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Freitas SMSF, de Freitas PB, Falaki A, Corson T, Lewis MM, Huang X, Latash ML. Synergic control of action in levodopa-naïve Parkinson's disease patients: II. Multi-muscle synergies stabilizing vertical posture. Exp Brain Res 2020; 238:2931-2945. [PMID: 33068173 PMCID: PMC7644647 DOI: 10.1007/s00221-020-05947-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/06/2020] [Indexed: 01/07/2023]
Abstract
Postural instability is a major disabling feature in Parkinson's disease (PD). We quantified the organization of leg and trunk muscles into synergies stabilizing the center of pressure (COP) coordinate within the uncontrolled manifold hypothesis in levodopa-naïve patients with PD and age-matched control subjects. The main hypothesis was that changes in the synergic control of posture are present early in the PD process even before levodopa exposure. Eleven levodopa-naïve patients with PD and 11 healthy controls performed whole-body cyclical voluntary sway tasks and a self-initiated load-release task during standing on a force plate. Surface electromyographic activity in 13 muscles on the right side of the body was analyzed to identify muscle groups with parallel scaling of activation levels (M-modes). Data were collected both before ("off-drug") and approximately 60 min after the first dose of 25/100 carbidopa/levodopa ("on-drug"). COP-stabilizing synergies were quantified for the load-release task. Levodopa-naïve patients with PD showed no COP-stabilizing synergy "off-drug", whereas controls showed posture-stabilizing multi-M-mode synergy. "On-drug", patients with PD demonstrated a significant increase in the synergy index. There were no significant drug effects on the M-mode composition, anticipatory postural adjustments, indices of motor equivalence, or indices of COP variability. The results suggest that levodopa-naïve patients with PD already show impaired posture-stabilizing multi-muscle synergies that may be used as promising behavioral biomarkers for emerging postural disorders in PD. Moreover, levodopa modified synergy metrics differently in these levodopa-naïve patients compared to a previous study of patients on chronic antiparkinsonian medications (Falaki et al. in J Electromyogr Kinesiol 33:20-26, 2017a), suggesting different neurocircuitry involvement.
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Affiliation(s)
- Sandra M S F Freitas
- Graduate Program in Physical Therapy, City University of São Paulo, São Paulo, SP, Brazil
- Department of Kinesiology, The Pennsylvania State University, Rec.Hall-267, University Park, PA, 16802, USA
- Department of Neurology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| | - Paulo B de Freitas
- Department of Kinesiology, The Pennsylvania State University, Rec.Hall-267, University Park, PA, 16802, USA
- Department of Neurology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
- Interdisciplinary Graduate Program in Health Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - Ali Falaki
- Department of Physiology, University of Montreal, Montreal, QC, Canada
| | - Tyler Corson
- Department of Neurology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| | - Mechelle M Lewis
- Department of Neurology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
- Department of Pharmacology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| | - Xuemei Huang
- Department of Kinesiology, The Pennsylvania State University, Rec.Hall-267, University Park, PA, 16802, USA
- Department of Neurology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
- Department of Pharmacology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
- Department of Radiology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
- Department of Neurosurgery, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| | - Mark L Latash
- Department of Kinesiology, The Pennsylvania State University, Rec.Hall-267, University Park, PA, 16802, USA.
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Synergic control of action in levodopa-naïve Parkinson's disease patients: I. Multi-finger interaction and coordination. Exp Brain Res 2019; 238:229-245. [PMID: 31838566 DOI: 10.1007/s00221-019-05709-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/09/2019] [Indexed: 01/25/2023]
Abstract
We explored the origin of the impaired control of action stability in Parkinson's disease (PD) by testing levodopa-naïve PD patients to disambiguate effects of PD from possible effects of long-term exposure to levodopa. Thirteen levodopa-naïve PD patients and 13 controls performed single- and multi-finger force production tasks, including producing a self-paced quick force pulse into a target. A subgroup of patients (n = 10) was re-tested about 1 h after the first dose of levodopa. Compared to controls, PD patients showed lower maximal forces and synergy indices stabilizing total force (reflecting the higher inter-trial variance component affecting total force). In addition, PD patients showed a trend toward shorter anticipatory synergy adjustments (a drop in the synergy index in preparation to a quick action) and larger non-motor equivalent finger force deviations. Lower maximal force, higher unintentional force production (enslaving) and higher inter-trial variance indices occurred in PD patients after one dosage of levodopa. We conclude that impairment in synergies is present in levodopa-naïve patients, mainly in indices reflecting stability (synergy index), but not agility (anticipatory synergy adjustments). A single dose of levodopa, however, did not improve synergy indices, as it did in PD patients on chronic anti-PD medication, suggesting a different mechanism of action. The results suggest that indices of force-stabilizing synergies may be used as an early behavioral sign of PD, although it may not be sensitive to acute drug effects in drug-naïve patients.
