords>
</textClass>
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<front><div type="abstract" xml:lang="en">Patients with advanced Parkinson's disease (PD) develop disabling axial symptoms, including gait disturbances, freezing and postural instability poorly responsive to levodopa replacement therapy. The pedunculopontine nucleus (PPN) is involved in locomotion, control of posture, and behavioral states [i.e. wakefulness, rapid eye movement sleep]. Recent reports suggested that PPN modulation with deep brain stimulation (DBS) may be beneficial in the treatment of axial symptoms. However, the mechanisms underlying these effects are still unknown. We used [<sup>15</sup>
O] H<sub>2</sub>
O PET to investigate regional cerebral blood flow in three patients with advanced PD who underwent a new experimental surgical procedure with implantation of unilateral PPN-DBS. Patients were studied Off-medication with stimulator Off and On, both at rest and during a self-paced alternating motor task of the lower limbs. We used SPM2 for imaging data analysis, threshold P < 0.05 corrected at the cluster level. Stimulation induced significant regional cerebral blood flow increment in subcortical regions such as the thalamus (P < 0.006), cerebellum (P < 0.001), and midbrain region (P < 0.001) as well as different cortical areas involving medial sensorimotor cortex extending into caudal supplementary motor area (BA 4/6; P < 0.001). PPN-DBS in advanced PD resulted in blood flow and presumably neuronal activity changes in subcortical and cortical areas involved in balance and motor control, including the mesencephalic locomotor region (e.g. PPN) and closely interconnected structures within the cerebello-(rubro)-thalamo-cortical circuit. Whether these findings are associated with the DBS-PPN clinical effect remains to be proven. However, they suggest that PPN modulation may induce functional changes in neural networks associated with the control of lower limb movements.</div>
</front>
</TEI>
</INIST>
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<author><name sortKey="Ballanger, Benedicte" sort="Ballanger, Benedicte" uniqKey="Ballanger B" first="Benedicte" last="Ballanger">Benedicte Ballanger</name>
</author>
<author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name>
</author>
<author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name>
</author>
<author><name sortKey="Van Eimeren, Thilo" sort="Van Eimeren, Thilo" uniqKey="Van Eimeren T" first="Thilo" last="Van Eimeren">Thilo Van Eimeren</name>
</author>
<author><name sortKey="Hamani, Clement" sort="Hamani, Clement" uniqKey="Hamani C" first="Clement" last="Hamani">Clement Hamani</name>
</author>
<author><name sortKey="Chen, Robert" sort="Chen, Robert" uniqKey="Chen R" first="Robert" last="Chen">Robert Chen</name>
</author>
<author><name sortKey="Cilia, Roberto" sort="Cilia, Roberto" uniqKey="Cilia R" first="Roberto" last="Cilia">Roberto Cilia</name>
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<author><name sortKey="Houle, Sylvain" sort="Houle, Sylvain" uniqKey="Houle S" first="Sylvain" last="Houle">Sylvain Houle</name>
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<author><name sortKey="Poon, Yu Yan" sort="Poon, Yu Yan" uniqKey="Poon Y" first="Yu Yan" last="Poon">Yu Yan Poon</name>
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<author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. Lang</name>
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<author><name sortKey="Strafella, Antonio P" sort="Strafella, Antonio P" uniqKey="Strafella A" first="Antonio P." last="Strafella">Antonio P. Strafella</name>
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<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
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<author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name>
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<orgName type="university">Université de Toronto</orgName>
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<orgName type="university">Université de Toronto</orgName>
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</affiliation>
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<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
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</placeName>
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<author><name sortKey="Hamani, Clement" sort="Hamani, Clement" uniqKey="Hamani C" first="Clement" last="Hamani">Clement Hamani</name>
