Defective utilization of sensory input as the basis for bradykinesia, rigidity and decreased movement repertoire in Parkinson's disease: a hypothesis

Latent Potential of Multifunctional Selenium Nanoparticles in Neurological Diseases and Altered Gut Microbiota

Neurological diseases remain a major concern due to the high world mortality rate and the absence of appropriate therapies to cross the blood-brain barrier (BBB). Therefore, the major focus is on the development of such strategies that not only enhance the efficacy of drugs but also increase their permeability in the BBB. Currently, nano-scale materials seem to be an appropriate approach to treating neurological diseases based on their drug-loading capacity, reduced toxicity, targeted delivery, and enhanced therapeutic effect. Selenium (Se) is an essential micronutrient and has been of remarkable interest owing to its essential role in the physiological activity of the nervous system, i.e., signal transmission, memory, coordination, and locomotor activity. A deficiency of Se leads to various neurological diseases such as Parkinson's disease, epilepsy, and Alzheimer's disease. Therefore, owing to the neuroprotective role of Se (selenium) nanoparticles (SeNPs) are of particular interest to treat neurological diseases. To date, many studies investigate the role of altered microbiota with neurological diseases; thus, the current review focused not only on the recent advancement in the field of nanotechnology, considering SeNPs to cure neurological diseases, but also on investigating the potential role of SeNPs in altered microbiota.

Therapeutic Potential and Main Methods of Obtaining Selenium Nanoparticles

This review presents the latest data on the importance of selenium nanoparticles in human health, their use in medicine, and the main known methods of their production by various methods. In recent years, a multifaceted study of nanoscale complexes in medicine, including selenium nanoparticles, has become very important in view of a number of positive features that make it possible to create new drugs based on them or significantly improve the properties of existing drugs. It is known that selenium is an essential trace element that is part of key antioxidant enzymes. In mammals, there are 25 selenoproteins, in which selenium is a key component of the active site. The important role of selenium in human health has been repeatedly proven by several hundred works in the past few decades; in recent years, the study of selenium nanocomplexes has become the focus of researchers. A large amount of accumulated data requires generalization and systematization in order to improve understanding of the key mechanisms and prospects for the use of selenium nanoparticles in medicine, which is the purpose of this review.

Speech Intensity Response to Altered Intensity Feedback in Individuals With Parkinson's Disease

Purpose Hypophonia (low speech intensity) is the most common speech symptom experienced by individuals with Parkinson's disease (IWPD). Previous research suggests that, in IWPD, there may be abnormal integration of sensory information for motor production of speech intensity. In the current study, intensity of auditory feedback was systematically manipulated (altered in both positive and negative directions) during sensorimotor conditions that are known to modulate speech intensity in everyday contexts in order to better understand the role of auditory feedback for speech intensity regulation. Method Twenty-six IWPD and 24 neurologically healthy controls were asked to complete the following tasks: converse with the experimenter, start vowel production, and read sentences at a comfortable loudness, while hearing their own speech intensity randomly altered. Altered intensity feedback conditions included 5-, 10-, and 15-dB reductions and increases in the feedback intensity. Speech tasks were completed in no noise and in background noise. Results IWPD displayed a reduced response to the altered intensity feedback compared to control participants. This reduced response was most apparent when participants were speaking in background noise. Specific task-based differences in responses were observed such that the reduced response by IWPD was most pronounced during the conversation task. Conclusions The current study suggests that IWPD have abnormal processing of auditory information for speech intensity regulation, and this disruption particularly impacts their ability to regulate speech intensity in the context of speech tasks with clear communicative goals (i.e., conversational speech) and speaking in background noise.

Glycine nano-selenium prevents brain oxidative stress and neurobehavioral abnormalities caused by MPTP in rats

BACKGROUND

Parkinson's disease (PD) is a common degenerative disease of the central nervous system in the elderly. In recent years, the results of clinical and experimental studies have shown that oxidative stress is one of the important pathogenesis of PD. Selenium is one of the minor elements reported to possess antioxidant properties. Thus, the purpose of this study was to investigate the recovery effect of glycine nano-selenium on neurobehavioral abnormalities and oxidative stress caused by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) in rat.

MATERIALS AND METHODS

SD male rats weighing 280-310 g were purchased from the Chengdu Dossy Experimental Animals Company, China. All rats were housed in a temperature-controlled room, with a 12 h light-dark cycles and had free access to food and water ad libitum. Rats were randomly divided into 4 groups with 8 animals in each group: the control group (normal saline), 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine group (MPTP), MPTP + 0.05 mg/kg glycine nano-selenium (MPTP + 0.05 Se), MPTP + 0.1 mg/kg glycine nano-selenium (MPTP + 0.1 Se). Behavioral assessment, clinical symptoms, Immunohistochemistry analysis of tyrosine hydroxylase (TH) and antioxidant activity were accessed to determine the protective effects glycine nano-selenium have on PD rats.

RESULTS

From the results, Rats showed a decrease in spontaneous motor behavior and an increase in pole test score. Also, the number of TH⁺ neurons were also significantly decreased (P < 0.05) after treated with MPTP for 7 days indicating that MPTP could successfully induce neurobehavioral abnormalities in rats. Furthermore, the lipid peroxide (MDA) levels of the PD model group were significantly increased and the antioxidant activities (SOD and GSH-PX) were significantly inhibited (P < 0.05) compared to the control group indicating the important role oxidative stress played in dopaminergic neuron death and neurobehavioral abnormalities in PD rats. Compared with the PD model group, glycine nano-selenium administration could significantly improve behavior and increase the number of TH⁺ neurons (P < 0.05) to protect against the loss of dopaminergic neurons. At the same time, glycine nano-selenium could decrease the MDA levels and increase the activities of SOD and GSH-PX significantly (P < 0.05).

CONCLUSION

In conclusion, PD rat model was successfully developed by intraperitoneal injection of MPTP and the intragastric administration of glycine nano-selenium reduced neurobehavioral abnormalities by decreasing oxidative stress in rat brain.

