New Targets for Deep Brain Stimulation Treatment of Parkinson's Disease

Anna Castrioto; Elena Moro


Expert Rev Neurother. 2013;13(12):1319-1328. 

In This Article

The Centromedian-parafascicular Complex

The CM-Pf complex is part of the caudal intralaminar nuclei of the thalamus and has a critical role on arousal, sensory awareness, pain control, behavior and cognition.[62] The CM nucleus is associated with the sensorimotor striatum, whereas the Pf nucleus with the limbic and associative striatum.[62] The CM-Pf complex has important reciprocal connections with the basal ganglia and undergoes partial neurodegeneration in PD.[63] In the hemi-parkinsonian rat, high-frequency stimulation of the CM-Pf complex had an anti-akinetic effect in the off-levodopa condition, whereas it had an anti-dyskinetic effect in the on-levodopa condition.[63] Some clinical data in humans have also pointed out its possible role in dyskinesias.[64–66] Indeed, the stimulation of this region for pain control showed by serendipity to also improve involuntary movements.[66] In some PD patients with thalamic stimulation, an improvement of tremor and dyskinesias was observed.[67] Postoperative MRIs showed that the control of both tremor and dyskinesia was associated with a more posterior and deeper position of the electrodes, corresponding to the CM-Pf complex.[68]

More recently, a multi-target strategy with double STN or GPi and CM-Pf stimulation has been experimented in few PD patients.[69,70] CM-Pf stimulation could improve tremor and dyskinesias, although slightly less than GPi. Moreover, CM-Pf stimulation might slightly reduce bradykinesia and rigidity, but less than STN or GPi stimulation.[70]

Further studies are necessary to support these preliminary observations.