title: Deep brain stimulation of pedunculopontine tegmental nucleus: role in sleep modulation in advanced Parkinson disease patients: one-year follow-up.
abstract: 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).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Our study suggests that PPTg-DBS plays an important role in reorganizing regular sleep in PD patients.
authors.affiliation: I.R.C.C.S. Fondazione Santa Lucia, Rome, Italy. a.peppe@hsantalucia.it
authors.forename: Antonella
authors.initials: A
authors.lastname: Peppe
authors.forename: Mariangela
authors.initials: M
authors.lastname: Pierantozzi
authors.forename: Valentina
authors.initials: V
authors.lastname: Baiamonte
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Moschella
authors.forename: Carlo
authors.initials: C
authors.lastname: Caltagirone
authors.forename: Paolo
authors.initials: P
authors.lastname: Stanzione
authors.forename: Alessandro
authors.initials: A
authors.lastname: Stefani
mesh_terms: D046690:Deep Brain Stimulation; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D045042:Pedunculopontine Tegmental Nucleus; D011597:Psychomotor Performance / Q000502:physiology; D012890:Sleep / Q000502:physiology*; D020531:Subthalamic Nucleus; D013997:Time Factors; D014851:Wakefulness / Q000502:physiology