Amplitude and velocity dependence of patellar pendulum triggered by T reflex in Parkinson's rigidity

OBJECTIVES

The relation between increase of tonus and joint movement velocity is controversial in Parkinson's rigidity. It is accepted that the increase of tonus in rigidity is constant during joint movement, and does not change within all limits of movement. However, there is thoughtful evidence that the change in tonus in rigidity has a correlation with joint movement velocity and amplitude of movement. The pendulum movement that is formed by triggering of the patellar T reflex allows the examination of phasic stretching reflexes and physiological changes of passive stretching. Therefore, the velocity and amplitude properties of tonus in Parkinson's rigidity can be scanned together.

MATERIALS AND METHODS

Patellar T reflex-triggered patellar pendulum was recorded in 40 Parkinson's patients. The velocity and amplitude changes in the pendulum were observed according to the rigidity scale. Muscle action potentials were recorded from the rectus femoris muscle and biceps femoris muscles simultaneously via superficial recording electrodes. Knee joint angle changes were recorded with a goniometer. The kinesiological and electromyographic features were compared with those of the control subjects.

RESULTS

The number of pendulums decreased significantly, the angle of joint movement decreased, the peak time decreased and the angular velocity slowed down significantly in the Parkinson's group. While the latency of the patellar T reflex did not change significantly, its amplitude decreased, and the onset time of joint movement measured by accelerometer was prolonged.

CONCLUSIONS

Parkinson's rigidity has a velocity-dependent component, and this correlates negatively with the rigidity scale.

Autophonic loudness perception in Parkinson's disease

The relationship between the intensity and loudness of self-generated (autophonic) speech remains invariant despite changes in auditory feedback, indicating that non-auditory processes contribute to this form of perception. The aim of the current study was to determine if the speech perception deficit associated with Parkinson's disease may be linked to deficits in such processes. Loudness magnitude estimates were obtained from parkinsonian and non-parkinsonian subjects across four separate conditions: self-produced speech under normal, perturbed, and masked auditory feedback, as well as auditory presentation of pre-recorded speech (passive listening). Slopes and intercepts of loudness curves were compared across groups and conditions. A significant difference in slope was found between autophonic and passive-listening conditions for both groups. Unlike control subjects, parkinsonian subjects' magnitude estimates under auditory masking increased in variability and did not show as strong a shift in intercept values. These results suggest that individuals with Parkinson's disease rely on auditory feedback to compensate for underlying deficits in sensorimotor integration important in establishing and regulating autophonic loudness.

Face-referenced measurement of perioral stiffness and speech kinematics in Parkinson's disease

PURPOSE

Perioral biomechanics, labial kinematics, and associated electromyographic signals were sampled and characterized in individuals with Parkinson's disease (PD) as a function of medication state.

METHOD

Passive perioral stiffness was sampled using the OroSTIFF system in 10 individuals with PD in a medication ON and a medication OFF state and compared to 10 matched controls. Perioral stiffness, derived as the quotient of resultant force and interoral angle span, was modeled with regression techniques. Labial movement amplitudes and integrated electromyograms from select lip muscles were evaluated during syllable production using a 4-D computerized motion capture system.

RESULTS

Multilevel regression modeling showed greater perioral stiffness in patients with PD, consistent with the clinical correlate of rigidity. In the medication-OFF state, individuals with PD manifested greater integrated electromyogram levels for the orbicularis oris inferior compared to controls, which increased further after consumption of levodopa.

CONCLUSIONS

This study illustrates the application of biomechanical, electrophysiological, and kinematic methods to better understand the pathophysiology of speech motor control in PD.

Loudness perception and speech intensity control in Parkinson's disease

The aim of this study was to examine loudness perception in individuals with hypophonia and Parkinson's disease. The participants included 17 individuals with hypophonia related to Parkinson's disease (PD) and 25 age-equivalent controls. The three loudness perception tasks included a magnitude estimation procedure involving a sentence spoken at 60, 65, 70, 75 and 80 dB SPL, an imitation task involving a sentence spoken at 60, 65, 70, 75 and 80 dB SPL, and a magnitude production procedure involving the production of a sentence at five different loudness levels (habitual, two and four times louder and two and four times quieter). The participants with PD produced a significantly different pattern and used a more restricted range than the controls in their perception of speech loudness, imitation of speech intensity, and self-generated estimates of speech loudness. The results support a speech loudness perception deficit in PD involving an abnormal perception of externally generated and self-generated speech intensity.

LEARNING OUTCOMES

Readers will recognize that individuals with hypophonia related to Parkinson's disease may demonstrate a speech loudness perception deficit involving the abnormal perception of externally generated and self-generated speech intensity.

Primary motor cortex of the parkinsonian monkey: altered neuronal responses to muscle stretch

Exaggeration of the long-latency stretch reflex (LLSR) is a characteristic neurophysiologic feature of Parkinson's disease (PD) that contributes to parkinsonian rigidity. To explore one frequently-hypothesized mechanism, we studied the effects of fast muscle stretches on neuronal activity in the macaque primary motor cortex (M1) before and after the induction of parkinsonism by unilateral administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). We compared results from the general population of M1 neurons and two antidromically-identified subpopulations: distant-projecting pyramidal-tract type neurons (PTNs) and intra-telecenphalic-type corticostriatal neurons (CSNs). Rapid rotations of elbow or wrist joints evoked short-latency responses in 62% of arm-related M1 neurons. As in PD, the late electromyographic responses that constitute the LLSR were enhanced following MPTP. This was accompanied by a shortening of M1 neuronal response latencies and a degradation of directional selectivity, but surprisingly, no increase in single unit response magnitudes. The results suggest that parkinsonism alters the timing and specificity of M1 responses to muscle stretch. Observation of an exaggerated LLSR with no change in the magnitude of proprioceptive responses in M1 is consistent with the idea that the increase in LLSR gain that contributes to parkinsonian rigidity is localized to the spinal cord.

