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• Both muscular and cutaneous somatosensory input arrives at the cuneate nucleus. • Muscle somatosensory input dose not evoke any low-frequency response from the cuneate nucleus. • Subcortical high-frequency oscillations include both presynaptic and postsynaptic components. To investigate the subcortical somatosensory evoked potentials (SEPs) to electrical stimulation of either muscle or cutaneous afferents. SEPs were recorded in 6 patients suffering from Parkinson's disease (PD) who underwent electrode implantation in the pedunculopontine (PPTg) nucleus area. We compared SEPs recorded from the scalp and from the intracranial electrode contacts to electrical stimuli applied to: 1) median nerve at the wrist, 2) abductor pollicis brevis motor point, and 3) distal phalanx of the thumb. Also the high-frequency oscillations (HFOs) were analysed. After median nerve and pure cutaneous (distant phalanx of the thumb) stimulation, a P1-N1 complex was recorded by the intracranial lead, while the scalp electrodes recorded the short-latency far-field responses (P14 and N18). On the contrary, motor point stimulation did not evoke any low-frequency component in the PPTg traces, nor the N18 potential on the scalp. HFOs were recorded to stimulation of all modalities by the PPTg electrode contacts. Stimulus processing within the cuneate nucleus depends on modality, since only the cutaneous input activates the complex intranuclear network possibly generating the scalp N18 potential. Our results shed light on the subcortical processing of the somatosensory input of different modalities. [ABSTRACT FROM AUTHOR]

• Single stimuli applied to the pedunculopontine tegmental nucleus (PPTg) modulate the blink reflex (BR) in Parkinson's disease. • The action of the PPTg on the BR differs from the action exerted by other basal ganglia nuclei. • The PPTg has a critical role in the pathway mediating the prepulse inhibition of the BR. To investigate the effects on the blink reflex (BR) of single stimuli applied to the pedunculopontine tegmental nucleus (PPTg). The BR was evoked by stimulating the supraorbital nerve (SON) in fifteen patients suffering from idiopathic Parkinson's disease (PD) who had electrodes monolaterally or bilaterally implanted in the PPTg for deep brain stimulation (DBS). Single stimuli were delivered to the PPTg through externalized electrode connection wires 3–4 days following PPTg implantation. PPTg stimuli increased the latency and reduced duration, amplitude and area of the R2 component of the BR in comparison to the response recorded in the absence of PPTg stimulation. These effects were independent of the side of SON stimulation and were stable for interstimulus interval (ISI) between PPTg prepulse and SON stimulus from 0 to 110 ms. The PPTg-induced prepulse inhibition of the BR was bilaterally present in the brainstem. The R1 component was unaffected. The prepulse inhibition of the R2 component may be modulated by the PPTg. These findings suggest that abnormalities of BR occurring in PD may be ascribed to a reduction of basal ganglia-mediated inhibition of brainstem excitability. [ABSTRACT FROM AUTHOR]

Objectives The study aimed to investigate the site of the movement related inhibition of the human dorsal column nuclei. Methods Median nerve somatosensory evoked potentials (SEPs) were recorded from 18 patients suffering from Parkinson’s disease, who underwent electrode implantation in the pedunculopontine (PPTg) nucleus. SEPs were recorded at rest and during active or passive movement of the thumb of the stimulated wrist. Results The PPTg electrode recorded a triphasic potential generated in the cuneate nucleus. The PPTg potential was subtended by 2 high frequency oscillation (HFO) components: (1) an earlier one with 1000 Hz frequency and (2) a later one with 1700 Hz frequency. Both HFO components were reduced by movement. No major difference between the effects of either active or passive movement was found. Discussion PPTg electrode can record SEPs generated in the dorsal column nuclei (DCN). We suggest that the 1000 Hz and 1700 Hz HFO bursts are generated at pre- and post-synaptical level, respectively. Conclusion Movement exerts both pre- and post-synaptic inhibition on dorsal column nuclei. Significance Investigating the effect of movement on the DCN activity by an intracerebral electrode located at the human PPTg level confirms what early studies in animals suggested. [ABSTRACT FROM AUTHOR]

Objective To investigate the generators of the somatosensory evoked potential (SEP) components recorded from the Pedunculopontine Tegmental nucleus (PPTg). Methods Twenty-two patients, suffering from Parkinson’s disease (PD), underwent electrode implantation in the PPTg area for deep brain stimulation (DBS). SEPs were recorded from the DBS electrode contacts to median nerve stimulation. Results SEPs recorded from the PPTg electrode contacts could be classified in 3 types, according to their waveforms. (1) The biphasic potential showed a positive peak (P16) whose latency (16.05 ± 0.61 ms) shifted of 0.18 ± 0.07 ms from the lower to the upper contact of the electrode. (2) The triphasic potential showed an initial positive peak (P15) whose latency (15.4 ± 0.2 ms) did not change across the DBS electrode contacts. (3) In the last SEP configuration (mixed biphasic and triphasic waveform), the positive peak was bifid including both the P15 and P16 potentials. Conclusion While the P16 potential is probably generated by the somatosensory volley travelling along the medial lemniscus, the P15 response represents a far-field potential probably generated at the cuneate nucleus level. Significance Our results show the physiological meaning of the somatosensory responses recorded from the PPTg nucleus area. [ABSTRACT FROM AUTHOR]

