Low frequency stimulation of the nucleus tegmenti pedunculopontini increases cortical metabolism in Parkinsonian patients
Identifieur interne : 000E91 ( Main/Corpus ); précédent : 000E90; suivant : 000E92Low frequency stimulation of the nucleus tegmenti pedunculopontini increases cortical metabolism in Parkinsonian patients
Auteurs : R. Ceravolo ; L. Brusa ; S. Galati ; D. Volterrani ; A. Peppe ; G. Siciliano ; M. Pierantozzi ; V. Moschella ; U. Bonuccelli ; P. Stanzione ; A. StefaniSource :
- European Journal of Neurology [ 1351-5101 ] ; 2011-06.
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Abstract
Background and purpose: To evaluate the effects of 25‐Hz deep brain stimulation of the nucleus tegmenti pedunculopontini (PPTg) on brain metabolic activity. Methods: Six patients with Parkinson’s disease (PD) who had bilateral stereotactic implantation of PPTg at least 12 months prior to evaluation were included in our study. All underwent, in separate sessions, 18‐FDG‐PET in core assessment programme for intra‐cerebral transplantation as well as motor evaluation [Unified Parkinson’s disease rating scale (UPDRS) – section III] and a battery of cognitive testing. Results: PPTg‐ON (low bipolar contacts, 25 Hz) promoted a significant increase of glucose utilization in bilateral prefrontal areas including dorsolateral prefrontal cortex (DLPFC, BA9), orbito‐frontal cortex (BA47), anterior cingulate (BA 25–32), superior frontal gyrus (BA 10) and supramarginal gyrus (BA40); a significant increase of uptake and consumption of FDG also occurred in the left ventral striatum, left subgyral (BA 46), right insula (BA 13) and right superior temporal gyrus (BA 22). PPTg‐ON was associated with a significant decrease of glucose utilization in the left cerebellar anterior lobe (culmen) and right cerebellar posterior lobe (declive). In the same patients, PPTg‐ON improved delayed recall (P < 0.05) and executive functions whilst the UPDRS revealed a modest (−21%) and variable treatment effect. Conclusions: Low frequency stimulation of PPTg, a sub‐region of the pedunculopontine nucleus complex, causes a minor motor benefit but a peculiar profile of cognitive improvement associated with a significant increase in FDG consumption in both prefrontal areas and mono‐lateral ventral striatum. These data are consistent with multiple limbic and/or associative domains modulated by PPTg stimulation in our patients with PD.
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DOI: 10.1111/j.1468-1331.2010.03254.x
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Methods: Six patients with Parkinson’s disease (PD) who had bilateral stereotactic implantation of PPTg at least 12 months prior to evaluation were included in our study. All underwent, in separate sessions, 18‐FDG‐PET in core assessment programme for intra‐cerebral transplantation as well as motor evaluation [Unified Parkinson’s disease rating scale (UPDRS) – section III] and a battery of cognitive testing. Results: PPTg‐ON (low bipolar contacts, 25 Hz) promoted a significant increase of glucose utilization in bilateral prefrontal areas including dorsolateral prefrontal cortex (DLPFC, BA9), orbito‐frontal cortex (BA47), anterior cingulate (BA 25–32), superior frontal gyrus (BA 10) and supramarginal gyrus (BA40); a significant increase of uptake and consumption of FDG also occurred in the left ventral striatum, left subgyral (BA 46), right insula (BA 13) and right superior temporal gyrus (BA 22). PPTg‐ON was associated with a significant decrease of glucose utilization in the left cerebellar anterior lobe (culmen) and right cerebellar posterior lobe (declive). In the same patients, PPTg‐ON improved delayed recall (P < 0.05) and executive functions whilst the UPDRS revealed a modest (−21%) and variable treatment effect. Conclusions: Low frequency stimulation of PPTg, a sub‐region of the pedunculopontine nucleus complex, causes a minor motor benefit but a peculiar profile of cognitive improvement associated with a significant increase in FDG consumption in both prefrontal areas and mono‐lateral ventral striatum. These data are consistent with multiple limbic and/or associative domains modulated by PPTg stimulation in our patients with PD.