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Siddiqi SH, Abraham NK, Geiger CL, Karimi M, Perlmutter JS, Black KJ. The Human Experience with Intravenous Levodopa. Front Pharmacol 2016; 6:307. [PMID: 26779024 PMCID: PMC4701937 DOI: 10.3389/fphar.2015.00307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/11/2015] [Indexed: 11/24/2022] Open
Abstract
Objective: To compile a comprehensive summary of published human experience with levodopa given intravenously, with a focus on information required by regulatory agencies. Background: While safe intravenous (IV) use of levodopa has been documented for over 50 years, regulatory supervision for pharmaceuticals given by a route other than that approved by the U.S. Food and Drug Administration (FDA) has become increasingly cautious. If delivering a drug by an alternate route raises the risk of adverse events, an investigational new drug (IND) application is required, including a comprehensive review of toxicity data. Methods: Over 200 articles referring to IV levodopa were examined for details of administration, pharmacokinetics, benefit, and side effects. Results: We identified 142 original reports describing IVLD use in humans, beginning with psychiatric research in 1959–1960 before the development of peripheral decarboxylase inhibitors. At least 2760 subjects have received IV levodopa, and reported outcomes include parkinsonian signs, sleep variables, hormone levels, hemodynamics, CSF amino acid composition, regional cerebral blood flow, cognition, perception and complex behavior. Mean pharmacokinetic variables were summarized for 49 healthy subjects and 190 with Parkinson's disease. Side effects were those expected from clinical experience with oral levodopa and dopamine agonists. No articles reported deaths or induction of psychosis. Conclusion: At least 2760 patients have received IV levodopa with a safety profile comparable to that seen with oral administration.
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Affiliation(s)
- Shan H Siddiqi
- Department of Psychiatry, Washington University School of Medicine St. Louis, MO, USA
| | - Natalia K Abraham
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Ottawa, ON, Canada
| | | | - Morvarid Karimi
- Department of Neurology, Washington University School of Medicine St. Louis, MO, USA
| | - Joel S Perlmutter
- Programs in Occupational Therapy and Physical Therapy, Division of Biology and Biomedical Sciences, Departments of Neurology, Radiology, and Anatomy and Neurobiology, Washington University School of Medicine St. Louis, MO, USA
| | - Kevin J Black
- Division of Biology and Biomedical Sciences, Departments of Psychiatry, Neurology, Radiology, and Anatomy and Neurobiology, Washington University School of Medicine St. Louis, MO, USA
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Chen Y, Pressman P, Simuni T, Parrish TB, Gitelman DR. Effects of acute levodopa challenge on resting cerebral blood flow in Parkinson's Disease patients assessed using pseudo-continuous arterial spin labeling. PeerJ 2015; 3:e1381. [PMID: 26734502 PMCID: PMC4699782 DOI: 10.7717/peerj.1381] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/14/2015] [Indexed: 01/20/2023] Open
Abstract
Introduction. Levodopa is the gold-standard for treatment of Parkinson’s disease (PD) related motor symptoms. In this study, we used pseudo-continuous arterial spin labeling (pCASL) to quantify changes in cerebral blood flow (CBF) after acute oral administration of levodopa in PD patients. Materials and Methods. Thirteen patients (3 females, age 66.2 ± 8.7 years) with moderately advanced PD (Hoehn and Yahr stage >2 (median 2.5), disease duration >3 years) were scanned on a 3T Siemens MR scanner before and after oral levodopa administration. Statistical parametric mapping was used to detect drug-induced changes in CBF and its correlation to clinical severity scales. Images were normalized and flipped in order to examine effects on the more affected (left) and less affected (right) cerebral hemispheres across the cohort. Results. Levodopa did not change global CBF but increased regional CBF in dorsal midbrain, precuneus/cuneus, more affected inferior frontal pars opercularis and triangularis, bilateral pre- and postcentral gyri, more affected inferior parietal areas, as well as less affected putamen/globus pallidus by 27–74% (p < 0.05, FWE corrected for multiple comparisons). CBF change was negatively correlated with improvement in bradykinesia UPDRS-III subscore in the more affected precentral gyrus, and total predrug UPDRS-III score in the mid-cingulate region. Drug-induced CBF change in a widespread network of regions including parietal and postcentral areas was also negatively correlated with the predrug rigidity UPDRS-III subscore. Conclusion. These findings are in line with prior reports of abnormal activity in the nigrostriatal pathway of PD patients and demonstrate the feasibility of pCASL as a neuroimaging tool for investigating in vivo physiological effects of acute drug administration in PD.
