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Zakaria Z, Idris Z, Abdul Halim S, Ghani ARI, Abdullah JM. Subthalamic Nucleus (STN)-Deep Brain Stimulation Reduces the Power of Mu and Beta Rhythms and Enhances Synchrony at the Motor Cortices in Parkinson's Disease: A Report of Two Cases. Cureus 2023; 15:e35057. [PMID: 36942168 PMCID: PMC10024512 DOI: 10.7759/cureus.35057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 02/18/2023] Open
Abstract
The motor circuit in Parkinson's disease (PD) involves the basal ganglia, thalamus, motor cortex, and cerebellum. Hence, subthalamic nucleus (STN) or globus pallidus internus deep brain stimulation is commonly used in treating refractory Parkinson's patients. During the procedure, the local field potential (LPF) is commonly made along the trajectory of the STN. Two cases were assessed, where an electroencephalographic recording at the sensorimotor cortices was also performed with and without stimulation at the optimal STN electrode site. The 'on' stimulation state associated with clinical improvement correlated with a marked reduction in the late theta (7.5 Hz), alpha (10.5 Hz) (Mu wave), and beta (20 Hz) wave power. Besides, more synchronized and coherent brainwaves were noted when the stimulation was 'on'.
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Affiliation(s)
- Zaitun Zakaria
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia (USM), Kota Bharu, MYS
| | - Zamzuri Idris
- Department of Neurosciences, School of Medical Sciences, Hospital Universiti Sains Malaysia (HUSM), Kota Bharu, MYS
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia (USM), Kota Bharu, MYS
| | - Sanihah Abdul Halim
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia (USM) Kubang Kerian, Kota Bharu, MYS
| | - Abdul Rahman Izaini Ghani
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia (USM) Kubang Kerian, Kota Bharu, MYS
| | - Jafri M Abdullah
- Department of Neurosurgery, Universiti Sains Malaysia (USM) Health Campus, Kota Bharu, MYS
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Weersink JB, Maurits NM, van Laar T, de Jong BM. Enhanced arm swing improves Parkinsonian gait with EEG power modulations resembling healthy gait. Parkinsonism Relat Disord 2021; 91:96-101. [PMID: 34547655 DOI: 10.1016/j.parkreldis.2021.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/02/2021] [Accepted: 09/12/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND The supplementary motor area (SMA) is implicated in stereotypic multi-limb movements such as walking with arm swing. Gait difficulties in Parkinson's Disease (PD) include reduced arm swing, which is associated with reduced SMA activity. OBJECTIVE To test whether enhanced arm swing improves Parkinsonian gait and explore the role of the SMA in such an improvement. METHODS Cortical activity and gait characteristics were assessed by ambulant EEG, accelerometers and video recordings in 27 PD patients with self-reported gait difficulties and 35 healthy participants when walking normally. Within these two groups, 19 PD patients additionally walked with enhanced arm swing and 30 healthy participants walked without arm swing. Power changes across the EEG frequency spectrum were assessed by Event Related Spectral Perturbation analysis of recordings from Fz over the putative SMA and gait analysis was performed. RESULTS Baseline PD gait, characterized by reduced arm swing among other features, exhibited reduced within-step Event Related Desynchronization (ERD)/Synchronization (ERS) alternation (Fz; 20-50Hz), accompanied by a reduced step length and walking speed. All became similar to normal gait when patients walked with enhanced arm swing. When healthy controls walked without arm swing, their alternating ERD-ERS pattern decreased, mimicking baseline PD gait. CONCLUSION Enhanced arm swing may serve as a driving force to overcome impaired gait control in PD patients by restoring reduced ERD-ERS alternation over the putative SMA. Accompanied by increased step length and walking speed, this provides a neural underpinning of arm swing as an effective rehabilitation concept for improving Parkinsonian gait.