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<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
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</placeName>
</affiliation>
<affiliation wicri:level="4"><country xml:lang="fr">Canada</country>
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<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Chen, Robert" sort="Chen, Robert" uniqKey="Chen R" first="Robert" last="Chen">Robert Chen</name>
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<wicri:regionArea>Toronto Western Research Institute (Division of Brain, Imaging and Behaviour ‐ Systems Neuroscience, BIB‐SN), UHN, University of Toronto, Toronto, Ontario</wicri:regionArea>
<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
<affiliation wicri:level="4"><country xml:lang="fr">Canada</country>
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<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
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<author><name sortKey="Cilia, Roberto" sort="Cilia, Roberto" uniqKey="Cilia R" first="Roberto" last="Cilia">Roberto Cilia</name>
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<wicri:regionArea>Toronto Western Research Institute (Division of Brain, Imaging and Behaviour ‐ Systems Neuroscience, BIB‐SN), UHN, University of Toronto, Toronto, Ontario</wicri:regionArea>
<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
<affiliation wicri:level="4"><country xml:lang="fr">Canada</country>
<wicri:regionArea>PET Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario</wicri:regionArea>
<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Houle, Sylvain" sort="Houle, Sylvain" uniqKey="Houle S" first="Sylvain" last="Houle">Sylvain Houle</name>
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<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
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<author><name sortKey="Poon, Yu Yan" sort="Poon, Yu Yan" uniqKey="Poon Y" first="Yu Yan" last="Poon">Yu Yan Poon</name>
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<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. Lang</name>
<affiliation wicri:level="4"><country xml:lang="fr">Canada</country>
<wicri:regionArea>Toronto Western Research Institute (Division of Brain, Imaging and Behaviour ‐ Systems Neuroscience, BIB‐SN), UHN, University of Toronto, Toronto, Ontario</wicri:regionArea>
<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
<affiliation wicri:level="4"><country xml:lang="fr">Canada</country>
<wicri:regionArea>Movement Disorders Center, Toronto Western Hospital, UHN, University of Toronto, Toronto, Ontario</wicri:regionArea>
<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Strafella, Antonio P" sort="Strafella, Antonio P" uniqKey="Strafella A" first="Antonio P." last="Strafella">Antonio P. Strafella</name>
<affiliation wicri:level="4"><country xml:lang="fr">Canada</country>
<wicri:regionArea>Toronto Western Research Institute (Division of Brain, Imaging and Behaviour ‐ Systems Neuroscience, BIB‐SN), UHN, University of Toronto, Toronto, Ontario</wicri:regionArea>
<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
<affiliation wicri:level="4"><country xml:lang="fr">Canada</country>
<wicri:regionArea>PET Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario</wicri:regionArea>
<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
<affiliation wicri:level="4"><country xml:lang="fr">Canada</country>
<wicri:regionArea>Movement Disorders Center, Toronto Western Hospital, UHN, University of Toronto, Toronto, Ontario</wicri:regionArea>
<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
<affiliation wicri:level="4"><country xml:lang="fr">Canada</country>
<wicri:regionArea>Toronto Western Hospital and Institute, UHN, CAMH‐PET Imaging Centre, University of Toronto, Toronto, ON</wicri:regionArea>
<orgName type="university">Université de Toronto</orgName>
<placeName><settlement type="city">Toronto</settlement>
<region type="state">Ontario</region>
</placeName>
</affiliation>
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<monogr></monogr>
<series><title level="j">Human Brain Mapping</title>
<title level="j" type="abbrev">Hum. Brain Mapp.</title>
<idno type="ISSN">1065-9471</idno>
<idno type="eISSN">1097-0193</idno>
<imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher>
<pubPlace>Hoboken</pubPlace>
<date type="published" when="2009-12">2009-12</date>