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Affiliation(s)
- Yufen Chen
- Department of Radiology, Feinberg School of Medicine, Northwestern University , Chicago, IL , USA
| | - Peter Pressman
- Department of Neurology, Memory and Aging Center, University of California , San Francisco, CA , USA
| | - Tanya Simuni
- Department of Neurology, Feinberg School of Medicine, Northwestern University , Chicago, IL , USA
| | - Todd B Parrish
- Department of Radiology, Feinberg School of Medicine, Northwestern University , Chicago, IL , USA
| | - Darren R Gitelman
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, USA; Department of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Martinu K, Nagano-Saito A, Fogel S, Monchi O. Asymmetrical effect of levodopa on the neural activity of motor regions in PD. PLoS One 2014; 9:e111600. [PMID: 25369523 PMCID: PMC4219727 DOI: 10.1371/journal.pone.0111600] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 09/03/2014] [Indexed: 01/20/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative illness often characterized by asymmetrical symptoms. However, the reason for this asymmetry and the cerebral correlates underlying symptom asymmetry are still not well understood. Furthermore, the effects of levodopa on the cerebral correlates of disease asymmetry have not been investigated. In this study, right-handed PD patients performed self-initiated, externally triggered and repetitive control finger movements with both their right and left hands during functional magnetic resonance imaging (fMRI) to investigate asymmetrical effects of levodopa on the hemodynamic correlates of finger movements. Patients completed two experimental sessions OFF and ON medication after a minimum of 12 hours medication withdrawal. We compared the effect of levodopa on the neural activation patterns underlying the execution of both the more affected and less affected hand for self-initiated and externally triggered movements. Our results show that levodopa led to larger differences in cerebral activity for movements of the more affected, left side: there were significant differences in activity after levodopa administration in regions of the motor cortico-striatal network when patients performed self-initiated and externally triggered movements with their left hand. By contrast, when patients used their right hand, levodopa led to differences in cerebellar activity only. As our patients were affected more severely on their left side, we propose that levodopa may help provide additional dopaminergic input, improving movements for the more severely affected side. These results suggest that the impact of reduced dopamine in the cortico-striatal system and the action of levodopa is not symmetrical.
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Affiliation(s)
- Kristina Martinu
- Centre de Recherche de l′Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
| | - Atsuko Nagano-Saito
- Centre de Recherche de l′Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
| | - Stuart Fogel
- Centre de Recherche de l′Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Brain & Mind Institute, Department of Psychology, Western University, London, Ontario, Canada
| | - Oury Monchi
- Centre de Recherche de l′Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Department of Radiology, Université de Montréal, Montreal, Quebec, Canada
- * E-mail:
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Van Lancker Sidtis D, Rogers T, Godier V, Tagliati M, Sidtis JJ. Voice and fluency changes as a function of speech task and deep brain stimulation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2010; 53:1167-77. [PMID: 20643796 PMCID: PMC4349390 DOI: 10.1044/1092-4388(2010/09-0154)] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE Speaking, which naturally occurs in different modes or "tasks" such as conversation and repetition, relies on intact basal ganglia nuclei. Recent studies suggest that voice and fluency parameters are differentially affected by speech task. In this study, the authors examine the effects of subcortical functionality on voice and fluency, comparing measures obtained from spontaneous and matched repeated speech samples. METHOD Subjects with Parkinson's disease who were being treated with bilateral deep brain stimulation (DBS) of the subthalamic nuclei were tested with stimulators ON and OFF. RESULTS The study found that a voice measure, harmonic to noise ratio, is improved in repetition and in the DBS-ON condition and that dysfluencies are more plentiful in conversation with little or variable influence of DBS condition. CONCLUSIONS These findings suggest that voice and fluency are differentially affected by DBS treatment and that task conditions, interacting with subcortical functionality, influence motor speech performance.