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Affiliation(s)
- Joyce B Weersink
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, POB 30.001, Groningen, the Netherlands
| | - Natasha M Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, POB 30.001, Groningen, the Netherlands
| | - Teus van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, POB 30.001, Groningen, the Netherlands
| | - Bauke M de Jong
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, POB 30.001, Groningen, the Netherlands.
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Tankus A, Lustig Y, Fried I, Strauss I. Impaired Timing of Speech-Related Neurons in the Subthalamic Nucleus of Parkinson Disease Patients Suffering Speech Disorders. Neurosurgery 2021; 89:800-809. [PMID: 34392374 DOI: 10.1093/neuros/nyab293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 06/06/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Our previous study found degradation to subthalamic neuronal encoding of speech features in Parkinson disease (PD) patients suffering from speech disorders. OBJECTIVE To find how timing of speech-related neuronal firing changes in PD patients with speech disorders compared to PD patients without speech disorders. METHODS During the implantation of deep brain stimulator (DBS), we recorded the activity of single neurons in the subthalamic nucleus (STN) of 18 neurosurgical patients with PD while they articulated, listened to, or imagined articulation of 5 vowel sounds, each following a beep. We compared subthalamic activity of PD patients with (n = 10) vs without speech disorders. RESULTS In this comparison, patients with speech disorders had longer reaction times and shorter lengths of articulation. Their speech-related neuronal activity preceding speech onset (planning) was delayed relative to the beep, but the time between this activity and the emission of speech sound was similar. Notwithstanding, speech-related neuronal activity following the onset of speech (feedback) was delayed when computed relative to the onset. Only in these patients was the time lag of planning neurons significantly correlated with the reaction time. Neuronal activity in patients with speech disorders was delayed during imagined articulation of vowel sounds but earlier during speech perception. CONCLUSION Our findings indicate that longer reaction times in patients with speech disorders are due to STN or earlier activity of the speech control network. This is a first step in locating the source(s) of PD delays within this network and is therefore of utmost importance for future treatment of speech disorders.
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Affiliation(s)
- Ariel Tankus
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Yael Lustig
- Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Fried
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Ido Strauss
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Chakravarthy KV, Chaturvedi R, Agari T, Iwamuro H, Reddy R, Matsui A. Single arm prospective multicenter case series on the use of burst stimulation to improve pain and motor symptoms in Parkinson's disease. Bioelectron Med 2020; 6:18. [PMID: 33005705 PMCID: PMC7520952 DOI: 10.1186/s42234-020-00055-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022] Open
Abstract
Background In this study we analyze new clinical data in the use of spinal cord stimulation (SCS) for the treatment of pain and motor symptoms in patients with Parkinson's Disease (PD), as both a singular bioelectric therapy and as a salvage therapy after deep brain stimulation (DBS). Methods Fifteen patients were recruited and had percutaneous electrodes implanted at the level of the thoracic or cervical spine. Participants were set to one of three stimulation modes: continuous tonic stimulation, continuous Burst stimulation (40 Hz, 500 Hz, 1000 μs), or cycle mode (on time of 10-15 s, off time of 15-30 s) with Burst (40 Hz, 500 Hz, 1000 μs). Patients completed the Visual Analogue Scale (VAS), Unified Parkinson's Disease Rating Scale, Self-Rating Depression Scale, Hamilton Depression Rating Scale, Profile of Mood State, 10-meter walking test, and the Timed Up and Go (TUG). Results All patients experienced significant improvement in VAS scores with a mean reduction of 59% across all patients. Patients who chose the cycling burst stimulation parameter had an average 67% reduction in VAS scores, as compared to the continuous burst parameter group, which had an average 48% reduction in VAS scores. Seventy-three percent of patients experienced improvement in the 10-meter walk, with an average improvement of 12%. Sixty-four percent of patients experienced clinically relevant improvements in the TUG, with an average improvement of 21%. Conclusions This study points to the potential utility of SCS to address both pain and certain aspects of motor symptoms in PD patients who have and have not received DBS therapy.