<biblScope unit="volume">30</biblScope>
<biblScope unit="issue">12</biblScope>
<biblScope unit="page" from="3901">3901</biblScope>
<biblScope unit="page" to="3909">3909</biblScope>
</imprint>
<idno type="ISSN">1065-9471</idno>
</series>
<idno type="istex">48DDDE5AB48033FA79EF7A5E0DA06978F23B9411</idno>
<idno type="DOI">10.1002/hbm.20815</idno>
<idno type="ArticleID">HBM20815</idno>
</biblStruct>
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<seriesStmt><idno type="ISSN">1065-9471</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term>
<term>Brain Mapping</term>
<term>Cerebrovascular Circulation (physiology)</term>
<term>Deep Brain Stimulation (methods)</term>
<term>Electrodes, Implanted</term>
<term>Humans</term>
<term>Image Interpretation, Computer-Assisted</term>
<term>Male</term>
<term>Motor Skills (physiology)</term>
<term>Oxygen Radioisotopes</term>
<term>Parkinson Disease (diagnostic imaging)</term>
<term>Parkinson Disease (physiopathology)</term>
<term>Parkinson Disease (therapy)</term>
<term>Parkinsonism</term>
<term>Pedunculopontine Tegmental Nucleus (blood supply)</term>
<term>Pedunculopontine Tegmental Nucleus (diagnostic imaging)</term>
<term>Pedunculopontine Tegmental Nucleus (physiopathology)</term>
<term>Positron-Emission Tomography</term>
<term>Radiopharmaceuticals</term>
<term>deep brain stimulation</term>
<term>imaging</term>
<term>locomotion</term>
<term>midbrain</term>
</keywords>
<keywords scheme="MESH" type="chemical" xml:lang="en"><term>Oxygen Radioisotopes</term>
<term>Radiopharmaceuticals</term>
</keywords>
<keywords scheme="MESH" qualifier="blood supply" xml:lang="en"><term>Pedunculopontine Tegmental Nucleus</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Parkinson Disease</term>
<term>Pedunculopontine Tegmental Nucleus</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Deep Brain Stimulation</term>
</keywords>
<keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Cerebrovascular Circulation</term>
<term>Motor Skills</term>
</keywords>
<keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Parkinson Disease</term>
<term>Pedunculopontine Tegmental Nucleus</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Brain Mapping</term>
<term>Electrodes, Implanted</term>
<term>Humans</term>
<term>Image Interpretation, Computer-Assisted</term>
<term>Male</term>
<term>Positron-Emission Tomography</term>
</keywords>
</textClass>
<langUsage><language ident="en">en</language>
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<front><div type="abstract" xml:lang="en">Patients with advanced Parkinson's disease (PD) develop disabling axial symptoms, including gait disturbances, freezing and postural instability poorly responsive to levodopa replacement therapy. The pedunculopontine nucleus (PPN) is involved in locomotion, control of posture, and behavioral states [i.e. wakefulness, rapid eye movement sleep]. Recent reports suggested that PPN modulation with deep brain stimulation (DBS) may be beneficial in the treatment of axial symptoms. However, the mechanisms underlying these effects are still unknown. We used [15O] H2O PET to investigate regional cerebral blood flow in three patients with advanced PD who underwent a new experimental surgical procedure with implantation of unilateral PPN‐DBS. Patients were studied Off‐medication with stimulator Off and On, both at rest and during a self‐paced alternating motor task of the lower limbs. We used SPM2 for imaging data analysis, threshold P < 0.05 corrected at the cluster level. Stimulation induced significant regional cerebral blood flow increment in subcortical regions such as the thalamus (P < 0.006), cerebellum (P < 0.001), and midbrain region (P < 0.001) as well as different cortical areas involving medial sensorimotor cortex extending into caudal supplementary motor area (BA 4/6; P < 0.001). PPN‐DBS in advanced PD resulted in blood flow and presumably neuronal activity changes in subcortical and cortical areas involved in balance and motor control, including the mesencephalic locomotor region (e.g. PPN) and closely interconnected structures within the cerebello‐(rubro)‐thalamo‐cortical circuit. Whether these findings are associated with the DBS‐PPN clinical effect remains to be proven. However, they suggest that PPN modulation may induce functional changes in neural networks associated with the control of lower limb movements. Hum Brain Mapp, 2009. © 2009 Wiley‐Liss, Inc.</div>
</front>
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