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Cardoso EF, Fregni F, Maia FM, Melo LM, Sato JR, Cruz AC, Bianchi ET, Fernandes DB, Monteiro MLR, Barbosa ER, Amaro E. Abnormal visual activation in Parkinson's disease patients. Mov Disord 2010; 25:1590-6. [DOI: 10.1002/mds.23101] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Frequency-specific effects of stimulation of the subthalamic area in treated Parkinson's disease patients. Neuroreport 2009; 20:975-8. [DOI: 10.1097/wnr.0b013e32832d2456] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Valálik I, Emri M, Lengyel Z, Mikecz P, Trón L, Csókay A, Márián T. Pallidal deep brain stimulation and L-dopa effect on PET motor activation in advanced Parkinson's disease. J Neuroimaging 2008; 19:253-8. [PMID: 19021848 DOI: 10.1111/j.1552-6569.2008.00304.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE The antiakinetic effect of internal Globus pallidus deep brain stimulation (Gpi-DBS) in Parkinson's disease is not clear and not either how this effect is modulated by L-dopa. METHODS Left Gpi-DBS and/or L-dopa effect was studied with auditory paced right-handed sequential movements on (15)O-butanol positron emission tomography (PET) in five patients. Rest and for conditions during movements (DBS off/L-dopa off; DBS on/L-dopa off; DBS off/L-dopa on; DBS on/L-dopa on) were compared with statistical parametric mapping. RESULTS Gpi-DBS activated the right supplementary motor area/premotor (SMA/PMC), and right insular cortex (IC), and as L-dopa decreased the left sensorimotor cortex (M1/S1) activity. L-dopa increased the left ventrolateral thalamus (VLTH), and decreased the left superior parietal cortex (PC) activity. Gpi-DBS and L-dopa interaction showed right SMA/PMC, IC, and left PC activation, decrease of left VLTH, PMC, and dorsolateral prefrontal cortex (PFC) activity. CONCLUSIONS The improvement of bradykinesia with Gpi-DBS is secondary and contributed to the regress of M1/S1-related rigidity and compensatory SMA/PMC, and IC activation. L-dopa and Gpi-DBS alone each reduces M1/S1 overactivity. Interaction ignores this effect, moreover has akinetic effect in the left VLTH, PMC, and PFC. Motor improvement possibly related to left PC and compensatory right SMA/PMC, and IC activation.
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Affiliation(s)
- István Valálik
- Department of Neurosurgery, St. John's Hospital, Budapest, Hungary.
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10
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Eckert T, Edwards C. The application of network mapping in differential diagnosis of parkinsonian disorders. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.cnr.2007.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tunik E, Feldman AG, Poizner H. Dopamine replacement therapy does not restore the ability of Parkinsonian patients to make rapid adjustments in motor strategies according to changing sensorimotor contexts. Parkinsonism Relat Disord 2007; 13:425-33. [PMID: 17446116 PMCID: PMC2211273 DOI: 10.1016/j.parkreldis.2007.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 01/30/2007] [Accepted: 02/12/2007] [Indexed: 11/18/2022]
Abstract
The ability of dopamine replacement to restore rapid motor adjustments in Parkinson's disease (PD) was investigated. Medicated and non-medicated patients performed finger-to-nose movements while simultaneously bending the trunk forward, without vision. Trunk motion was blocked unexpectedly, necessitating rapid adjustments in arm trajectories. Patients exhibited irregular hand paths, plateaus in hand velocity, and prolonged movement times, which were significantly greater in perturbed trials. Medication improved kinematics but perturbation-induced disturbances persisted and did not approximate the levels of non-perturbed trials nor those of controls. Dopaminergic replenishment in PD may therefore have limited restorative benefits for rapid context-specific motor control.
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Affiliation(s)
- E. Tunik
- Department of Physical Therapy, New York University, New York, NY
| | - A. G. Feldman
- Department of Physiology, University of Montreal, Montreal, Canada
| | - H. Poizner
- Institute for Neural Computation, University of California, San Diego, 9500 Gilman Drive MC-0523 La Jolla, CA. 92093-0523 ; (858) -822-6765 Tel.; (858) 822-2014 Fax;
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Ghilardi MF, Feigin AS, Battaglia F, Silvestri G, Mattis P, Eidelberg D, Di Rocco A. L-Dopa infusion does not improve explicit sequence learning in Parkinson's disease. Parkinsonism Relat Disord 2007; 13:146-51. [PMID: 17055764 DOI: 10.1016/j.parkreldis.2006.08.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 07/28/2006] [Accepted: 08/15/2006] [Indexed: 10/24/2022]
Abstract
We have recently introduced a set of sequence learning tasks that emphasize explicit learning and target anticipation and involve the activation of frontal lobes. This type of learning is impaired even in the early stages of Parkinson's disease (PD). Studies on the effects of L-Dopa on cognitive symptoms of PD have yielded controversial results. To verify whether L-Dopa acutely improves explicit sequence learning, we tested six normal subjects and seven PD patients both off-drug and during L-Dopa infusion with two tasks: SEQ, a motor task with multiple demands, where a sequence had to be learned while reaching for a targets; VSEQ, a visual task where a sequence had to be learned by attending to a visual display without moving. Motor performance was assessed with simple motor tasks. L-Dopa improved motor scores and movement speed, but had no beneficial effect on either type of sequence learning.
