Cardiovascular autonomic responses in patients with Parkinson disease to pedunculopontine deep brain stimulation

Journal article


Hyam, Jonathan A., Roy, Holly A., Huang, Yongzhi, Martin, Sean, Wang, Shouyan, Rippey, Jodi, Coyne, Terry J., Stewart, Ian, Kerr, Graham, Silburn, Peter, Paterson, David J., Aziz, Tipu Z. and Green, Alexander L.. (2019). Cardiovascular autonomic responses in patients with Parkinson disease to pedunculopontine deep brain stimulation. Autonomic Neuroscience: Basic and Clinical. 29(6), pp. 615-624. https://doi.org/10.1007/s10286-019-00634-8
AuthorsHyam, Jonathan A., Roy, Holly A., Huang, Yongzhi, Martin, Sean, Wang, Shouyan, Rippey, Jodi, Coyne, Terry J., Stewart, Ian, Kerr, Graham, Silburn, Peter, Paterson, David J., Aziz, Tipu Z. and Green, Alexander L.
Abstract

Purpose
Dysautonomia can be a debilitating feature of Parkinson disease (PD). Pedunculopontine nucleus (PPN) stimulation may improve gait disorders in PD, and may also result in changes in autonomic performance.

Methods
To determine whether pedunculopontine nucleus stimulation improves cardiovascular responses to autonomic challenges of postural tilt and Valsalva manoeuver, eight patients with pedunculopontine nucleus deep brain stimulation were recruited to the study; two were excluded for technical reasons during testing. Participants underwent head up tilt and Valsalva manoeuver with stimulation turned ON and OFF. Continuous blood pressure and ECG waveforms were recorded during these tests. In a single patient, local field potential activity was recorded from the implanted electrode during tilt.

Results
The fall in systolic blood pressure after tilt was significantly smaller with stimulation ON (mean − 8.3% versus − 17.2%, p = 0.044). Valsalva ratio increased with stimulation from median 1.15 OFF to 1.20 ON (p = 0.028). Baroreflex sensitivity increased during Valsalva compared to rest with stimulation ON versus OFF (p = 0.028). The increase in baroreflex sensitivity correlated significantly with the mean depth of PPN stimulating electrode contacts. This accounted for 89% of its variance (r = 0.943, p = 0.005).

Conclusion
PPN stimulation can modulate the cardiovascular system in patients with PD. In this study, it reduced the postural fall in systolic blood pressure during head-up tilt and improved the cardiovascular response during Valsalva, presumably by altering the neural control of baroreflex activation.

Keywordspedunculopontine nucleus; deep brain stimulation; Parkinson disease; postural hypotension; autonomic nervous system
Year2019
JournalAutonomic Neuroscience: Basic and Clinical
Journal citation29 (6), pp. 615-624
PublisherSpringer-Verlag
ISSN0959-9851
Digital Object Identifier (DOI)https://doi.org/10.1007/s10286-019-00634-8
Scopus EID2-s2.0-85071767082
Research or scholarlyResearch
Page range615-624
FunderNational Health and Medical Research Council (NHMRC)
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online06 Sep 2019
Publication process dates
Accepted22 Aug 2019
Deposited01 Jun 2021
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