Pedunculopontine Nucleus Deep Brain Stimulation for Parkinsonian Disorders: A Case Series

<b><i>Background:</i></b> Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) has been investigated for the treatment of levodopa-refractory gait dysfunction in parkinsonian disorders, with equivocal results so far. <b><i>Objectives:</i></b> To summarize the clinical outcomes of PPN-DBS-treated patients at our centre and elicit any patterns that may guide future research. <b><i>Materials and Methods:</i></b> Pre- and post-operative objective overall motor and gait subsection scores as well as patient-reported outcomes were recorded for 6 PPN-DBS-treated patients, 3 with Parkinson’s disease (PD), and 3 with progressive supranuclear palsy (PSP). Electrodes were implanted unilaterally in the first 3 patients and bilaterally in the latter 3, using an MRI-guided MRI-verified technique. Stimulation was initiated at 20–30 Hz and optimized in an iterative manner. <b><i>Results:</i></b> Unilaterally treated patients did not demonstrate significant improvements in gait questionnaires, UPDRS-III or PSPRS scores or their respective gait subsections. This contrasted with at least an initial response in bilaterally treated patients. Diurnal cycling of stimulation in a PD patient with habituation to the initial benefit reproduced substantial improvements in freezing of gait (FOG) 3 years post-operatively. Among the PSP patients, 1 with a parkinsonian subtype had a sustained improvement in FOG while another with Richardson syndrome (PSP-RS) did not benefit. <b><i>Conclusions:</i></b> PPN-DBS remains an investigational treatment for levodopa-refractory FOG. This series corroborates some previously reported findings: bilateral stimulation may be more effective than unilateral stimulation; the response in PSP patients may depend on the disease subtype; and diurnal cycling of stimulation to overcome habituation merits further investigation.

Diurnal Cycling of Submesoscale Dynamics: Lagrangian Implications in Drifter Observations and Model Simulations of the Northern Gulf of Mexico

The diurnal cycling of submesoscale circulations in vorticity, divergence, and strain is investigated using drifter data collected as part of the Lagrangian Submesoscale Experiment (LASER) experiment, which took place in the northern Gulf of Mexico during winter 2016, and ROMS simulations at different resolutions and degree of realism. The first observational evidence of a submesoscale diurnal cycle is presented. The cycling is detected in the LASER data during periods of weak winds, whereas the signal is obscured during strong wind events. Results from ROMS in the most realistic setup and in sensitivity runs with idealized wind patterns demonstrate that wind bursts disrupt the submesoscale diurnal cycle, independently of the time of day at which they happen. The observed and simulated submesoscale diurnal cycle supports the existence of a shift of approximately 1–3 h between the occurrence of divergence and vorticity maxima, broadly in agreement with theoretical predictions. The amplitude of the modeled signal, on the other hand, always underestimates the observed one, suggesting that even a horizontal resolution of 500 m is insufficient to capture the strength of the observed variability in submesoscale circulations. The paper also presents an evaluation of how well the diurnal cycle can be detected as function of the number of Lagrangian particles. If more than 2000 particle triplets are considered, the diurnal cycle is well captured, but for a number of triplets comparable to that of the LASER analysis, the reconstructed diurnal cycling displays high levels of noise both in the model and in the observations.

Oscillatory subglacial drainage in the absence of surface melt

The presence of strong diurnal cycling in basal water pressure records obtained during the melt season is well established for many glaciers. The behaviour of the drainage system outside the melt season is less well understood. Here we present borehole observations from a surge-type valley glacier in the St Elias Mountains, Yukon Territory, Canada. Our data indicate the onset of strongly correlated multi-day oscillations in water pressure in multiple boreholes straddling a main drainage axis, starting several weeks after the disappearance of a dominant diurnal mode in August 2011 and persisting until at least January 2012, when multiple data loggers suffered power failure. Jökulhlaups provide a template for understanding spontaneous water pressure oscillations not driven by external supply variability. Using a subglacial drainage model, we show that water pressure oscillations can also be driven on a much smaller scale by the interaction between conduit growth and distributed water storage in smaller water pockets, basal crevasses and moulins, and that oscillations can be triggered when water supply drops below a critical value. We suggest this in combination with a steady background supply of water from ground water or englacial drainage as a possible explanation for the observed wintertime pressure oscillations.