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Affiliation(s)
- M Felice Ghilardi
- Department of Physiology & Pharmacology, CUNY Medical School at City College, City University of New York, 138th Street & Convent Avenue, New York, NY 10031, USA.
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Mentis MJ, Delalot D, Naqvi H, Gordon MF, Gudesblatt M, Edwards C, Donatelli L, Dhawan V, Eidelberg D. Anticholinesterase effect on motor kinematic measures and brain activation in Parkinson's disease. Mov Disord 2006; 21:549-55. [PMID: 16228997 PMCID: PMC4457276 DOI: 10.1002/mds.20706] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Anticholinesterase (AChE) drugs are being prescribed off label for nonmotor symptoms in Parkinson's disease (PD). Theoretically, these drugs can impair motor function. A small literature suggests AChE therapy has little effect on clinical motor evaluation; however, no study has made objective motor kinematic measures or evaluated brain function. We hypothesized that even if clinical examination was normal in PD patients on dopamine therapy, (1) sensitive kinematic measures would be abnormal during AChE therapy or (2) normal kinematic measures would be maintained by compensatory brain activation. We carried out a randomized, double-blind, placebo-controlled trial of 8 weeks donepezil (10 mg/day) in 17 PD subjects. Subjects carried out a computerized motor task during a positron emission tomography (PET) scan before starting the drug and again after 8 weeks of donepezil or placebo. Kinematic measures of motor function and PET scans were analyzed to compare the effects of donepezil and placebo. Neither placebo nor donepezil altered motor kinematic measures. Furthermore, movement integrity while on donepezil was maintained without compensatory brain activity. Donepezil 10 mg/day can be given for nonmotor symptoms in PD without adverse motor effects or compensatory brain activity.
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Affiliation(s)
- Marc J Mentis
- Center for Neurosciences, North Shore-LIJ Health System, New Hyde Park, NY 11030, USA.
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Abstract
Sequence learning, a cognitive task linked to cortico-striatal function, is impaired in Parkinson's disease (PD). We chose this task as a behavioral paradigm to study the functional architecture of PD in treated and untreated conditions. In our studies, participants were scanned with H(2)(15)O while performing a kinematically controlled motor sequence learning task and a matching motor baseline task. Experiments revealed that a specific sequence learning network predicts learning in normal subjects, and in independent cohorts of early and advanced PD patients. The analysis of the relationship of network activity to learning performance revealed diverging influences of dopaminergic therapy and deep brain stimulation (DBS). DBS of the internal GP and of STN increased network activity and task performance, while levodopa decreased both measures. In separate studies, we investigated the role of dopaminergic modulation on brain activation during sequence learning. In healthy subjects dopamine transporter (DAT) binding correlated with learning-related brain activation in prefrontal, premotor and cingulate cortices, and in the thalamus. By contrast, in PD most of these regional relationships were lost. Only ventral and dorsolateral prefrontal cortex activation correlated with caudate dopaminergic input. In a final set of studies, we found a significant decline in learning performance in early stage PD patients followed over the course of 2 years. Longitudinal declines in learning-related activation were found in parietal areas, while concomitant increases were localized to the left hippocampus. These observations support hypotheses on disease-stage and task-specific effects within the different cortico-striato-pallido-thalamocortical loops and the mesocortical system in PD.
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Affiliation(s)
- Maren Carbon
- Center for Neurosciences, Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030, USA.
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Asanuma K, Carbon-Correll M, Eidelberg D. Neuroimaging in human dystonia. THE JOURNAL OF MEDICAL INVESTIGATION 2006; 52 Suppl:272-9. [PMID: 16366514 DOI: 10.2152/jmi.52.272] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Functional neuroimaging, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), provides a valuable technique for detecting regional changes in brain metabolic activity associated with human disease. These techniques have been applied in different dystonic disorders including primary generalized dystonia and dopa-responsive dystonia (DRD), as well as focal dystonic syndromes such as torticollis, writer's cramp, and blepharospasm. A common finding is abnormality of the basal ganglia and associated outflow pathways to sensorimotor cortex and other regions involved with motor performance. Other recent imaging research has utilized diffusion-based MRI techniques to localize distinct microstructural abnormalities in dystonia patients and gene carriers. This presentation will focus on an integrated approach to understanding the pathophysiology of this genetic and biochemically diverse disorder.