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>R. Ceravolo</name><affiliations><json:string>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Pisa, Pisa</json:string></affiliations></json:item><json:item><name>L. Brusa</name><affiliations><json:string>U.O.C. Neurologia, Ospedale S. Eugenio, ASL RMC, Rome</json:string></affiliations></json:item><json:item><name>S. Galati</name><affiliations><json:string>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</json:string></affiliations></json:item><json:item><name>D. Volterrani</name><affiliations><json:string>Unità di Medicina Nucleare‐Università di Pisa, Pisa</json:string></affiliations></json:item><json:item><name>A. Peppe</name><affiliations><json:string>IRCCS Fondazione S. Lucia, Rome, Italy</json:string></affiliations></json:item><json:item><name>G. Siciliano</name><affiliations><json:string>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Pisa, Pisa</json:string></affiliations></json:item><json:item><name>M. Pierantozzi</name><affiliations><json:string>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</json:string></affiliations></json:item><json:item><name>V. Moschella</name><affiliations><json:string>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</json:string></affiliations></json:item><json:item><name>U. Bonuccelli</name><affiliations><json:string>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Pisa, Pisa</json:string></affiliations></json:item><json:item><name>P. Stanzione</name><affiliations><json:string>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</json:string><json:string>IRCCS Fondazione S. Lucia, Rome, Italy</json:string></affiliations></json:item><json:item><name>A. Stefani</name><affiliations><json:string>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</json:string><json:string>IRCCS Fondazione S. Lucia, Rome, Italy</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>deep brain stimulation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>executive functions</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>FDG‐PET</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PPN</value></json:item></subject><articleId><json:string>ENE3254</json:string></articleId><language><json:string>eng</json:string></language><abstract>Background and purpose: To evaluate the effects of 25‐Hz deep brain stimulation of the nucleus tegmenti pedunculopontini (PPTg) on brain metabolic activity. Methods: Six patients with Parkinson’s disease (PD) who had bilateral stereotactic implantation of PPTg at least 12 months prior to evaluation were included in our study. All underwent, in separate sessions, 18‐FDG‐PET in core assessment programme for intra‐cerebral transplantation as well as motor evaluation [Unified Parkinson’s disease rating scale (UPDRS) – section III] and a battery of cognitive testing. Results: PPTg‐ON (low bipolar contacts, 25 Hz) promoted a significant increase of glucose utilization in bilateral prefrontal areas including dorsolateral prefrontal cortex (DLPFC, BA9), orbito‐frontal cortex (BA47), anterior cingulate (BA 25–32), superior frontal gyrus (BA 10) and supramarginal gyrus (BA40); a significant increase of uptake and consumption of FDG also occurred in the left ventral striatum, left subgyral (BA 46), right insula (BA 13) and right superior temporal gyrus (BA 22). PPTg‐ON was associated with a significant decrease of glucose utilization in the left cerebellar anterior lobe (culmen) and right cerebellar posterior lobe (declive). In the same patients, PPTg‐ON improved delayed recall (P > 0.05) and executive functions whilst the UPDRS revealed a modest (−21%) and variable treatment effect. Conclusions: Low frequency stimulation of PPTg, a sub‐region of the pedunculopontine nucleus complex, causes a minor motor benefit but a peculiar profile of cognitive improvement associated with a significant increase in FDG consumption in both prefrontal areas and mono‐lateral ventral striatum. These data are consistent with multiple limbic and/or associative domains modulated by PPTg stimulation in our patients with PD.