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Affiliation(s)
- Krishnan V Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego Health Center, 9400 Campus Point Dr, La Jolla, San Diego, CA USA.,VA San Diego Health Care, 3350 La Jolla Village Dr, San Diego, CA USA
| | - Rahul Chaturvedi
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego Health Center, 9400 Campus Point Dr, La Jolla, San Diego, CA USA
| | - Takashi Agari
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Hirokazu Iwamuro
- Department of Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Rajiv Reddy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego Health Center, 9400 Campus Point Dr, La Jolla, San Diego, CA USA
| | - Ayano Matsui
- Department of Orthopedics, National Center Hospital of Neurology and Psychiatry, Tokyo, Japan
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França C, de Andrade DC, Silva V, Galhardoni R, Barbosa ER, Teixeira MJ, Cury RG. Effects of cerebellar transcranial magnetic stimulation on ataxias: A randomized trial. Parkinsonism Relat Disord 2020; 80:1-6. [PMID: 32920321 DOI: 10.1016/j.parkreldis.2020.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cerebellar ataxia remains a neurological symptom orphan of treatment interventions, despite being prevalent and incapacitating. We aimed to study, in a double-blind design, whether cerebellar modulation could improve ataxia. METHODS We included patients with diagnosis of spinocerebellar ataxia type 3, multiple systems atrophy cerebellar type, or post-lesion ataxia. Patients received five sessions each of sham and active cerebellar 1 Hz deep repetitive transcranial magnetic stimulation in randomized order. Our primary outcome was the decrease in the Scale for the Assessment and Rating of Ataxia when comparing phases (active x sham). Secondary outcomes measures included the International Cooperative Ataxia Rating Scale, and other motor, cognitive, and quality of life scales. This study was registered at clinicaltrials.gov (protocol NCT03213106). RESULTS Twenty-four patients aged 29-74 years were included in our trial. After active stimulation, the Scale for the Assessment and Rating of Ataxia score was significantly lower than the score after sham stimulation [median (interquartile range) of 10.2 (6.2, 16.2) versus 12.8 (9.6, 17.8); p = 0.002]. The International Cooperative Ataxia Rating Scale score also improved after active stimulation versus sham [median (interquartile range) of 29.0 (21.0, 43.5) versus 32.8 (22.0, 47.0); p = 0.005]. Other secondary outcomes were not significantly modified by stimulation. No patient presented severe side effects, and nine presented mild and self-limited symptoms. CONCLUSIONS Our protocol was safe and well-tolerated. These findings suggest that cerebellar modulation may improve ataxic symptom and provide reassurance about safety for clinical practice.
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Affiliation(s)
- Carina França
- Movement Disorders Center, LIM 62, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel C de Andrade
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Valquíria Silva
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Egberto R Barbosa
- Movement Disorders Center, LIM 62, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Functional Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rubens G Cury
- Movement Disorders Center, LIM 62, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil; Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
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Waldmann A, Volkmann J, Zeller D. Parkinson's disease may reduce sensitivity to visual-tactile asynchrony irrespective of dopaminergic treatment: Evidence from the rubber hand illusion. Parkinsonism Relat Disord 2020; 78:100-104. [PMID: 32805636 DOI: 10.1016/j.parkreldis.2020.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The feeling of body ownership relies on the binding of multisensory body-related signals. Various sensory abnormalities have been described in Parkinson's disease (PD). OBJECTIVE To assess the rubber hand illusion (RHI) in patients with PD (PwPD) and age-matched healthy controls (CTRL). To evaluate the influence of the dopaminergic system in a PwPD subgroup OFF medication. METHODS The RHI paradigm was applied to 42 PwPD and 48 CTRL. In this experimental setup, stroking a visible plastic hand simultaneously with the covered real hand elicits the feeling of ownership over the seen hand. Asynchronous stroking served as a control condition. Proprioceptive bias and an illusion score based on a questionnaire were used as measures of the RHI. Seventeen PwPD additionally underwent the experiments "OFF medication". RESULTS Compared to CTRL, PwPD showed higher proprioceptive bias independent of the stroking condition (p = 0.015), and had higher illusion scores in the asynchronous condition (p < 0.05). In PwPD, there were no significant differences between ON- and OFF-medication state. CONCLUSION In PwPD, responses to the RHI are less specific with respect to the degree of synchronicity of brushstrokes. This might be attributed to a less stable body representation, internal "noise" during multisensory integration, or a blur of temporal discrimination in PD. The fact that RHI measures did not differ between ON- and OFF-medication states indicates an involvement of non-dopaminergic transmitter systems in this finding.