Gait disorders

This chapter deals with the neuronal mechanisms underlying impaired gait. The aim is, first, a better understanding of the underlying pathophysiology and, second, the selection of an adequate treatment. One of the first symptoms of a lesion within the central motor system perceived by patients is a movement disorder, which is most characteristic during locomotion, e.g. in patients suffering spasticity after stroke or a spinal cord injury or Parkinson disease. By the recording and analysis of electrophysiological and biomechanical signals during a movement, the significance of impaired reflex behavior or muscle tone and its contribution to the movement disorder can reliably be assessed. Adequate treatment should not be restricted to the correction of an isolated clinical sign but should be based on the mechanisms underlying the movement disorder that impairs the patient. Therapy should be directed toward functional training, which takes advantage of the plasticity of the nervous system. In the future a combination of repair and functional training will further improve the mobility of disabled patients.

Increased use of target cues during visuo-motor tracking in Parkinson's disease

The effect of temporarily suppressing the visual display of either the target or actual movement trajectory upon the accuracy of visuo-motor tracking was studied in patients with Parkinson's disease (PD) and healthy subjects. Subjects made wrist movements to superimpose a movement cursor upon a target cursor on a VDU screen. The tracking of slow ramp and sinewave target waveforms was investigated. Trials involving the three conditions of visual suppression, namely, target suppressed (TS), movement suppressed (MS) and non-suppressed (NS) were ordered randomly. In TS and MS trials, respectively, the target or movement cursor disappeared from the subject's view for a 4 s period whilst in NS trials both the target and movement cursors were continuously present. Prior to experimental trials, subjects initially practised a series of NS movements. Tracking errors were analysed by ANOVA for group, suppression condition and waveform effects. The tracking performance of the PD patients, during each form of suppression condition, was worse than that of healthy subjects. Both TS and MS elicited significant reductions in accuracy across groups and waveforms. TS induced a more pronounced impairment of tracking accuracy in the PD group than in the control group suggesting that parkinsonians exhibit an abnormally increased reliance upon visual information of the required trajectory during the present visuo-motor tracking tasks. By contrast, there was no between-group effect of MS in these tasks, suggesting that PD patients show a comparable dependence upon visual feedback of their own movements to that shown by controls.

Vocal responses to perturbations in voice auditory feedback in individuals with Parkinson's disease

BACKGROUND

One of the most common symptoms of speech deficits in individuals with Parkinson's disease (PD) is significantly reduced vocal loudness and pitch range. The present study investigated whether abnormal vocalizations in individuals with PD are related to sensory processing of voice auditory feedback. Perturbations in loudness or pitch of voice auditory feedback are known to elicit short latency, compensatory responses in voice amplitude or fundamental frequency.

METHODOLOGY/PRINCIPAL FINDINGS

Twelve individuals with Parkinson's disease and 13 age- and sex-matched healthy control subjects sustained a vowel sound (/α/) and received unexpected, brief (200 ms) perturbations in voice loudness (±3 or 6 dB) or pitch (±100 cents) auditory feedback. Results showed that, while all subjects produced compensatory responses in their voice amplitude or fundamental frequency, individuals with PD exhibited larger response magnitudes than the control subjects. Furthermore, for loudness-shifted feedback, upward stimuli resulted in shorter response latencies than downward stimuli in the control subjects but not in individuals with PD.

CONCLUSIONS/SIGNIFICANCE

The larger response magnitudes in individuals with PD compared with the control subjects suggest that processing of voice auditory feedback is abnormal in PD. Although the precise mechanisms of the voice feedback processing are unknown, results of this study suggest that abnormal voice control in individuals with PD may be related to dysfunctional mechanisms of error detection or correction in sensory feedback processing.

Rhythmic movement in Parkinson's disease: effects of visual feedback and medication state

Previous studies examining discrete movements of Parkinson's disease (PD) patients have found that in addition to performing movements that were slower than those of control participants, they exhibit specific deficits in movement coordination and in sensorimotor integration required to accurately guide movements. With medication, movement speed was normalized, but the coordinative aspects of movement were not. This led to the hypothesis that dopaminergic medication more readily compensates for intensive aspects of movement (such as speed), than for coordinative aspects (such as coordination of different limb segments) (Schettino et al., Exp Brain Res 168:186-202, 2006). We tested this hypothesis on rhythmic, continuous movements of the forearm. In our task, target peak speed and amplitude, availability of visual feedback, and medication state (on/off) were varied. We found, consistent with the discrete-movement results, that peak speed (intensive aspect) was normalized by medication, while accuracy, which required coordination of speed and amplitude modulation (coordinative aspect), was not normalized by dopaminergic treatment. However, our findings that amplitude, an intensive aspect of movement, was also not normalized by medication, suggests that a simple pathway gain increase does not act to remediate all intensive aspects of movement to the same extent. While it normalized movement peak speed, it did not normalize movement amplitude. Furthermore, we found that when visual feedback was not available, all participants (PD and controls) made faster movements. The effects of dopaminergic medication and availability of visual feedback on movement speed were additive. The finding that movement speed uniformly increased both in the PD and the control groups suggests that visual feedback may be necessary for calibration of peak speed, otherwise underestimated by the motor control system.

Nociceptive behavioral responses to chemical, thermal and mechanical stimulation after unilateral, intrastriatal administration of 6-hydroxydopamine

The basal ganglia are involved not only with motor processes such as posture, pre-movement planning and movement initiation, but also with the processing and modulation of nociceptive somatosensory information. In the current studies, unilateral, intrastriatal 6-hydroxydopamine (6-OHDA) was used to investigate how dopamine depletion alters nociceptive behavioral responses to chemical, thermal and mechanical stimulation in rats. Compared to control rats injected with intrastriatal saline, rats depleted of dopamine displayed increased nociceptive responses to chemical stimulation of the face and hyperalgesic responses to thermal stimulation of the hind paw without alterations in rearing behavior or body weight gain. Minor changes were observed in the response to mechanical stimulation of the hind paws and face. These data provide further evidence that the dopaminergic nigrostriatal pathway plays a role in the modulation of nociceptive information.

