Movement-related cortical potentials in patients with Machado-Joseph disease

Bereitschaftspotential in Multiple System Atrophy

Objective: Multiple system atrophy (MSA) is a neurodegenerative disorder manifesting as parkinsonism, cerebellar ataxia, and autonomic dysfunction. It is categorized into MSA with predominant parkinsonism (MSA-P) and into MSA with predominant cerebellar ataxia (MSA-C). The pathophysiology of motor control circuitry involvement in MSA subtype is unclear. Bereitschaftspotential (BP) is a feasible clinical tool to measure electroencephalographic activity prior to volitional motions. We recorded BP in patients with MSA-P and MSA-C to investigate their motor cortical preparation and activation for volitional movement.

Methods: We included eight patients with MSA-P, eight patients with MSA-C, and eight age-matched healthy controls. BP was recorded during self-paced rapid wrist extension movements. The electroencephalographic epochs were time-locked to the electromyography onset of the voluntary wrist movements. The three groups were compared with respect to the mean amplitudes of early (1,500–500 ms before movement onset) and late (500–0 ms before movement onset) BP.

Results: Mean early BP amplitude was non-significantly different between the three groups. Mean late BP amplitude in the two patient groups was significantly reduced in the parietal area contralateral to the movement side compared with that in the healthy control group. In addition, the late BP of the MSA-C group but not the MSA-P group was significantly reduced at the central parietal area compared with that of the healthy control group.

Conclusions: Our findings suggest that patients with MSA exhibit motor cortical dysfunction in voluntary movement preparation and activation. The dysfunction can be practicably evaluated using late BP, which represents the cerebello-dentato-thalamo-cortical pathway.

Rating scales and biomarkers for CAG-repeat spinocerebellar ataxias: Implications for therapy development

Spinocerebellar ataxias (SCAs) are a group of dominantly-inherited cerebellar ataxias, among which CAG expansion-related SCAs are most common. These diseases have very high penetrance with defined disease progression, and emerging therapies are being developed to provide either symptomatic or disease-modifying benefits. In clinical trial design, it is crucial to incorporate biomarkers to test target engagement or track disease progression in response to therapies, especially in rare diseases such as SCAs. In this article, we review the available rating scales and recent advances of biomarkers in CAG-repeat SCAs. We divided biomarkers into neuroimaging, body fluid, and physiological studies. Understanding the utility of each biomarker will facilitate the design of robust clinical trials to advance therapies for SCAs.

Event-Related Desynchronization/Synchronization in Spinocerebellar Ataxia Type 3

Introduction: Spinocerebellar ataxia type 3 (SCA3) is an autosomal dominant, cerebellar degeneration predominant disease caused by excessive CAG repeats. We examined event-related dysynchronization/synchronization (ERD/ERS) in patients with SCA3.

Methods: We assessed ERD/ERS of self-paced voluntary hand movements in 15 patients with genetically proven SCA3 in comparison with healthy controls.

Results: In ERS, a significant interaction effect between group, frequency, and period (F = 1.591; p = 0.005; ρI = 0.86) was observed. The post-hoc two-tailed independent t-test showed significant differences in high beta and low beta ERS. By contrast, in ERD, no apparent differences were observed in the pattern of patients with SCA3 in comparison with healthy controls (F = 1.01; p = 0.442).

Conclusion: The study revealed a decreased ERS in patients with SCA3, especially at the frequency of 20–30 Hz. This study elucidates the significant role of cerebellum in motor control.

State biomarkers for Machado Joseph disease: Validation, feasibility and responsiveness to change

Machado-Joseph disease (SCA3/MJD) is the most common spinocerebellar ataxia worldwide, and particularly so in Southern Brazil. Due to an expanded polyglutamine at ataxin-3, SCA3/MJD presents a relentless course with no current disease modifying treatment. Clinical scales used to measure SCA3/MJD progression present moderate effect sizes, a major drawback for their use as main outcomes in clinical trials, given the rarity and slow progression of the disease. This limitation might be overcome by finding good surrogate markers. We present here a review of studies on peripheral and neurophysiological markers in SCA3/MJD that can be candidates for state biomarkers. Data on markers already studied were summarized, giving emphasis on validation against clinical scale, and responsiveness to change. While some biological fluid compounds and neurophysiological parameters showed poor responsiveness, others seemed to be good candidates. Some potential candidates that are waiting for responsiveness studies were serum levels of neuron specific enolase, vestibulo-ocular reflex and video-oculography. Candidates evaluated by RNA and microRNA expression levels need further studies to improve their measurements. Data on peripheral levels of Beclin-1 and DNAJB1 are promising but still incipient. We conclude that several potential candidates should follow onto validating studies for surrogate state biomarkers of SCA3/MJD.

