I would probably never have begun looking into this part of the brain except for the posts here about arterial compression of the penducle in the brain and how, at least in one patient, alleviating that pressure resulted in disappearance of PD symptoms.

The penduncle is very heavily involved, it seems, in movement for all of the body. The following excerpt is from wiki:

"Mainly, the three common areas that give rise to the cerebral peduncles are the cortex, the spinal cord and the cerebellum.[1] The cerebral peduncle, by most classifications, is everything in the mesencephalon except the tectum.[citation needed] The region includes the midbrain tegmentum, crus cerebri and pretectum. By this definition, the cerebral peduncles are also known as the basis pedunculi, while the large ventral bundle of efferent fibers is referred to as the crus cerebri or the pes pedunculi. There are numerous nerve tracts located within this section of the brainstem. Of note, in the cerebral peduncular loop fibers from motor areas of the brain project to the cerebral peduncle and then project to various thalamic nuclei.

Important fibers running through the cerebral peduncles include the corticospinal tract and the corticobulbar tract, among others. In as much as the peduncles are an anatomic landmark, for details regarding the function of this area interested readers are referred to the individual referenced articles. On a broad scale, though, this area contains many nerve tracts conveying motor information to and from the brain to the rest of the body."

I find it especially interesting that fibers project into the thalamic nuclei, an area targeted for DBS.

that PPN DBS targets is it not?

Check this out:
http://www.itnonline.com/article/mri-study-suggests-brain-blood-vessel-abnormality-may-be-factor-parkinsons-disease

I would LOVE for my problem be a compression of a vessel feeding the brain!
Peg

Yes, this Dr. is what got me started on this path, it's amazing. If you google his name, you'll find that the 20 patients who have had MRI are now being set up for surgery to see if they can replicate the results of the first patient. At least that's how I understand the status of things right now.

What is also very intriguing to me is that of the 20 control/nonPD folks used in the study, only 2 of the 20 had any compression of the penduncle, and one of those was subsequently dx'd with PD I think a year later. I do not believe that is a coincidence. One of the articles I read said that they grade the compression as either 0, for no compression, grade1, for slight compression, and grade 2, for severe compression. I think the control person who was dx'd with PD after the MRI study participation was a grade 2. Again, this is significant. The body can cope for so long, and then the balance just tips and symptoms start to show. And to complicate things, everyone has their own unique tipping point.

Like most here, I spend a huge amount of time and energy researching PD. I have never read of anything close to the 78% similarity among his PWP group reported by Dr. Jannetta. It seems so much time and money has been spent looking for biomarkers, common genetic patterns, geographical similarities, etc, and nothing has shown as high a percentage as a common factor in the PWP studied as this does. Remember uric acid, and that was only about 15-20% of PWP studied who had high levels of uric acid, if I remember correctly.

From the articles I have read on this, it sounds like they are going to try to do the decompression surgery on the 20 PWP in the MRI study soon, so results should be out soon. Given that the first patient woke up from surgery almost PD symptom free, and was completely symptom free by day 5 post-op, I think we will hear relatively soon after these surgeries whether those spectacular results seen with the first patient were replicated. Let's all hope and pray that they are.

If this research is valid it has to relate, explain or negate the accepted fact that dopamine defficiency plays a major role in PD.
The report that "the first patient woke up from surgery almost PD symptom free, and was completely symptom free by day 5 post-op" indicates that the PD this patient has is not related to l-dopa responsive disease.
It is nothing short of miracle if this research throws from window 50 years of work since l-dopa was discovered to treat symtomps of PD.
Imad

http://neurotalk.psychcentral.com/thread157362.html

i posted about this a few days ago and there is a comment from annamaria that is very interesting.

paula

the full text of the journal article is at

http://www.pagepress.org/journals/in...ni.2011.e7/pdf

well worth reading

in Neurology International, v. 3 #2, 2011
"Parkinson’s disease: an inquiry into the etiology and treatment", peter Jannetta, et al.

This is an open-access, online journal.

p. 26 -- Discussion section is especially interesting. They state that they have known about the role of this syndrome in a number of other diseases since 1966, but the knowledge has "not penetrated into the general medicine literature"

One reason arterial compression of the cerebral penduncle has not been noted is that the procedures used in autopsy of the brain destroys the anatomical evidence .