</abstract><qualityIndicators><score>7.416</score><pdfVersion>1.3</pdfVersion><pdfPageSize>595.276 x 782.362 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>4</keywordCount><abstractCharCount>1825</abstractCharCount><pdfWordCount>4416</pdfWordCount><pdfCharCount>29064</pdfCharCount><pdfPageCount>8</pdfPageCount><abstractWordCount>256</abstractWordCount></qualityIndicators><title>Low frequency stimulation of the nucleus tegmenti pedunculopontini increases cortical metabolism in Parkinsonian patients</title><genre><json:string>article</json:string></genre><host><volume>18</volume><publisherId><json:string>ENE</json:string></publisherId><pages><total>8</total><last>849</last><first>842</first></pages><issn><json:string>1351-5101</json:string></issn><issue>6</issue><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1468-1331</json:string></eissn><title>European Journal of Neurology</title><doi><json:string>10.1111/(ISSN)1468-1331</json:string></doi></host><publicationDate>2011</publicationDate><copyrightDate>2011</copyrightDate><doi><json:string>10.1111/j.1468-1331.2010.03254.x</json:string></doi><id>50E8F6473130758763877C85165F6F3374C43DA3</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/50E8F6473130758763877C85165F6F3374C43DA3/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/50E8F6473130758763877C85165F6F3374C43DA3/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/50E8F6473130758763877C85165F6F3374C43DA3/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Low frequency stimulation of the nucleus tegmenti pedunculopontini increases cortical metabolism in Parkinsonian patients</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><availability><p>WILEY</p></availability><date>2011</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Low frequency stimulation of the nucleus tegmenti pedunculopontini increases cortical metabolism in Parkinsonian patients</title><author><persName><forename type="first">R.</forename><surname>Ceravolo</surname></persName><note type="biography">Both authors equally contributed to the manuscript.</note><affiliation>Both authors equally contributed to the manuscript.</affiliation><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Pisa, Pisa</affiliation></author><author><persName><forename type="first">L.</forename><surname>Brusa</surname></persName><note type="biography">Both authors equally contributed to the manuscript.</note><affiliation>Both authors equally contributed to the manuscript.</affiliation><affiliation>U.O.C. Neurologia, Ospedale S. Eugenio, ASL RMC, Rome</affiliation></author><author><persName><forename type="first">S.</forename><surname>Galati</surname></persName><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</affiliation></author><author><persName><forename type="first">D.</forename><surname>Volterrani</surname></persName><affiliation>Unità di Medicina Nucleare‐Università di Pisa, Pisa</affiliation></author><author><persName><forename type="first">A.</forename><surname>Peppe</surname></persName><affiliation>IRCCS Fondazione S. Lucia, Rome, Italy</affiliation></author><author><persName><forename type="first">G.</forename><surname>Siciliano</surname></persName><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Pisa, Pisa</affiliation></author><author><persName><forename type="first">M.</forename><surname>Pierantozzi</surname></persName><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</affiliation></author><author><persName><forename type="first">V.</forename><surname>Moschella</surname></persName><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</affiliation></author><author><persName><forename type="first">U.</forename><surname>Bonuccelli</surname></persName><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Pisa, Pisa</affiliation></author><author><persName><forename type="first">P.</forename><surname>Stanzione</surname></persName><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</affiliation><affiliation>IRCCS Fondazione S. 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Methods: Six patients with Parkinson’s disease (PD) who had bilateral stereotactic implantation of PPTg at least 12 months prior to evaluation were included in our study. All underwent, in separate sessions, 18‐FDG‐PET in core assessment programme for intra‐cerebral transplantation as well as motor evaluation [Unified Parkinson’s disease rating scale (UPDRS) – section III] and a battery of cognitive testing. Results: PPTg‐ON (low bipolar contacts, 25 Hz) promoted a significant increase of glucose utilization in bilateral prefrontal areas including dorsolateral prefrontal cortex (DLPFC, BA9), orbito‐frontal cortex (BA47), anterior cingulate (BA 25–32), superior frontal gyrus (BA 10) and supramarginal gyrus (BA40); a significant increase of uptake and consumption of FDG also occurred in the left ventral striatum, left subgyral (BA 46), right insula (BA 13) and right superior temporal gyrus (BA 22). PPTg‐ON was associated with a significant decrease of glucose utilization in the left cerebellar anterior lobe (culmen) and right cerebellar posterior lobe (declive). In the same patients, PPTg‐ON improved delayed recall (P < 0.05) and executive functions whilst the UPDRS revealed a modest (−21%) and variable treatment effect. Conclusions: Low frequency stimulation of PPTg, a sub‐region of the pedunculopontine nucleus complex, causes a minor motor benefit but a peculiar profile of cognitive improvement associated with a significant increase in FDG consumption in both prefrontal areas and mono‐lateral ventral striatum. These data are consistent with multiple limbic and/or associative domains modulated by PPTg stimulation in our patients with PD.