Dopaminergic influence on disturbed spatial discrimination in Parkinson's disease

Various sensory symptoms and disturbed sensory perception are often observed in patients with idiopathic Parkinson's disease (PD). The basis of sensory disturbance in PD is unknown but possibly reflects a role for the basal ganglia in sensory processing. To investigate the relationship between the sensory dysfunction and dopaminergic deficiency in PD, we measured spatial discrimination using the Grating Orientation Task in 21 drug-naive patients with PD, before and after long-term antiparkinson therapy, and 25 age-matched healthy controls. The grating orientation threshold was significantly higher in patients (3.03 +/- 0.84) than controls (2.03 +/- 0.79). After 3 to 10 months of antiparkinson therapy, the grating orientation threshold was significantly lowered (2.66 +/- 0.84), although it was still higher than that in controls. Improvement in the patients' sensory function was significantly correlated with motor improvement (r = 0.44). These results suggest that sensory dysfunction in Parkinson's disease is related at least in part to the dopaminergic deficit.

Deficits in saccadic eye-movement control in Parkinson's disease

In contrast to their slowed limb movements, individuals with Parkinson's disease (PD) produce rapid automatic eye movements to sensory stimuli and show an impaired ability to generate voluntary eye movements in cognitive tasks. Eighteen PD patients and 18 matched control volunteers were instructed to look either toward (pro-saccade) or away from (anti-saccade) a peripheral stimulus as soon as it appeared (immediate, gap and overlap conditions) or after a variable delay; or, they made sequential saccades to remembered targets after a variable delay. We found that PD patients made more express saccades (correct saccades in the latency range of 90-140 ms) in the immediate pro-saccade task, more direction errors (automatic pro-saccades) in the immediate anti-saccade task, and were less able to inhibit saccades during the delay period in all delay tasks. PD patients also made more directional and end-point errors in the memory-guided sequential task. Their inability to plan eye movements to remembered target locations suggests that PD patients have a deficit in spatial working memory which, along with their deficit in automatic saccade suppression, is consistent with a disorder of the prefrontal-basal ganglia circuit. Impairment of this pathway may release the automatic saccade system from top-down inhibition and produce deficits in volitional saccade control. Parallel findings across various motor, cognitive and oculomotor tasks suggest a common mechanism underlying a general deficit in automatic response suppression.

Visual kinesthesia and locomotion in Parkinson's disease

We investigated predominance of visual control in Parkinson's disease (PD) gait regulation and whether visual kinesthesia has systematic effects on gait parameters. Effects of artificial optic flow were studied on walking velocity (WV), stride length (SL), and stride frequency (SF) during treadmill walking in PD patients and young and elderly adults. The independent variable was relative optic flow (rOF), ranging from -1 times (forward flow, i.e., in walking direction) to 3 times WV (backward flow, natural direction). All walkers were influenced similarly by rOF, inducing systematic changes of WV. Backward flow caused a decrease and forward flow an increase of WV. Without effect of rOF, PD patients on average walked at 0.89 meters per second compared to 1.31 meters per second in the age-matched healthy group. The rOF-induced mean changes of WV in all PD patients amounted to 0.45 meters per second (50.4%), with 45.1% due to changes in SL and 5.3% to SF. In the age-matched, rOF-induced WV changes reached 0.18 meters per second (13.8%), with 10.8% due to SL and 3.2% to SF. Thus, compared to the results of the age-matched group, effects of rOF in PD patients were stronger, which increased WV to a normal level by normalization of SL. Contrary to the healthy subjects, no attenuation of optic flow effects over time was observed in the PD patients. Predominance of visual control in PD gait is suggested due to deficits in proprioception compensated by visual kinesthesia, causing exaggerated reaction to visual feedback. The results extend beyond earlier findings, generally stating improvement of PD gait by presence of visual feedback but show systematic effects on gait parameters due to reweighting of visual kinesthesia.

Effect of duration of pitch-shifted feedback on vocal responses in patients with Parkinson's disease

Study of the pitch-shift reflex is useful for the investigation of how auditory feedback is used in the control of voice fundamental frequency. The present study was an attempt to learn if the basal ganglia are involved in central mechanisms of the pitch-shift reflex by comparing measures of the reflex in a group of Parkinson's disease patients with those measures in a group of control participants. The effect of varying duration of the pitch-shift stimulus (PSS) on the voice fundamental frequency (F0) response in 10 Parkinson's disease (PD) patients and 10 age-matched unaffected participants was investigated. Participants were instructed to vocalize into a microphone while their voice was fed back to them over headphones. This feedback of the vocal signal was shifed in pitch either up or down, with the duration of this shift systematically manipulated at 100 ms, 500 ms, and 1000 ms. Although the participants were on medication, making interpretation of the results problematic with regard to basal ganglia function, it was reasoned that positive effects could nevertheless suggest basal ganglia involvement in this reflex and motivate further research. Results indicated that both groups responded to increased stimulus duration of the pitch-shift stimulus with increases in reflex peak time, magnitude, and end times. However, PD patients had significantly longer peak times and end times than control participants for stimulus durations of 100 ms. These results suggest that basal ganglia dysfunction may affect mechanisms relating to the execution and termination of the pitch-shift reflex for brief stimulus durations. The results also support hypotheses of impaired sensory integration of auditory feedback in PD patients.

Volume perception in parkinsonian speech

This study contrasted the volume level of speech production with perceived volume. Fifteen idiopathic patients with Parkinson's disease who have hypophonic dysarthria and 15 healthy age- and sex-matched control subjects participated in this study. Testing took place in a sound-proof room. Ability to regulate volume was tested at three instructional levels of loudness: participants were given no instructions regarding volume (to elicit normal default volume) or were asked to read loudly or quietly. Two types of volume-perception judgments were made. First, an estimate of one's own volume, immediately after speaking (that is, immediate perception), and secondly, an estimation of reading volume after hearing one's own voice played back (that is, playback perception). These perceptual ratings were compared with actual speech volume produced in reading and conversation tasks. It was found that there was less of a difference between patients' production and perception of speech volume compared with that of the control subjects. While patients spoke more quietly than control subjects, they nevertheless perceived (immediate and playback perception) their own speech to be louder than did the control subjects. Patients overestimated the volume of their speech during both reading and conversation. The findings raise the question as to whether impaired speech production is driven by a basic perceptual fault or whether perception is abnormal as a consequence of impaired mechanisms involved in the generation of quiet speech.

