Early-occurrence of manual motor blocks in Parkinson's disease: a quantitative assessment

OBJECTIVES

Quantitative analysis of internally-cued, repetitive motor performance in patients with Parkinson's disease (PD).

MATERIAL AND METHODS

Computerized quantitative measurements of the frequency, duration and temporal profile of manual motor blocks (MMBs) during performance of a manual tapping task, in 39 patients with PD, as compared to 17 age-matched healthy controls.

RESULTS

Performance of PD patients was markedly abnormal both quantitatively and qualitatively, as reflected by an increase (7.0% vs. 4.6%) in MMBs, and by their occurrence from onset of movement. The phenomenon was already observed in the early stages of the disease, and was also correlated with the occurrence of freezing of gait. A standard levodopa-carbidopa (125-12.5 mg) dose only partially affected this phenomenon.

CONCLUSIONS

Augmented motor blocks in internally-cued performance should be recognized as a frequent, distinct and generalized feature of PD. Whereas the gait disorder is regarded as characteristic of the advanced stage of PD, our findings suggest that the basic defect in internal rhythm formation can be detected by sensitive measurement tools from the early stages of the disease. In addition, the methodology developed in this study to quantitatively measure manual motor blocks may be a useful tool for future development of therapeutic regimens for this debilitating aspect of motor dysfunction in PD.

Diagnosis of "non-organic" limb paresis by a novel objective motor assessment: the quantitative Hoover's test

The differentiation of "non-organic" limb weakness from genuine paralysis is sometimes difficult in neurological practice. To address this problem, we developed a computerized quantitative method, based on the Hoover's test principle, that determines the extent of involuntary limb activation when contralateral movement is performed. Measurements of hip or arm extension isometric force are performed during direct maximal voluntary effort and during contralateral hip flexion. Maximal involuntary/voluntary force ratio (IVVR) is calculated. IVVR of the lower limbs in ten healthy subjects was 0.614, 0.044 (mean, SEM). Similar results were obtained from seven patients with genuine weakness and in the non-affected limbs of nine patients with "non-organic" mono- or hemiparesis. In contrast, IVVR in the affected limbs in the "non-organic" group was markedly increased (2.48, 0.61; P < 0.001). The same pattern was elicited in the upper limbs (2.27, 0.46 vs 0.406, 0.06; P < 0,001). We conclude that Hoover's sign in "nonorganic" paralysis is a preservation or increase of a normal synkinetic phenomenon. Quantitative measurement of the IVVR can serve as a useful ancillary test in diagnosing non-organic weakness in either lower or upper limbs.

Enhanced fatigue during motor performance in patients with Parkinson's disease

OBJECTIVE

To measure fatigue quantitatively during continuous motor performance in patients with PD.

BACKGROUND

Enhanced fatigue on performance of motor tasks is a very frequent and disabling complaint of PD patients, and is poorly characterized and understood. Recent evidence suggests a role for mitochondrial dysfunction in the pathogenesis of PD. Reduced exercise capacity is one of the hallmarks of systemic mitochondrial impairment.

METHODS

The authors used an automated system to measure muscle fatigue during a continuous (30-second), maximal, isometric forearm flexion in 17 PD patients and 10 age-matched control subjects. A fatigue index (FI) was then calculated. Peak force (PF) was measured as an internal standard of the examination. Measurements were performed before and 2 hours after an oral dose of levodopa/carbidopa (125 mg/12.5 mg).

RESULTS

In PD patients there was a 50% increase in FI. The increased FI was often asymmetric and more pronounced on the side more affected by the disease. FI was significantly responsive to, and improved after, an oral dose of levodopa. The rate of improvement in FI induced by levodopa correlated with disease severity, as measured by the Unified Parkinson's Disease Rating Scale. No significant alterations in PF were observed.

CONCLUSIONS

Enhanced muscle fatigue should be recognized as an integral part of the spectrum of motor impairment of PD. However, our data argue for its association with a central dopamine deficiency rather than with a muscle mitochondrial abnormality.

Muscle force and endurance in untreated and human growth hormone or insulin-like growth factor-I-treated patients with growth hormone deficiency or Laron syndrome

Muscle force and endurance of four muscle groups (biceps, triceps, hamstrings and quadriceps) were measured by a computerized device in three groups: (A) 4 boys with isolated growth hormone deficiencies (IGHD) examined before at 10 and 24 months of hGH treatment; (B) 5 children (2 F, 3 M) with Laron syndrome were examined 3.5-4 years after initiation of insulin-like growth factor-I (IGF-I) treatment, and (C) comprised 8 untreated adults (5 F, 3 M) with Laron syndrome. For each patient, 2 matched controls, by age, sex, physical activity and height below the 50th percentile, were examined. GH- or IGF-I-deficient patients before treatment revealed reduced muscle force and endurance. GH treatment (0.6 U/kg/week) restored muscle force and endurance, progressively, mainly in the boys with puberty. Three to 4 years of IGF-I treatment (150 micrograms/kg/day) in patients with Laron syndrome proved to have a weaker effect than GH in restoring muscle force. The difference in effectiveness between hGH and IGF-I in restoring muscle force may be due to either the more marked muscle underdevelopment in Laron syndrome patients than in patients with IGHD or a difference in action potential between the two hormones.