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>deep brain stimulation</term></item><item><term>executive functions</term></item><item><term>FDG‐PET</term></item><item><term>PPN</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2011-06">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/50E8F6473130758763877C85165F6F3374C43DA3/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Ltd</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1468-1331</doi><issn type="print">1351-5101</issn><issn type="electronic">1468-1331</issn><idGroup><id type="product" value="ENE"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="EUROPEAN JOURNAL OF NEUROLOGY">European Journal of Neurology</title></titleGroup></publicationMeta><publicationMeta level="part" position="06106"><doi origin="wiley">10.1111/ene.2011.18.issue-6</doi><numberingGroup><numbering type="journalVolume" number="18">18</numbering><numbering type="journalIssue" number="6">6</numbering></numberingGroup><coverDate startDate="2011-06">June 2011</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="8" status="forIssue"><doi origin="wiley">10.1111/j.1468-1331.2010.03254.x</doi><idGroup><id type="unit" value="ENE3254"></id></idGroup><countGroup><count type="pageTotal" number="8"></count></countGroup><titleGroup><title type="tocHeading1">Original Articles</title></titleGroup><copyright>© 2010 The Author(s). European Journal of Neurology © 2010 EFNS</copyright><eventGroup><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.4.9 mode:FullText" date="2011-05-09"></event><event type="publishedOnlineEarlyUnpaginated" date="2010-11-19"></event><event type="firstOnline" date="2010-11-19"></event><event type="publishedOnlineFinalForm" date="2011-05-09"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-24"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-16"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="842">842</numbering><numbering type="pageLast" number="849">849</numbering></numberingGroup><correspondenceTo>A. Stefani, MD, IRCCS foundation S. Lucia, c/o Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor Vergata, Rome, Italy (tel.: +39 620903119; fax: +39 620903118; e‐mail: <email>stefani@uniroma2.it</email>).</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:ENE.ENE3254.pdf"></link></linkGroup></publicationMeta><contentMeta><unparsedEditorialHistory>Received 17 May 2010 Accepted 23 September 2010</unparsedEditorialHistory><countGroup><count type="figureTotal" number="3"></count><count type="tableTotal" number="1"></count></countGroup><titleGroup><title type="main">Low frequency stimulation of the nucleus tegmenti pedunculopontini increases cortical metabolism in Parkinsonian patients</title><title type="shortAuthors">R. Ceravolo <i>et al.</i></title><title type="short">FDG‐PET under PPN‐ON</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1" noteRef="#fn1"><personName><givenNames>R.</givenNames><familyName>Ceravolo</familyName></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a2" noteRef="#fn1"><personName><givenNames>L.</givenNames><familyName>Brusa</familyName></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a3"><personName><givenNames>S.</givenNames><familyName>Galati</familyName></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a4"><personName><givenNames>D.</givenNames><familyName>Volterrani</familyName></personName></creator><creator creatorRole="author" xml:id="cr5" affiliationRef="#a5"><personName><givenNames>A.</givenNames><familyName>Peppe</familyName></personName></creator><creator creatorRole="author" xml:id="cr6" affiliationRef="#a1"><personName><givenNames>G.</givenNames><familyName>Siciliano</familyName></personName></creator><creator creatorRole="author" xml:id="cr7" affiliationRef="#a3"><personName><givenNames>M.</givenNames><familyName>Pierantozzi</familyName></personName></creator><creator creatorRole="author" xml:id="cr8" affiliationRef="#a3"><personName><givenNames>V.