• Antonella Peppe, Mariangela Pierantozzi, Valentina Baiamonte, Vincenzo Moschella, Carlo Caltagirone, Paolo Stanzione, and Alessandro Stefani.
• I.R.C.C.S. Fondazione Santa Lucia, Rome, Italy. a.peppe@hsantalucia.it
• Sleep. 2012 Dec 1;35(12):1637-42.

Study ObjectiveSleep 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).Study DesignSleep 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).ResultsIn 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.ConclusionOur study suggests that PPTg-DBS plays an important role in reorganizing regular sleep in PD patients.

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