Harinder Jaseja
Vellore EEG Center, India
Biography
The pathogenesis and management of intractable epilepsy (IE) remain a challenge to neuroscientists even today. Electrical stimulation techniques like vagal nerve and deep brain stimulations have assumed significant role as adjunctive therapies. The author postulates pedunculopontine nucleus (PPN) stimulation as an adjunctive therapy in IE, essentially based on the strong antiepileptic property of rapid eye movement (REM) sleep controlled by acetylcholine neurons (AChN) in the PPN, the stimulation of which is found to induce and enhance REM sleep. Even the severe EEG abnormalities (hypsarrhythmia) in West syndrome (WS) disappear during REM sleep; furthermore, in autopsy examination of cases of WS, the number of AChN in PPN in particular have been found to be reduced with relative preservation of other neurons, suggesting a specific involvement of AChN in epileptogenesis. Adrenocorticotrphic hormone is believed to decrease intractable spasms in WS not only through hypothalamo-hypophyseal-adrenal axis but also through a direct action on the pontine tegmentum probably via REM sleep and the anticonvulsant, lamotrigine, is also found to block alpha4beta2nAChRs-mediated currents. Therefore, PPN stimulation is postulated for inducing and enhancing the genesis of REM sleep throughout the night sleep time that is composed mainly of non-rapid eye movement fraction during which the susceptibility to seizure generation and occurrence is known to be enhanced. Involvement and functioning of the PPN in locomotion have formed the basis of its stimulation in controlling gait impairment in Parkinson’s disease. Based on the novel technique, a patent-application has been filed in the United States Patent and Trademark Office.