</givenNames><familyName>Moschella</familyName></personName></creator><creator creatorRole="author" xml:id="cr9" affiliationRef="#a1"><personName><givenNames>U.</givenNames><familyName>Bonuccelli</familyName></personName></creator><creator creatorRole="author" xml:id="cr10" affiliationRef="#a3 #a5"><personName><givenNames>P.</givenNames><familyName>Stanzione</familyName></personName></creator><creator creatorRole="author" xml:id="cr11" affiliationRef="#a3 #a5"><personName><givenNames>A.</givenNames><familyName>Stefani</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="a1"><unparsedAffiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Pisa, Pisa</unparsedAffiliation></affiliation><affiliation xml:id="a2"><unparsedAffiliation>U.O.C. Neurologia, Ospedale S. Eugenio, ASL RMC, Rome</unparsedAffiliation></affiliation><affiliation xml:id="a3"><unparsedAffiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</unparsedAffiliation></affiliation><affiliation xml:id="a4"><unparsedAffiliation>Unità di Medicina Nucleare‐Università di Pisa, Pisa</unparsedAffiliation></affiliation><affiliation xml:id="a5" countryCode="IT"><unparsedAffiliation>IRCCS Fondazione S. Lucia, Rome, Italy</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">deep brain stimulation</keyword><keyword xml:id="k2">executive functions</keyword><keyword xml:id="k3">FDG‐PET</keyword><keyword xml:id="k4">PPN</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><p><b>Background and purpose: </b> To evaluate the effects of 25‐Hz deep brain stimulation of the nucleus tegmenti pedunculopontini (PPTg) on brain metabolic activity.</p><p><b>Methods: </b> Six patients with Parkinson’s disease (PD) who had bilateral stereotactic implantation of PPTg at least 12 months prior to evaluation were included in our study. All underwent, in separate sessions, 18‐FDG‐PET in core assessment programme for intra‐cerebral transplantation as well as motor evaluation [Unified Parkinson’s disease rating scale (UPDRS) – section III] and a battery of cognitive testing.</p><p><b>Results: </b> PPTg‐ON (low bipolar contacts, 25 Hz) promoted a significant increase of glucose utilization in bilateral prefrontal areas including dorsolateral prefrontal cortex (DLPFC, BA9), orbito‐frontal cortex (BA47), anterior cingulate (BA 25–32), superior frontal gyrus (BA 10) and supramarginal gyrus (BA40); a significant increase of uptake and consumption of FDG also occurred in the left ventral striatum, left subgyral (BA 46), right insula (BA 13) and right superior temporal gyrus (BA 22). PPTg‐ON was associated with a significant decrease of glucose utilization in the left cerebellar anterior lobe (culmen) and right cerebellar posterior lobe (declive). In the same patients, PPTg‐ON improved delayed recall (<i>P </i>< 0.05) and executive functions whilst the UPDRS revealed a modest (−21%) and variable treatment effect.</p><p><b>Conclusions: </b> Low frequency stimulation of PPTg, a sub‐region of the pedunculopontine nucleus complex, causes a minor motor benefit but a peculiar profile of cognitive improvement associated with a significant increase in FDG consumption in both prefrontal areas and mono‐lateral ventral striatum. These data are consistent with multiple limbic and/or associative domains modulated by PPTg stimulation in our patients with PD.</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1"><p> Both authors equally contributed to the manuscript.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Low frequency stimulation of the nucleus tegmenti pedunculopontini increases cortical metabolism in Parkinsonian patients</title></titleInfo><titleInfo type="abbreviated"><title>FDG‐PET under PPN‐ON</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Low frequency stimulation of the nucleus tegmenti pedunculopontini increases cortical metabolism in Parkinsonian patients</title></titleInfo><name type="personal"><namePart type="given">R.</namePart><namePart type="family">Ceravolo</namePart><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Pisa, Pisa</affiliation><description>Both authors equally contributed to the manuscript.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">L.</namePart><namePart type="family">Brusa</namePart><affiliation>U.O.C. Neurologia, Ospedale S. Eugenio, ASL RMC, Rome</affiliation><description>Both authors equally contributed to the manuscript.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S.</namePart><namePart type="family">Galati</namePart><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D.