Parkinson's disease and lower limb somatosensory evoked potentials: apomorphine-induced relief of the akinetic-rigid syndrome and vertex P37-N50 potentials

We evaluated brainstem P30, vertex-central P37-N50 and contralateral frontal N37 somatosensory evoked potentials (SEPs) from the tibial nerve in 14 patients affected by Parkinson's disease (PD) with akinetic-rigid syndrome. In seven patients SEPs were recorded after administration of apomorphine. The cortical P37-N50 complex was either absent (five patients, eight tested sides) or significantly smaller in patients as compared to the control group (n = 18). There was a relationship between abnormalities of early vertex potentials and degree of motor impairment. Administration of apomorphine was followed by an increase in amplitude of P37-N50 response, which was maximal after 15-30 min and then progressively returned to basal values in parallel with clinical improvement. Amplitude of brainstem P30 and frontal N37 responses was within normal values and did not vary following drug administration. These results suggest that the P37-N50 complex arises from independent cortical generators, probably located in the pre-rolandic cortex, which may be selectively affected by basal ganglia dysfunction. Amplitude decrease of the P37-50 complex may reflect an abnormal processing of somatosensory inputs within the pre-central cortex due to defective modulation exerted by basal ganglia circuitry on cortical excitability. SEP potentiation following apomorphine, besides indicating that this dysfunction is partly reversible, might suggest objective method to measure therapeutic efficacy.

Neurophysiology of gait disorders: present and future applications

This article will review those electrophysiological investigations which have addressed the neuronal mechanisms underlying impaired gait. The aims of the review are to provide further insights to the underlying pathophysiology of impaired gait and also towards the selection of an appropriate treatment. From the patients' point of view the first indication of a central motor system lesion is an impairment of movement, most notably locomotion. These symptoms are characteristic in cases of spasticity, cerebellar lesion or Parkinson's disease. Clinical examination reveals typical changes in tendon tap reflexes and muscle tone which were believed to account for the movement disorder presented. However, we now know that there is only a weak relationship between the physical symptoms observed during clinical examination under passive motor conditions and the altered neuronal mechanisms underlying the impairment during active motion. By recording and analysing electrophysiological and biomechanical parameters during functional movements such as locomotion, the significance of impaired reflex behaviour or the pathophysiology of muscle tone and its contribution to the movement disorder can be reliably assessed. Consequently, the treatment should not be cosmetic, i.e. the correction of an isolated clinical parameter, but should be based on the pathophysiology and significance of those mechanisms underlying the impairment of the patients' movements. Data from electrophysiological and biomechanical investigations of locomotion of patients with spasticity, cerebellar disorder or Parkinson's disease are discussed in this review. The neuronal mechanisms, which are essentially central programs and afferent input, involved in disorders of gait are evaluated on the basis of their function in healthy subjects. The impact of this analysis in deciding an appropriate treatment are discussed with respect to the pathophysiology underlying the gait disorder (spasticity, cerebellar disorder or Parkinson's disease). At the present time we have only a basic understanding of the essential receptor systems, such as leg extensor load receptors, and their interaction with other systems involved in postural control. In the future, the knowledge gained from gait analysis may help in the selection of the appropriate pharmacological and physical treatment required even though the patient may only be at an early stage of motor impairment.

A mismatch between kinesthetic and visual perception in Parkinson's disease

Kinesthesia may be defective in patients with Parkinson's disease (PD), and this defect conceivably has a role in parkinsonian hypokinetic symptoms. In the present study, PD patients used kinesthetic perception to estimate the amplitude of passive angular displacements of the index finger about the metacarpophalangeal joint and to scale them as a percentage of a reference stimulus. The reference stimulus was either a standard kinesthetic stimulus preceding each test stimulus (task K) or a visual representation of the standard kinesthetic stimulus (task V). In task V, the PD patients' underestimation of the amplitudes of finger perturbations was significantly greater than that of normal subjects, but not for task K. PD patients' underestimation was also greater in task V than in task K; the difference between the underestimations was significantly greater than for normal subjects. These results suggest that, when kinesthesia is used to match a visual target, distances are perceived to be shorter by the PD patients. Assuming that visual perception is normal, kinesthesia is "reduced" in PD patients. This reduced kinesthesia, when combined with the well-known reduced motor output and probably reduced corollary discharges, implies that the sensorimotor apparatus is "set" smaller in PD patients than in normal subjects.

Impairment of posturo-kinetic co-ordination during initiation of forward oriented stepping movements in parkinsonian patients

In order to differentiate between a specific impairment affecting gait initiation and a non-specific deficit in the postural adjustment which occurs prior to any forward oriented stepping movement, 3 forward oriented movements (FOMs), performed by a group of parkinsonian patients and a group of healthy age-matched subjects, were compared in the present study. These FOMs all consisted of initiating 1 step, but differed in their respective planning characteristics. The first consisted of initiating normal walking. The second consisted of initiating a single step, while the third was a visually guided task, consisting of placing the foot just behind a mark on the ground. In all 3 FOMs, the postural phase, i.e., the time elapsing between the initial shift of the center of pressure (CP) and the onset of the first step, was significantly longer in the patients than in the healthy subjects, whereas the duration of the subsequent movement phase, i.e., that of the first step, was within the same range in both groups. The horizontal reaction forces that led to a forward center of gravity (CG) acceleration during the postural phase were markedly reduced in the patients in all 3 FOMs, and the maximal velocity of the iliac crest marker, which corresponds approximately to that of the CG, decreased significantly in the patients. In addition, the length of the first step was significantly shorter in the patients than in the healthy subjects, in all 3 FOMs. The EMG pattern differed significantly between the patients and the healthy subjects; the amplitudes of the early tibialis anterior (TA) and vastus lateralis (VL) activations often decreased and were unilateral rather than bilateral. In addition, the gastrocnemius medialis (GM) burst associated with foot lift-off at the end of the postural phase was either absent or greatly reduced, thus suggesting that the co-ordination between the preparatory postural adjustment of the whole body and the actual stepping movement was impaired. The present results suggested that the lengthening of the postural phase is a common deficit in all FOM tasks in parkinsonian patients and is due to the impaired production of the requisite propulsive forces providing the forward acceleration of the CG. Consequently, a shortening of the first step length occurs. However, the step length is reduced less in the FOM tasks which provide some information about the goal of the first step (single step, visually guided step) than in a normal walking task, during which such information is missing. This suggests that although the stepping movement can be improved with the aid of any sensory cue about the end of the step in patients with Parkinson's disease, the postural phase will always be prolonged whichever FOM task they perform.