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Affiliation(s)
- Amelie Waldmann
- Dept. of Neurology, University of Würzburg, 97080, Würzburg, Germany.
| | - Jens Volkmann
- Dept. of Neurology, University of Würzburg, 97080, Würzburg, Germany
| | - Daniel Zeller
- Dept. of Neurology, University of Würzburg, 97080, Würzburg, Germany
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Bogdan ID, van Laar T, Oterdoom DM, Drost G, van Dijk JMC, Beudel M. Optimal Parameters of Deep Brain Stimulation in Essential Tremor: A Meta-Analysis and Novel Programming Strategy. J Clin Med 2020; 9:jcm9061855. [PMID: 32545887 PMCID: PMC7356338 DOI: 10.3390/jcm9061855] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 01/10/2023] Open
Abstract
The programming of deep brain stimulation (DBS) parameters for tremor is laborious and empirical. Despite extensive efforts, the end-result is often suboptimal. One reason for this is the poorly understood relationship between the stimulation parameters’ voltage, pulse width, and frequency. In this study, we aim to improve DBS programming for essential tremor (ET) by exploring a new strategy. At first, the role of the individual DBS parameters in tremor control was characterized using a meta-analysis documenting all the available parameters and tremor outcomes. In our novel programming strategy, we applied 10 random combinations of stimulation parameters in eight ET-DBS patients with suboptimal tremor control. Tremor severity was assessed using accelerometers and immediate and sustained patient-reported outcomes (PRO’s), including the occurrence of side-effects. The meta-analysis showed no substantial relationship between individual DBS parameters and tremor suppression. Nevertheless, with our novel programming strategy, a significantly improved (accelerometer p = 0.02, PRO p = 0.02) and sustained (p = 0.01) tremor suppression compared to baseline was achieved. Less side-effects were encountered compared to baseline. Our pilot data show that with this novel approach, tremor control can be improved in ET patients with suboptimal tremor control on DBS. In addition, this approach proved to have a beneficial effect on stimulation-related complications.
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Affiliation(s)
- I. Daria Bogdan
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (I.D.B.); (G.D.)
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (J.M.C.v.D.)
| | - Teus van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (I.D.B.); (G.D.)
- Correspondence:
| | - D.L. Marinus Oterdoom
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (J.M.C.v.D.)
| | - Gea Drost
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (I.D.B.); (G.D.)
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (J.M.C.v.D.)
| | - J. Marc C. van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (J.M.C.v.D.)