</namePart><namePart type="family">Volterrani</namePart><affiliation>Unità di Medicina Nucleare‐Università di Pisa, Pisa</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A.</namePart><namePart type="family">Peppe</namePart><affiliation>IRCCS Fondazione S. Lucia, Rome, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">G.</namePart><namePart type="family">Siciliano</namePart><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Pisa, Pisa</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M.</namePart><namePart type="family">Pierantozzi</namePart><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">V.</namePart><namePart type="family">Moschella</namePart><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">U.</namePart><namePart type="family">Bonuccelli</namePart><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Pisa, Pisa</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P.</namePart><namePart type="family">Stanzione</namePart><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</affiliation><affiliation>IRCCS Fondazione S. Lucia, Rome, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A.</namePart><namePart type="family">Stefani</namePart><affiliation>Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma Tor, Vergata, Rome</affiliation><affiliation>IRCCS Fondazione S. Lucia, Rome, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2011-06</dateIssued><edition>Received 17 May 2010 Accepted 23 September 2010</edition><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">3</extent><extent unit="tables">1</extent></physicalDescription><abstract lang="en">Background and purpose: To evaluate the effects of 25‐Hz deep brain stimulation of the nucleus tegmenti pedunculopontini (PPTg) on brain metabolic activity. Methods: Six patients with Parkinson’s disease (PD) who had bilateral stereotactic implantation of PPTg at least 12 months prior to evaluation were included in our study. All underwent, in separate sessions, 18‐FDG‐PET in core assessment programme for intra‐cerebral transplantation as well as motor evaluation [Unified Parkinson’s disease rating scale (UPDRS) – section III] and a battery of cognitive testing. Results: PPTg‐ON (low bipolar contacts, 25 Hz) promoted a significant increase of glucose utilization in bilateral prefrontal areas including dorsolateral prefrontal cortex (DLPFC, BA9), orbito‐frontal cortex (BA47), anterior cingulate (BA 25–32), superior frontal gyrus (BA 10) and supramarginal gyrus (BA40); a significant increase of uptake and consumption of FDG also occurred in the left ventral striatum, left subgyral (BA 46), right insula (BA 13) and right superior temporal gyrus (BA 22). PPTg‐ON was associated with a significant decrease of glucose utilization in the left cerebellar anterior lobe (culmen) and right cerebellar posterior lobe (declive). In the same patients, PPTg‐ON improved delayed recall (P < 0.05) and executive functions whilst the UPDRS revealed a modest (−21%) and variable treatment effect. Conclusions: Low frequency stimulation of PPTg, a sub‐region of the pedunculopontine nucleus complex, causes a minor motor benefit but a peculiar profile of cognitive improvement associated with a significant increase in FDG consumption in both prefrontal areas and mono‐lateral ventral striatum. These data are consistent with multiple limbic and/or associative domains modulated by PPTg stimulation in our patients with PD.</abstract><subject lang="en"><genre>Keywords</genre><topic>deep brain stimulation</topic><topic>executive functions</topic><topic>FDG‐PET</topic><topic>PPN</topic></subject><relatedItem type="host"><titleInfo><title>European Journal of Neurology</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">1351-5101</identifier><identifier type="eISSN">1468-1331</identifier><identifier type="DOI">10.1111/(ISSN)1468-1331</identifier><identifier type="PublisherID">ENE</identifier><part><date>2011</date><detail type="volume"><caption>vol.</caption><number>18</number></detail><detail type="issue"><caption>no.</caption><number>6</number></detail><extent unit="pages"><start>842</start><end>849</end><total>8</total></extent></part></relatedItem><identifier type="istex">50E8F6473130758763877C85165F6F3374C43DA3</identifier><identifier type="DOI">10.1111/j.1468-1331.2010.03254.x</identifier><identifier type="ArticleID">ENE3254</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2010 The Author(s). 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