Leg muscle activation during gait in Parkinson's disease: adaptation and interlimb coordination

Adaptation in leg muscle activity and coordination between lower limbs were studied during walking on a treadmill with split belts in one group of parkinsonian patients and one of age-matched healthy subjects. Four different belt speeds (0.25/0.5/0.75/1.0 m/sec) were applied in selected combinations to the left and right leg. While these walking conditions were easily tolerated by the healthy subjects, the parkinsonian patients usually reached the limits of their walking capabilities. Both groups adapted automatically to a change in belt speed within approximately 20 stride cycles. Healthy subjects adapted by reorganizing their stride cycle with a relative shortening of duration of support and lengthening of the swing phase of the "fast" leg and vice versa on the "slow" leg. The patients showed a restricted range of stride frequencies for the various belt speeds during normal and split-belt walking with consequent deviations in the reorganization of the stride cycle. In both healthy subjects and patients, ipsilateral gastrocnemius and contralateral tibialis anterior electromyographic (EMG) activity increased predominantly with an ipsilateral increase in belt speed. Two main differences were observed in the EMG patterns: (1) In the patients leg muscle EMG activity was less modulated and gastrocnemius EMG amplitude was small during normal and split-belt walking. However, there was no significant difference between the two groups in respect to the reorganization of the EMG pattern required for the various split-belt walking conditions. (2) The amount of co-activation of antagonistic leg muscles during the support phase of the stride cycle was greater in the patients compared to the healthy subjects during normal and split-belt walking. It is suggested that reduced EMG modulation and recruitment in the leg extensors may contribute to the impaired walking of the patients. This in turn is a result of an impaired proprioceptive feedback from extensor load receptors. This defective control is partially compensated for in parkinsonian patients by a greater amount of leg flexor activation which leads to a higher degree of co-activation. Visual input plays a role in the control of this increased activation.

Postural reflexes in Parkinson's disease during 'resist' and 'yield' tasks

Postural reflexes in leg muscles appear to be set at a fixed gain in Parkinson's disease. To further investigate gain adaptation, we instructed 16 patients with idiopathic Parkinson's disease (studied during the 'off' phase) and 21 healthy controls to either 'resist' or 'yield' in response to 20 serial 4 degrees toe-up perturbations of a supporting platform on which they were standing. We bilaterally recorded destabilizing medium latency (ML) reflexes from stretched gastrocnemius muscles and corrective long latency (LL) reflexes from shortened tibialis anterior muscles. We also assessed changes in center of foot pressure (CFP) and center of gravity (COG). During the 'resist' condition, patients had increased destabilizing ML reflexes, decreased corrective LL reflexes, increased backward displacement of the COG and increased forward (destabilizing) displacement of the CFP. In addition, the backward (corrective) displacement of CFP between 150 and 250 ms was delayed. During the 'yield' condition, reflex gains were modified in controls: LL reflexes were markedly attenuated, whereas ML reflexes were markedly increased. Although this reflex pattern resembled the 'resist' condition in patients, it was not associated with an increased forward displacement of the CFP, but only with a strongly delayed backward displacement of CFP which started after 150 ms. In patients, ML reflex amplitudes remained unchanged during the 'yield' condition, suggesting a fixed reflex gain. LL reflex amplitudes were reduced in patients but significantly less compared to controls, which again suggests a fixed reflex gain. This 'inflexibility' of postural reflexes was reflected by the CFP which showed much smaller changes between 0 and 250 ms in patients than controls. These results could not be ascribed to a different ability to yield because posterior displacement of the COG was identical in patients and controls during the 'yield' condition. We conclude that (1) patients with Parkinson's disease have abnormal and 'inflexible' postural reflexes, associated with delayed corrective movements about the ankle joint and increased body sway; and (2) the increased forward displacement of the CFP in patients likely reflects high stiffness in ankle muscles because reflex changes in controls only affected the CFP more than 150 ms after the perturbation. The increased muscle stiffness and inflexibility of postural reflexes in Parkinson's disease may contribute to balance impairment in daily life.