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Affiliation(s)
- Kotaro Asanuma
- Center for Neurosciences, Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030, and Department of Neurology, North Shore University Hospital, New York, NY, USA
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Agostino R, Bagnato S, Dinapoli L, Modugno N, Berardelli A. Neither simple nor sequential arm movements are bradykinetic in parkinsonian patients with peak-dose dyskinesias. Clin Neurophysiol 2005; 116:2077-82. [PMID: 16055379 DOI: 10.1016/j.clinph.2005.04.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 04/11/2005] [Accepted: 04/27/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To find out whether parkinsonian patients with levodopa-induced peak-dose dyskinesias are bradykinetic. METHODS The performance of a sequential internally determined arm movement and a simple externally triggered arm movement was studied in a group of dyskinetic parkinsonian patients during their best clinical condition and when they were OFF treatment. Patients' performance was compared with that of an age-matched control group. Movements in the three-dimensional space were recorded by the ELITE motion analysis system. Kinematic variables analysed for the sequential motor task were total movement duration and total pause duration; for the simple motor task, movement duration and reaction time; and for both tasks, movement inaccuracy. RESULTS When patients were OFF therapy they performed sequential and simple movement tasks slower than healthy subjects whereas when they were dyskinetic they did not. During the sequential task, when the patients were dyskinetic total pause duration shortened and movement inaccuracy increased. CONCLUSIONS Our kinematic finding indicates that parkinsonian patients' with peak-dose dyskinesias are not bradykinetic. SIGNIFICANCE Parkinsonian patients with peak-dose dyskinesias are not bradykinetic, probably because dopamine at peak doses functionally normalizes the mechanisms controlling movement speed.
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Affiliation(s)
- R Agostino
- Department of Neurological Sciences and Istituto Neurologico Mediterraneo Neuromed IRCCS, Pozzilli (IS), University of Rome La Sapienza, Italy
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Abstract
In this review, we discuss the role of neuroimaging in assessing treatment options for movement disorders, particularly Parkinson's disease (PD). Imaging methods to assess dopaminergic function have recently been applied in trials of potential neuroprotective agents. Other imaging methods using regional metabolism and/or cerebral perfusion have been recently introduced to quantify the modulation of network activity as an objective marker of the treatment response. Both imaging strategies have provided novel insights into the mechanisms underlying a variety of pharmacological and stereotaxic surgical treatment strategies for PD and other movement disorders.
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Affiliation(s)
- Thomas Eckert
- Department of Neurology II and Psychiatry, University of Magdeburg, Germany
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Schettino LF, Adamovich SV, Hening W, Tunik E, Sage J, Poizner H. Hand preshaping in Parkinson’s disease: effects of visual feedback and medication state. Exp Brain Res 2005; 168:186-202. [PMID: 16041510 DOI: 10.1007/s00221-005-0080-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Accepted: 06/01/2005] [Indexed: 11/29/2022]
Abstract
Previous studies in our laboratory examining pointing and reach-to-grasp movements of Parkinson's disease patients (PDPs) have found that PDPs exhibit specific deficits in movement coordination and in the sensorimotor transformations required to accurately guide movements. We have identified a particular difficulty in matching unseen limb position, sensed by proprioception, with a visible target. In the present work, we further explored aspects of complex sensorimotor transformation and motor coordination using a reach-to-grasp task in which object shape, visual feedback, and dopaminergic medication were varied. Normal performance in this task requires coordinated generation of appropriate reach, to bring the hand to the target, and differentiated grasp, to preshape the hand congruent with object form. In Experiment 1, we tested PDPs in the off-medication state. To examine the dependence of subjects on visual feedback and their ability to implement intermodal sensory integration, we required them to reach and grasp the target objects in three conditions: (1) Full Vision, (2) Object Vision with only the target object visible and, (3) No Vision with neither the moving arm nor the target object visible. PDPs exhibited two types of deficits. First, in all conditions, they demonstrated a generalized slowing of movement or bradykinesia. We consider this an intensive deficit, since it involves largely a modulation of the gain of specific task parameters: in this case, velocity of movement. Second, they were less able than controls to extract critical proprioceptive information and integrate it with vision in order to coordinate the reach and grasp components of movement. These deficits which involve the coordination of different inputs and motor components, we classify as coordinative deficits. As in our previous work, the PDPs' deficits were most marked when they were required to use proprioception to guide their hand to a visible target (Object Vision condition). But even in the full-vision condition, their performance only became fully accurate when both the target and effector (hand) were simultaneously visible. In Experiment 2, PDPs were tested on their dopaminergic replacement therapy. Dopaminergic treatment significantly ameliorated the bradykinesia of the PDPs, but produced no changes in the hand preshaping deficiencies of PDPs. These results suggest that adequate treatment of the PDPs may more readily compensate for intensive, than coordinative deficits, since the latter are likely to depend on specific and time-dependent neural interdependencies that are unlikely to be remediated simply by increasing the gain of a pathway.