| | - Martijn Beudel
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, 1007 MB Amsterdam, The Netherlands;
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Yousif N, Bain PG, Nandi D, Borisyuk R. A Population Model of Deep Brain Stimulation in Movement Disorders From Circuits to Cells. Front Hum Neurosci 2020; 14:55. [PMID: 32210779 PMCID: PMC7066497 DOI: 10.3389/fnhum.2020.00055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/05/2020] [Indexed: 01/04/2023] Open
Abstract
For more than 30 years, deep brain stimulation (DBS) has been used to target the symptoms of a number of neurological disorders and in particular movement disorders such as Parkinson’s disease (PD) and essential tremor (ET). It is known that the loss of dopaminergic neurons in the substantia nigra leads to PD, while the exact impact of this on the brain dynamics is not fully understood, the presence of beta-band oscillatory activity is thought to be pathological. The cause of ET, however, remains uncertain, however pathological oscillations in the thalamocortical-cerebellar network have been linked to tremor. Both of these movement disorders are treated with DBS, which entails the surgical implantation of electrodes into a patient’s brain. While DBS leads to an improvement in symptoms for many patients, the mechanisms underlying this improvement is not clearly understood, and computational modeling has been used extensively to improve this. Many of the models used to study DBS and its effect on the human brain have mainly utilized single neuron and single axon biophysical models. We have previously shown in separate models however, that the use of population models can shed much light on the mechanisms of the underlying pathological neural activity in PD and ET in turn, and on the mechanisms underlying DBS. Together, this work suggested that the dynamics of the cerebellar-basal ganglia thalamocortical network support oscillations at frequency range relevant to movement disorders. Here, we propose a new combined model of this network and present new results that demonstrate that both Parkinsonian oscillations in the beta band and oscillations in the tremor frequency range arise from the dynamics of such a network. We find regions in the parameter space demonstrating the different dynamics and go on to examine the transition from one oscillatory regime to another as well as the impact of DBS on these different types of pathological activity. This work will allow us to better understand the changes in brain activity induced by DBS, and allow us to optimize this clinical therapy, particularly in terms of target selection and parameter setting.
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Affiliation(s)
- Nada Yousif
- School of Engineering and Computer Science, University of Hertfordshire, Hatfield, United Kingdom
| | - Peter G Bain
- Division of Brain Sciences, Imperial College Healthcare NHS Trust, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Dipankar Nandi
- Division of Brain Sciences, Imperial College Healthcare NHS Trust, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Roman Borisyuk
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, United Kingdom.,Institute of Mathematical Problems of Biology, The Branch of Keldysh Institute of Applied Mathematics of Russian Academy of Sciences, Pushchino, Russia
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Weersink JB, Gefferie SR, van Laar T, Maurits NM, de Jong BM. Pre-Movement Cortico-Muscular Dynamics Underlying Improved Parkinson Gait Initiation after Instructed Arm Swing. JOURNAL OF PARKINSON'S DISEASE 2020; 10:1675-1693. [PMID: 32773398 PMCID: PMC7683047 DOI: 10.3233/jpd-202112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/12/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The supplementary motor area (SMA) is implicated in both motor initiation and stereotypic multi-limb movements such as walking with arm swing. Gait in Parkinson's disease exhibits starting difficulties and reduced arm swing, consistent with reduced SMA activity. OBJECTIVE We tested whether enhanced arm swing could improve Parkinson gait initiation and assessed whether increased SMA activity during preparation might facilitate such improvement. METHODS Effects of instructed arm swing on cortical activity, muscle activity and kinematics were assessed by ambulant EEG, EMG, accelerometers and video in 17 Parkinson patients and 19 controls. At baseline, all participants repeatedly started walking after a simple auditory cue. Next, patients started walking at this cue, which now meant starting with enhanced arm swing. EEG changes over the putative SMA and leg motor cortex were assessed by event related spectral perturbation (ERSP) analysis of recordings at Fz and Cz. RESULTS Over the putative SMA location (Fz), natural PD gait initiation showed enhanced alpha/theta synchronization around the auditory cue, and reduced alpha/beta desynchronization during gait preparation and movement onset, compared to controls. Leg muscle activity in patients was reduced during preparation and movement onset, while the latter was delayed compared to controls. When starting with enhanced arm swing, these group differences virtually disappeared. CONCLUSION Instructed arm swing improves Parkinson gait initiation. ERSP normalization around the cue indicates that the attributed information may serve as a semi-internal cue, recruiting an internalized motor program to overcome initiation difficulties.
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Affiliation(s)
- Joyce B. Weersink
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Silvano R. Gefferie
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Natasha M. Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bauke M. de Jong
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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