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dc.contributor.authorHyam, JA
dc.contributor.authorRoy, HA
dc.contributor.authorHuang, Y
dc.contributor.authorMartin, S
dc.contributor.authorWang, S
dc.contributor.authorRippey, J
dc.contributor.authorCoyne, TJ
dc.contributor.authorStewart, I
dc.contributor.authorKerr, G
dc.contributor.authorSilburn, P
dc.contributor.authorPaterson, DJ
dc.contributor.authorAziz, TZ
dc.contributor.authorGreen, AL
dc.date.accessioned2021-12-02T18:32:10Z
dc.date.issued2019-12
dc.identifier.issn0959-9851
dc.identifier.issn1619-1560
dc.identifier.urihttp://hdl.handle.net/10026.1/18437
dc.description.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.

dc.format.extent615-624
dc.format.mediumPrint-Electronic
dc.languageen
dc.language.isoeng
dc.publisherSpringer Science and Business Media LLC
dc.subjectPedunculopontine nucleus
dc.subjectDeep brain stimulation
dc.subjectParkinson disease
dc.subjectPostural hypotension
dc.subjectAutonomic nervous system
dc.titleCardiovascular autonomic responses in patients with Parkinson disease to pedunculopontine deep brain stimulation
dc.typejournal-article
dc.typeArticle
plymouth.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/31493114
plymouth.issue6
plymouth.volume29
plymouth.publisher-urlhttp://dx.doi.org/10.1007/s10286-019-00634-8
plymouth.publication-statusPublished
plymouth.journalClinical Autonomic Research
dc.identifier.doi10.1007/s10286-019-00634-8
plymouth.organisational-group/Plymouth
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Faculty of Health/Peninsula Medical School
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA01 Clinical Medicine
plymouth.organisational-group/Plymouth/Research Groups
plymouth.organisational-group/Plymouth/Research Groups/FoH - Applied Parkinson's Research
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
plymouth.organisational-group/Plymouth/Users by role/Researchers in ResearchFish submission
dc.publisher.placeGermany
dcterms.dateAccepted2019-08-22
dc.rights.embargodate9999-12-31
dc.identifier.eissn1619-1560
dc.rights.embargoperiodNot known
rioxxterms.funderNational Institute for Health Research
rioxxterms.identifier.projectNIHR Academic Clinical Fellowship
rioxxterms.versionofrecord10.1007/s10286-019-00634-8
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2019-12
rioxxterms.typeJournal Article/Review
plymouth.funderNIHR Academic Clinical Fellowship::National Institute for Health Research


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