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Affiliation(s)
- Luis F Schettino
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA
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Abstract
In this brief article, we report preliminary results from an NIH-funded project to use functional brain imaging to study the natural history of neurodegeneration during the earliest clinical stages of PD. We used positron emission tomography (PET) to measure DAT binding (18F-FPCIT), resting glucose metabolism (18FFDG), and brain activation (H215O) responses in 20 newly diagnosed PD patients. The longitudinal study is being conducted at three time points for each measurement during a 5-year period. The interim results indicate the evolution of abnormal metabolic brain networks and activation responses occurring in parallel with presynaptic nigrostriatal dopamine dysfunction in early PD.
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Affiliation(s)
- Kotaro Asanuma
- Center for Neurosciences, North Shore-Long Island Jewish Research Institute, 350 Community Drive, Manhasset, New York 11030, USA
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20
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Zgaljardic DJ, Feigin A. Neuroimaging of Parkinson's disease and atypical parkinsonism. Curr Neurol Neurosci Rep 2004; 4:284-9. [PMID: 15217542 DOI: 10.1007/s11910-004-0053-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The basal ganglia and its associated circuitry can be assessed with a variety of neuroimaging methods that can provide information regarding specific neurotransmitter systems, the functional activity of brain regions, and the structural integrity of these regions. In Parkinson's disease (PD) and related atypical parkinsonian syndromes (APS), these imaging methods may be useful for many reasons, including aiding in differential diagnosis and measuring the efficacy of new therapies. This paper reviews recent developments in the application of neuroimaging to the assessment of PD and related APS.
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Affiliation(s)
- Dennis J Zgaljardic
- Center for Neurosciences, North Shore-Long Island Jewish Research Institute, 350 Community Drive, Manhasset, NY 11030, USA.
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21
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Rieck RW, Ansari MS, Whetsell WO, Deutch AY, Kessler RM. Distribution of dopamine D2-like receptors in the human thalamus: autoradiographic and PET studies. Neuropsychopharmacology 2004; 29:362-72. [PMID: 14627996 DOI: 10.1038/sj.npp.1300336] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The distribution of dopamine (DA) D(2)-like receptors in the human thalamus was studied using in vitro autoradiographic techniques and in vivo positron emission tomography in normal control subjects. [(125)I]Epidepride, which binds with high affinity to DA D(2) and D(3) receptors, was used in autoradiographic studies to determine the distribution and density of D(2)-like receptors, and the epidepride analogue [(18)F]fallypride positron was used for positron emission tomography studies to delineate D(2)-like receptors in vivo. Both approaches revealed a heterogeneous distribution of thalamic D(2/3) receptors, with relatively high densities in the intralaminar and midline thalamic nuclei, including the paraventricular, parataenial, paracentral, centrolateral, and centromedian/parafascicular nuclei. Moderate densities of D(2/3) sites were seen in the mediodorsal and anterior nuclei, while other thalamic nuclei expressed lower levels of D(2)-like receptors. Most thalamic nuclei that express high densities of D(2)-like receptors project to forebrain DA terminal fields, suggesting that both the thalamic neurons expressing D(2)-like receptors and the projection targets of these neurons are regulated by DA. Because the midline/intralaminar nuclei receive prominent projections from both the ascending reticular activating core and the hypothalamus, these thalamic nuclei may integrate activity conveying both interoceptive and exteroceptive information to telencephalic DA systems involved in reward and cognition.