Anatomical and electrophysiological manifestations in a patient with congenital corpus callosum agenesis

The corpus callosum is the major brain structure responsible for the transferring of information between the two hemispheres. In congenital agenesis of the corpus callosum (ACC), an alternative functional connection might exist between the hemispheres; however, this has yet to be demonstrated. The present study evaluated a 27-year-old man with ACC but no detectable motor function deficits using diffusion tensor imaging (DTI), movement-related cortical potential (MRCP), and interhemispheric inhibition (IHI). The MRCP was analyzed at the electrodes of C3, FCZ, and C4. IHI was measured using paired transcranial magnetic stimulation over the hand area of the primary motor cortex at both hemispheres. Data of the patient were compared with those of an age-matched healthy control group (n = 8, mean age: 27.6 ± 2.5 years). DTI showed absence of the callosal fibers and the presence of enhanced transcommissural fibers in the ACC patient. The mean fractional anisotropy of the transcommissural fibers revealed a significant difference between the patient and the control group (0.62 vs. 0.43, p < 0.01). The MRCP and IHI, supposed to be highly relevant to the transcallosal pathway, were present in the patient though they occurred to a relatively low degree compared to the control group. Findings suggest that in the ACC patient, the abnormal transcommissural fibers might be functional and serve as an alternative pathway connecting the bilateral hemispheres.

The role of the sub-thalamic nucleus in the preparation of volitional movement termination in Parkinson's disease

The sub-thalamic nucleus (STN) is relevant to the preparation of movement ignition but its role in movement termination is uncertain. Fourteen patients with Parkinson's disease (PD) received local field potentials (LFPs) recording at the left STN on the fourth day after deep brain stimulation surgery. They performed phasic and tonic movements of the right wrist extensor. Movement onset (Mon) and movement offset (Moff) of the electromyographic activities were used as triggers to determine an eight-second LFPs epoch for time-frequency analysis. Movement-related power changes were assessed by repeated measures analysis of variance with within-subject factors of Event (Mon and Moff), Period (ten time periods for phasic movement and six time periods for tonic movement), and Frequency (alpha, low-beta, and high-beta). There was significant triple interaction in both the phasic and tonic movements. By post-hoc analysis, high-beta event-related de-synchronization (ERD) appeared earlier (3s prior to Mon) than those of low-beta and alpha for the Mon phasic movement. There was no alpha ERD for the Mon tonic movement. Alpha, low-beta, and high-beta ERD all appeared about 1s prior to the Moff tonic movement. The current findings suggest that STN participates in the preparation of volitional movement termination but via a different mechanism from that in movement initiation. Unlike asynchronous ERD frequency bands present in movement initiation, a simultaneous ERD across wide frequency bands in STN may play a pivotal role in terminating volitional movement.

The Bereitschaftspotential in essential tremor

OBJECTIVE

Essential tremor (ET) is an involuntary postural oscillation. It is unclear to which extent motor cortical activity in preparation of volitional movement is abnormal in ET. We measured the Bereitschaftspotential (BP) to address this question.

METHODS

Given the known influence of the cerebello-dentato-thalamo-cortical projection in the generation of the BP, patients were divided into two groups, defined by purely postural tremor (ET(PT)) or additional presence of intention tremor (ET(IT)) and compared to healthy controls. BP was recorded during self-paced rapid wrist extension movements.

RESULTS

The late BP (500-0 ms before movement onset) was increased over the mid-frontal area in ET(PT), whereas it was reduced over the mid-parietal area in ET(IT) when compared to healthy controls. In addition, the late BP was reduced over a widespread centro-parietal area in ET(IT) compared to ET(PT).

CONCLUSIONS

Findings suggest that presence vs. absence of cerebellar signs (intention tremor) in ET results in differential affection of volitional preparatory motor cortical activity. The BP increase in ET(PT) may indicate compensatory activity, whereas the widespread centro-parietal BP reduction in ET(IT) suggests dysfunction of the cerebello-dentato-thalamo-cortical projection.

SIGNIFICANCE

Reduction of the late BP amplitude may serve as a surrogate marker for dysfunction of the cerebello-dentato-thalamo-cortical projection in ET.

Modulation of preparatory volitional motor cortical activity by paired associative transcranial magnetic stimulation

Paired associative transcranial magnetic stimulation (PAS) has been shown to induce long-term potentiation (LTP)-like or long-term depression (LTD)-like change in excitability of human primary motor cortex (M1), as probed by motor evoked potential (MEP) amplitude. In contrast, little is known about PAS effects on volitional motor cortical activity. In 10 healthy subjects, movement related cortical potentials (MRCP) were recorded to index volitional motor cortical activity during preparation of simple thumb abduction (prime mover: abductor pollicis brevis, APB) or wrist extension movements (prime mover: extensor carpi radialis, ECR). PAS(LTP) increased, PAS(LTD) decreased, and PAS(control) did not change MEP(APB), while MEP(ECR), not targeted by PAS, remained unchanged in all PAS conditions. PAS(LTP) decreased MRCP negativity during the late Bereitschaftspotential (-500 to 0 ms before movement onset), only in the APB task, and predominantly over central scalp electrodes contralateral to the thumb movements. This effect correlated negatively with the PAS(LTP) induced increase in MEP(APB). PAS(LTD) and PAS(control) did not affect MRCP amplitude. Findings indicate a specific interference of PAS with preparatory volitional motor cortical activity, suggestive of a net result caused by increased M1 excitability and disrupted effective connectivity between premotor areas and M1.