The role of the basal ganglia in nociception and pain

The involvement of the basal ganglia in motor functions has been well studied. Recent neurophysiological, clinical and behavioral experiments indicate that the basal ganglia also process non-noxious and noxious somatosensory information. However, the functional significance of somatosensory information processing within the basal ganglia is not well understood. This review explores the role of the striatum, globus pallidus and substantia nigra in nociceptive sensorimotor integration and suggests several roles of these basal ganglia structures in nociception and pain. Electrophysiological experiments have detailed the non-nociceptive and nociceptive response properties of basal ganglia neurons. Most studies agree that some neurons within the basal ganglia encode stimulus intensity. However, these neurons do not appear to encode stimulus location since the receptive fields of these cells are large. Many basal ganglia neurons responsive to somatosensory stimulation are activated exclusively or differentially by noxious stimulation. Indirect techniques used to measure neuronal activity (i.e., positron emission tomography and 2-deoxyglucose methods) also indicate that the basal ganglia are activated differentially by noxious stimulation. Neuroanatomical experiments suggest several pathways by which nociceptive information may reach the basal ganglia. Neuroanatomical studies have also indicated that the basal ganglia are rich in many different neuroactive chemicals that may be involved in the modulation of nociceptive information. Microinjection of opiates, dopamine and gamma-aminobutyric acid (GABA) into the basal ganglia have varied effects on pain behavior. Administration of these neurochemicals into the basal ganglia affects supraspinal pain behaviors more consistently than spinal reflexive behaviors. The reduction of pain behavior following electrical stimulation of the substantia nigra and caudate nucleus provides additional evidence for a role of the basal ganglia in pain modulation. Some patients with basal ganglia disease (e.g., Parkinson's disease, Huntington's disease) have alterations in pain sensation in addition to motor abnormalities. Frequently, these patients have intermittent pain that is difficult to localize. Collectively, these data suggest that the basal ganglia may be involved in the (1) sensory-discriminative dimension of pain, (2) affective dimension of pain, (3) cognitive dimension of pain, (4) modulation of nociceptive information and (5) sensory gating of nociceptive information to higher motor areas. Further experiments that correlate neuronal discharge activity with stimulus intensity and escape behavior in operantly conditioned animals are necessary to fully understand how the basal ganglia are involved in nociceptive sensorimotor integration.

Pre- and postcentral cortical somatosensory evoked potentials in hemiparkinsonism

We recorded cortical frontal, central, and parietal somatosensory evoked potentials (SEPs) in 9 patients with hemiparkinsonism and in a group of 25 healthy volunteers. No differences were observed in the SEPs recorded after stimulation of the asymptomatic and symptomatic sides in the patients. Likewise, comparison with the healthy controls did not reveal significant group differences or abnormal waveforms in the patients. Even frontal N30 deflection, which has been reported to be diminished in Parkinson's disease (PD), was normal and symmetric in the patients. Therefore, no evidence was found for altered sensory input to the motor or premotor and supplementary motor cortices in PD.

L-deprenyl confers specific protection against MPTP-induced Parkinson's disease-like movement disorder in the goldfish

Administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) to the goldfish causes a reversible, Parkinson's disease-like syndrome which includes loss of noradrenaline and dopamine from the brain, accumulation of the toxic metabolite 1-methyl-4-phenylpyridinium species (MPP+), and substantial reduction in movement. L-Deprenyl, a selective monoamine oxidase-B inhibitor, protects the goldfish from loss of movement, but clorgyline, a selective monoamine oxidase-A inhibitor, has no such protective action. L-Deprenyl and clorgyline primarily inhibit goldfish brain monoamine oxidase-B and monoamine oxidase-A, respectively. The mechanism by which MPTP causes reduced movement in goldfish is to cause an increase in resting time. Otherwise normal average velocity occurred during periods of movement. L-Deprenyl protection results in entirely 'normal' levels of resting time and average velocity during times of movement. Equivalent observations regarding l-deprenyl and clorgyline have been made in primate models of MPTP toxicity, and l-deprenyl is used for treatment of Parkinson's disease in humans. Therefore it is suggested that the evolutionarily equivalent subcortical circuitry and neural density of the goldfish brain may provide a useful model upon which to search for drugs relevant to human Parkinson's disease.

Effect of video feedback on the performance of a weight shifting controlled tracking task in subjects with parkinsonism and neurologically intact individuals

This study compared the performance of a visual motor task, accomplished by standing weight shifting, of 34 people with Parkinson's disease (P.D.) and 34 neurologically intact (N.I.) subjects. Twenty of the P.D. subjects were in Stage 1 and 14 were in Stage 2. The performance of ten, 10-s trials was each examined under two feedback (FB) conditions: continuous video display of performance and end of trial position. Visual FB was composed of displaying a target and cursor on a video monitor, with the cursor controlled by the subject through weight shifting on a platform interfaced with a microprocessor. Once the cursor was centered, the computer then transferred the target to the upper right quadrant of the monitor, and the subject was required, through weight shifting, to relocate the cursor inside the target. ANOVA with repeated measures was used for data analysis. The visual motor performance of P.D. subjects was significantly worse than that of N.I. (P less than 0.01), as well as between FB conditions (P less than 0.01). The interaction of the FB condition by trial segment was significant (P less than 0.01), as was the interaction of group membership by the trial segment (P less than 0.01). FB condition and group membership did not significantly interact, confirming that performance was worse under end of trial position FB, regardless of group membership (P less than 0.01). Post hoc analysis yielded significant differences (P less than 0.05) in task performance between N.I. and P.D. subjects after the first second of the trials regardless of FB condition. In either group, significant differences between continuous visual FB and end of trial position FB (P less than 0.05) were verified after the fourth second. Performance between N.I., Stage 1, and Stage 2 P.D. subjects revealed significant differences (P less than 0.01) among all three groups, regardless of FB condition. One of the revealing aspects of this investigation was the establishment of significant differences in visual motor performance of individuals in the early stages of the disease compared to previous reports of extremity deficits in the later stages.

Organization of visual cortical inputs to the striatum and subsequent outputs to the pallido-nigral complex in the monkey