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Affiliation(s)
- Richard W Rieck
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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22
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Higashi Y, Fujii Y. Liquid chromatographic determination of 1-adamantanamine and 2-adamantanamine in human plasma after pre-column derivatization with o-phthalaldehyde and 1-thio-β-d-glucose. J Chromatogr B Analyt Technol Biomed Life Sci 2004; 799:349-54. [PMID: 14670755 DOI: 10.1016/j.jchromb.2003.10.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We investigated high-performance liquid chromatographic (HPLC) determination of 1-adamantanamine hydrochloride (1-ADA) and 2-adamantanamine hydrochloride (2-ADA) in human plasma after the derivatization with o-phthalaldehyde (OPA) and 1-thio-beta-D-glucose (TG). Extracted human plasma samples were mixed with OPA and TG at room temperature for 6 min and injected onto HPLC. Retention times of 1-ADA and 2-ADA derivatives were 12.6 and 14.1 min, respectively. The lower limits of detection of 1-ADA and 2-ADA were 0.02 and 0.008 microg/ml, and the lower limits of quantitation of 1-ADA and 2-ADA were 0.025 and 0.01 microg/ml, respectively. The coefficients of variation for intra-day and inter-day assay of 1-ADA and 2-ADA were less than 4.4 and 6.0%, respectively. L-Dopa and dopamine were not found to interfere with the peaks of 1-ADA and 2-ADA derivatives. Human plasma unbound fraction (f(p)) values of 1-ADA varied between 0.32 and 0.48, while those of 2-ADA varied between 0.38 and 0.68. These results indicate that HPLC assay of 1-ADA and 2-ADA by derivatization with OPA and TG is simple, rapid, sensitive and reproducible for determining 1-ADA and 2-ADA in human plasma.
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Affiliation(s)
- Yasuhiko Higashi
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Hokuriku University, Ho-3, Kanagawa-machi, Kanazawa 920-1181, Japan.
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Carbon M, Ghilardi MF, Feigin A, Fukuda M, Silvestri G, Mentis MJ, Ghez C, Moeller JR, Eidelberg D. Learning networks in health and Parkinson's disease: reproducibility and treatment effects. Hum Brain Mapp 2003; 19:197-211. [PMID: 12811735 PMCID: PMC6871830 DOI: 10.1002/hbm.10115] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
In a previous H(2) (15)O/PET study of motor sequence learning, we used principal components analysis (PCA) of region of interest (ROI) data to identify performance-related activation patterns in normal subjects and patients with Parkinson's disease (PD). In the present study, we determined whether these patterns predicted learning performance in subsequent normal and untreated PD cohorts. Using a voxel-based PCA approach, we correlated the changes in network activity that occurred during antiparkinsonian treatment and their relationship to learning performance. We found that the previously identified ROI-based patterns correlated with learning performance in the prospective normal (P < 0.01) and untreated PD (P < 0.05) cohorts. Voxel analysis revealed that target retrieval was related to a network characterized by bilateral activation of the dorsolateral prefrontal, premotor and anterior cingulate cortex, the precuneus, and the occipital association areas as well as the right ventral prefrontal and inferior parietal regions. Target acquisition was associated with a different network involving activation of the caudate, putamen, and right dentate nucleus, as well as the left ventral prefrontal and inferior parietal areas. Antiparkinsonian therapy gave rise to changes in retrieval performance that correlated with network modulation (P < 0.01). Increases in network activation and learning performance occurred with internal pallidal deep brain stimulation (GPi DBS); decrements in these measures were present with levodopa. Our findings suggest that network analysis of activation data can provide stable descriptors of learning performance. Network quantification can provide an objective means of assessing the effects of therapy on cognitive functioning in neurodegenerative disorders.
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Affiliation(s)
- Maren Carbon
- Center for Neurosciences, North Shore‐Long Island Jewish Research Institute, Manhasset, New York
- Department of Neurology, North Shore University Hospital and New York University School of Medicine, New York, New York
| | - Maria Felice Ghilardi
- Center for Neurobiology and Behavior, Motor Control Laboratory, Columbia College of Physicians and Surgeons, New York, New York
| | - Andrew Feigin
- Center for Neurosciences, North Shore‐Long Island Jewish Research Institute, Manhasset, New York
- Department of Neurology, North Shore University Hospital and New York University School of Medicine, New York, New York
| | - Masafumi Fukuda
- Center for Neurosciences, North Shore‐Long Island Jewish Research Institute, Manhasset, New York
- Department of Neurology, North Shore University Hospital and New York University School of Medicine, New York, New York
| | - Giulia Silvestri
- Center for Neurobiology and Behavior, Motor Control Laboratory, Columbia College of Physicians and Surgeons, New York, New York
| | - Marc J. Mentis
- Center for Neurosciences, North Shore‐Long Island Jewish Research Institute, Manhasset, New York
- Department of Neurology, North Shore University Hospital and New York University School of Medicine, New York, New York
| | - Claude Ghez
- Center for Neurobiology and Behavior, Motor Control Laboratory, Columbia College of Physicians and Surgeons, New York, New York
| | - James R. Moeller
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York
| | - David Eidelberg
- Center for Neurosciences, North Shore‐Long Island Jewish Research Institute, Manhasset, New York
- Department of Neurology, North Shore University Hospital and New York University School of Medicine, New York, New York
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