Deep Brain Stimulation (DBS)

upon Parkinson’s Disease

From conventional targets to Nucleus
Basalis of Meynert
 Overview
• Parkinson’s Disease (PD)
• Etiology/Pathogenesis
• Symptoms
• DBS history upon PD
• The relevance of DBS therapy in PD
• Target
• Nucleus Basalis of Meynert
Nucleus Basalis of Meynert (nbM)

(Liu et al, 2015)

Where is nbM in the brain?

Gratwicke et al, 2013

Basal Forebrain Cholinergic Cell Groups and
Their Projections in the Brain

Mesulam et al, 1983

Projected Innervation Map of the Various
Ch4 Region

(Liu et al, 2015)

Studies of the nbM in PD

(Liu et al, 2015)

Studies of the nbM in PDD

(Liu et al, 2015)

anatomical progression of pathology within the nbM
with possible clinicopathological correlations
(Liu et al, 2015)
(Liu et al, 2015)
nbM around other structurese
 NBM in AD
• NGF-R ligand: trkA & p75NTR; p75NTR is less
expressed in AD -> promote less
neuroregeneration in NBM
• Ca imbalance due to reduced expression of
calbindin and GluR2 -> excitotoxic cell death
• Hyper-inervation of galaninergic neuron
(potentially inhibit neighboring chol neuron

Gratwicke et al, 2013

 NBM Function (Gratwicke et al 2013)
• Memory
• Attention
• Modulation of the behavioural state:
readiness, enhancing perceptual
enhancement and lowered threshold to
induce memory
 Pathological difference
between AD & PD
• PD: neurodegeneration in NBM, while cortical
projection loss of cholinergic neuron is more
common in AD
• Structural imaging: DT-MRI, MRI
• Functional imaging: PET: AChE tracer
• Test: MMSE & WAIS-III digit span test