Abstract: The present paper was aimed at investigating the effect of low-frequency electrical stimulation (25 Hz) of the peduncolopontine (PPN) area on working memory (WM) functioning in patients with Parkinson''s disease (PD). Five PD patients who underwent simultaneous PPN area- and subthalamic nucleus-deep brain stimulation (DBS) implantation participated in the study. PD patients were evaluated in the morning at least 12 h after antiparkinsonian therapy withdrawal in two conditions: i) after continuous PPN area stimulation (Off Therapy/On PPN: “On” condition); ii) at least 120 min after PPN area had been switched “Off” (Off Ther/Off PPN: “Off” condition). The experimental WM task consisted of an n-back paradigm with verbal and visual-object stimuli. PD patients showed a consistent response time decrease on both the verbal and the visual-object tasks passing from the “Off” to the “On” condition (p < 0.05). However, the accuracy score did not significantly differ between the two experimental conditions. The present findings, although preliminary, suggest that PPN area stimulation facilitates the speed processing of information in the content of WM, possibly through the modulation of the attentional resources. [Copyright &y& Elsevier]

Abstract: Combined deep brain stimulation of the subthalamic (STN) and pedunculopontine (PPN) nuclei has been recently proposed as surgical treatment of advanced Parkinson''s disease. STN stimulation alone has been shown to provide selective improvement of the grammatical aspect of language. We studied five advanced Parkinson''s disease patients who underwent combined deep brain stimulation (STN + PPN). Overall cognitive profile did not change. On the contrary, an interesting trend towards reduction of ungrammatical errors (particularly substitution of free and inflectional morphemes) was found when stimulating the STN, and also the PPN, when the STN was switched off. These findings replicate previous observations on the STN, and provide the rationale for further investigation of the role of the PPN in processing linguistic grammar. [Copyright &y& Elsevier]

Abstract: The intra-laminar (IL) thalamic complex, composed of centromedian (CM) and parafascicular (Pf) nucleus, is a strategic crossroad for the activity of the basal ganglia and is recently regaining its position has a putative neurosurgical target for Parkinsonian syndromes. The multi-target approach we have encouraged since the late nineties has allowed the combined implantation of a standard target (the subthalamic nucleus—STN or the internal pallidus—GPi) plus an innovative one (CM/Pf) in well-identified Parkinson’s disease (PD) patients; hence, it is possible to study, in the same PD patients, the specific target-mediated effects on different clinical signs. Here, we focus on the potential usefulness of implanting the CM/Pf complex when required in the management of contra-lateral tremor (resistant to standard deep brain stimulation—DBS – in STN – , n =2) and disabling involuntary movements, partially responsive to GPi–DBS (n =6). When considering global UPDRS scores, CM/Pf–DBS ameliorate extra-pyramidal symptoms but not as strongly as STN (or GPi) does. Yet, CM/Pf acts very powerfully on tremor and contributes to the long-term management of l-Dopa-induced involuntary movements. The lack of cognitive deficits and psychic impairment associated with the improvement of their quality of life, in our small cohort of CM/Pf implanted patients, reinforces the notion of CM/Pf as a safe and attractive area for surgical treatment of advanced PD, possibly affecting not only motor but also associative functions. [Copyright &y& Elsevier]

Objective: To investigate whether the reduction of amplitude of the scalp somatosensory evoked potentials (SEPs) during movement (gating) is due to an attenuation of the afferent volley at subcortical level.Methods: Median nerve SEPs were recorded from 9 patients suffering from Parkinson''s disease, who underwent implant of intracerebral (IC) electrodes in the subthalamic nucleus or in the globus pallidum. SEPs were recorded from Erb''s point ipsilateral to stimulation, from the scalp surface and from the IC leads, at rest and during a voluntary flexo-extension movement of the stimulated wrist. The recorded IC traces were submitted to an off-line filtering by a 300–1500 bandpass to obtain the high-frequency SEP bursts.Results: IC leads recorded a triphasic component (P1–N1–P2) from 14 to 22 ms of latency. The amplitudes of the scalp N20, P20 and N30 potentials and of the IC triphasic component were significantly decreased during movement, while the peripheral N9 amplitude remained unchanged. Also the IC bursts, whose frequency was around 1000 Hz, were reduced in amplitude by the voluntary movement.Conclusions: Since the IC triphasic component is probably generated by neurons of the thalamic ventro-postero-lateral nucleus, which receive the somatosensory afferent volley, the P1–N1 amplitude reduction during movement suggests that the gating phenomenon involves also the subcortical structures. [Copyright &y& Elsevier]

Here we seek to establish whether there are activities in the human pallidum that may predict a specific aspect of performance, timing. When recording from two patients with Parkinson''s disease and primary generalised dystonia following functional neurosurgery we found that the amplitude of oscillatory pallidal activity occurring prior to the completion of a bimanual timing task was strongly correlated with eventual task duration. The frequency of this oscillatory activity was around 25 Hz. We conclude that the human pallidum may be involved in the prediction of movement timings and that such internal estimates may be reflected in amplitude modulation of oscillatory activity around 25 Hz. [Copyright &y& Elsevier]