When i read stuff like the above statement, I just about lose hope. That was 35 years ago. How does one react to that? It seems like we have no one representing us anywhere. Now it finallly makes it into the media.....that's just the tip of the iceberg before it might ever become a treatment. Are they training doctors for the surgery? The FDA wants us all dead it seems- they take so long. The older it is the better i'm learning. we have an ideal situation here. we have knowledgeable scientists, knowledgeable patients, global organization in progress, and the #1 fundraiser in the history of PD on this board. Can we please get this funded with urgency?

AS I posted on a different thread, I think this has associations with normal pressure hydrocephalus, syringomelia, and arnold chiari malformations, because they too lead to PD type symptoms that are hard to differentiate.

For an interesting and different perspective try this link:

http://www.upright-health.com/parkinsons.html

There is another connection with chronic venous insufficiency, CCSVI is mentioned. And compression of the venous system...... if the arteries get the blood there, then the venous system returns it..... seems like two aspects of the same thing......

Together these things offer a picture of brains that are structurally individual, that may be malfunctioning due to compression of different parts of the same system......

This author is coming from a very different perspective, one I am happy to take into consideration because many people, and that includes myself, reported early neck and shoulder symptoms that preceded their diagnosis.

My rationale is that potentially these kind of perspectives add to a picture of Pd........ that they are not mutually exclusive.

I think that the big key word we seem to have overlooked is this from the article abstract:

Microvascular decompression of that artery away from the peduncle may be considered for treatment for Parkinson's Disease for some patients.

Paula makes a provocative statement about this theory being around and now finally making its way into media. Yet Paula it isn't really...and this is the telling part. There is absolutely no mention of Dr. Jannetta or the peduncle at either PD Online Research or MJF site!! If this was a major anything, wouldn't researchers be all abuzz at their "think tank" PD Online Research and MJF at least mention it anywhere? Neither site references it anywhere. The silence is deafening.

I think that it is not going to make a splash because they have us all believing that Parkinsonism is a sporadic disease in the vast majority of us. This doctor from Pittsburgh has just uncovered something for "Vascular Parkinsonism", not us in the idiopathic dumping ground. My question is how do they know that this does not have wider implication for any of us. The statistics Jannetta quoted were also telling. How do they know that the vast majority of us do not have this going on?

They test us for absolutely nothing. If we are lucky we get an MRI...yet there are causes of Parkinsonism that are undetectable because the imaging is so inadequate with MRI. I ran across a PD fact sheet somewhere that listed over 50 causes of Parkinsonism. I run across more monthly. Call me crazy and it sounds out there, but I believe more and more that we do not have a disease! This is our brain's reaction to trauma that primarily impacts the substantia nigra. This is why we have cardinal symptoms but the similarities stop right there. Where our differences lie lead us back to one of those 50 or so things that cause Parkinsonsim. Read Harley's post. She is not producing dopamine like she should but she is not losing neurons. To these main causes we can add the peduncle constricture and two more I found this past week both of which I think also may be much more prevalent.

One article, but if you read any more on "chronic diffuse axonal injury" you'll see Parkinsonism symptoms appear quite frequently.

Blink reflex changes in parkinsonism following severe traumatic brain injury correlates with diffuse axonal injury.


This finding on subdural hematoma merits just as much head scratching...there are numerous case studies and the syndrome is reversible; patients respond to levodopa.
Parkinsonian syndrome associated with subacute subdural haematoma and its effective surgical treatment: a case report.


How many of us have ever fallen and clunked our heads? You need not have a concussion to end up with a subdural hematoma.

Furthermore, I have read of cases where PWP develop vascular parkinsonism that results in what we would call "freezing of gait"
but is called "Gait Apraxia" in the vascular form. In reading lit in both areas, I can't see how gait apraxia and freezing differ though apraxia doesn't respond to levodopa, well sometimes neither does freezing. Are these even separate entities?

So my crazy theory is that 70% of us diagnosed with "Idiopathic PD"...if we were given even a battery of basic tests to rule out genetic PD, vascular, or viral PD, that a good chunk of that idiopathic percentage would redistribute into one of these categories. Nope, instead when Young Onset, maybe they test you for Wilson's Disease, proclaim your MRI normal, and slap you with the the PD label and set you off on a conveyor belt that profoundly alters the course of your life. I understand they cannot test us for 50+ things, but I think we can see here that we should be offered way more in diagnosis and treatment than the crap we now have that passes for medicine. This also tells me it is a colossal waste of talent, time, and money looking for a cause when far better for all of us would be to figure out why the heck the Substantia Nigra is so vulnerable in the first place.