To determine the organization of visual inputs and outputs of the striatum, we placed multiple retrograde and anterograde tracers into physiologically identified portions of the striatum known to receive inputs from visual cortex in seven macaques. The injection sites included the tail and genu of the caudate nucleus (14 cases), the head of the caudate (1 case), and the ventral putamen (3 cases). Retrogradely labeled cells were located predominantly in layer 5 of the ipsilateral cortex but were also found in layers 3 and 6. After caudate injections, labeled cells were found both in large, nearly continuous regions of cortex topographically related to the site of the injection, and in several smaller cortical regions that were discontinuous and common to many or all of the injection sites. The continuously labeled regions included nearly all known visual cortical areas, except for the striate cortex. After injections in the rostral tail, the continuously labeled region included the rostral portion of Bonin and Bailey's (Urbana: University of Illinois Press. '47) area TE and adjacent portions of TF, TH, TG, and, occasionally, area 35 (Brodmann, Leipzig: J.A. Barth. '09). After injections into the posterior tail and ventral genu, the labeled region shifted posteriorly in TE and TF, and into TEO and the ventral parts of prestriate areas V4, V3, and (sparsely) V2. As the injection site was advanced into the dorsal genu, the labeled region shifted dorsally toward the parietal lobe, including prestriate areas MT and PO, parietal area PG (Brodmann's area 7), the ventral and lateral intraparietal sulcal areas (VIP and LIP, respectively), and area PE and adjacent area LC (Brodmann's areas 5 and 23, respectively). The discontinuous areas labeled by many different injections included the principal sulcus/frontal eye field region, the anterior cingulate cortex, and the superior temporal polysensory area. Thus, whereas temporal, occipital, and parietal visual cortical areas project into the caudate largely according to proximity, certain multimodal cortical areas seem to have a much wider projection. To determine whether visual cortical areas have additional projections to the caudate beyond the territory of our retrograde injection sites in the tail and genu. 3H-labeled amino acids were injected into areas TE, V4, and MT in three additional monkeys. The topographic location of label in the tail and genu of the caudate in these cases was consistent with the results from injections of retrograde tracers into the caudate.(ABSTRACT TRUNCATED AT 400 WORDS)

Afferents contributing to the exaggerated long latency reflex response to electrical stimulation in Parkinson's disease

Reflex pathways to tibialis anterior motoneurons from low threshold afferents of the common peroneal nerve were examined in 13 Parkinsonian subjects and 12 age-matched normals. Post-synaptic events occurring in single motoneurons were derived from changes in the firing probability of single voluntarily activated motor units during afferent stimulation. A period of increased firing probability of "monosynaptic" latency (about 33 ms) occurred in all subjects in both groups. A second, later, period of increased firing probability (latency about 64 ms) was seen in 2/12 normals and 8/13 Parkinsonian subjects. Neither of these responses could be produced by cutaneous stimulation. The electrical threshold of the afferents mediating the later effect was 0.82 of the threshold of alpha motoneuron axons which is similar to that of the afferents mediating the shorter latency response. Thus, large non cutaneous afferents contribute to this long latency response in man presumably through polysynaptic pathways. Transmission in these pathways is enhanced in Parkinson's disease.

Posture in Parkinson's disease: impairment of reflexes and programming

The leg muscle electromyographic responses induced during stance by impulsive displacements of a treadmill belt (directed forward or backward and at different rates) were studied in a group of patients with Parkinson's disease and a group of age-matched healthy subjects. Young normal subjects were also studied both before and after intake of a dopamine antagonist (haloperidol). Compensatory gastrocnemius electromyographic responses resulting from backward-directed displacements were significantly smaller in both the patients and the young normal subjects following intake of haloperidol. The reduced sensitivity of the gastrocnemius muscle to stretch correlated with an inability to compensate for the perturbations. In the patients, the gastrocnemius response was followed by enhanced activation of the tibialis anterior muscle. This was not the case in the normal subjects after intake of dopamine antagonist and is probably not, therefore, the consequence of acute dopamine deficiency. In the patients the angular rotation at the ankle joint induced during faster backward-directed displacements was slower than that in normal subjects, despite identical amounts of gastrocnemius electromyographic activity. This supports earlier findings of changes in intrinsic muscle stiffness in Parkinson's disease. None of these differences were seen when the tibialis anterior muscle was stretched. This differential behavior of the antagonist leg muscles can best be explained by the different function fulfilled by these muscles in regulation of stance and gait.

Impaired sensorimotor integration in parkinsonism and dyskinesia: a role for corollary discharges?

In a bimanual slow matching task patients with asymmetric bradykinesia overestimated the movement of the more bradykinetic limb. Patients with drug induced or idiopathic asymmetric dyskinesia or dystonia, and patients with unilateral arm weakness underestimated movement of the abnormal limb. Bradykinesia may be caused by reduction, and dyskinesia and dystonia by exaggeration of corollary discharges.

Deficits in orofacial sensorimotor function in Parkinson's disease

Orofacial sensorimotor function was assessed in patients with Parkinson's disease and in age-matched controls. Tests were designed to assess sensory function, motor abilities, and the integration of sensory information for the performance of specific movements. Patients with Parkinson's disease and normal subjects both made more errors with increasing age; however, overall, patients with Parkinson's disease made significantly more errors in our tests than did normal subjects. Interestingly, patients with Parkinson's disease showed greater deficits in tests of sensory function and sensorimotor integration than in tests of motor function. These results suggest that one aspect of Parkinson's disease consists of complex deficits in the utilization of specific sensory inputs to organize and guide movements. The results are further discussed in relation to a proposed sensory gating or filtering schema of basal ganglia motor functioning.

Auditory and somatosensory evoked potentials (AEPs and SEPs) and ballistic movements in Parkinson disease

In five patients with initial idiopathic Parkinson disease AEPs (early and late components of auditory evoked potentials), SEPs (somatosensory evoked potentials) and arm ballistic movements (abduction of the humerus) were studied. Experimental sessions were conducted before starting treatment (L-Dopa plus Carbidopa) and at two and six month intervals. Before treatment evoked potential abnormalities were found in four out of five patients; EMG patterns underlying ballistic arm abduction movements were altered in all patients; corresponding prolonged duration of initial movements and low mean velocities were found. After treatment AEP and SEP showed a reduction of previously observed abnormalities and both EMG patterns and kinematic variables consistently improved. It is suggested that the electrophysiological investigations employed in this preliminary study may be a useful tool in clinical and pharmacological researches on Parkinson disease.

Striatal dopamine distribution in parkinsonian patients during life

Eleven neuropsychologically normal Parkinsonian patients were studied with [18F]6-fluoro-L-dopa and positron tomography. In all of the patients dopaminergic activity was reduced in the putamen on the side opposite to the major motor signs. The reduction was similar in tremulous and rigid patients. In contrast dopaminergic activity was normal in the caudate nuclei. It is argued that the putamen is mainly involved in the regulation of movement while the caudate nuclei assume a role in cognitive processes.