Electrode implantation into the subthalamic nucleus for deep brain stimulation in Parkinson's disease (PD) is associated with a temporary motor improvement occurring prior to neurostimulation. We studied this phenomenon by functional magnetic resonance imaging (fMRI) when considering the Unified Parkinson's Disease Rating Scale (UPDRS-III) and collateral oedema. Twelve patients with PD (age 55.9± (SD)6.8 years, PD duration 9–15 years) underwent bilateral electrode implantation into the subthalamic nucleus. The fMRI was carried out after an overnight withdrawal of levodopa (OFF condition): (i) before and (ii) within three days after surgery in absence of neurostimulation. The motor task involved visually triggered finger tapping. The OFF/UPDRS-III score dropped from 33.8±8.7 before to 23.3±4.8 after the surgery (p<0.001), correlating with the postoperative oedema score (p<0.05). During the motor task, bilateral activation of the thalamus and basal ganglia, motor cortex and insula were preoperatively higher than after surgery (p<0.001). The results became more enhanced after compensation for the oedema and UPDRS-III scores. In addition, the rigidity and axial symptoms score correlated inversely with activation of the putamen and globus pallidus (p<0.0001). One month later, the OFF/UPDRS-III score had returned to the preoperative level (35.8±7.0, p = 0.4).In conclusion, motor improvement induced by insertion of an inactive electrode into the subthalamic nucleus caused an acute microlesion which was at least partially related to the collateral oedema and associated with extensive impact on the motor network. This was postoperatively manifested as lowered movement-related activation at the cortical and subcortical levels and differed from the known effects of neurostimulation or levodopa. The motor system finally adapted to the microlesion within one month as suggested by loss of motor improvement and good efficacy of deep brain stimulation.

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Aim: Rapid eye movement (REM) sleep behaviour disorder (RBD) is a sleep abnormality heralded by the absence of physiological atonia in REM sleep and dream enactment behaviour. Idiopathic RBD (iRBD), dia g nosed when no primary RBD cause can be identified, is a marker of prodromal synucleinopathy with a high conversion rate to overt neurodegenerative disorders from the synucleinopathy group. The aim of this cross-sectional study was to investigate olfactory function in iRBD patients and its relation to other symptoms. Patients and methods: This study included 54 iRBD patients with a median age of 67 (IQR 63-72) years; the 37 control subjects, matched by gender and age, had a median age of 67 (57.5-70.0) years. All subjects underwent a complex examination, which included olfactory testing using the University of Pennsylvania Smell Identifi cation Test (UPSIT). Results: In total, 62.9% of iRBD patients had either total loss of olfactory function or severe hyposmia. In contrast, only 8.1% of controls showed such a degree of olfactory dysfunction. Furthermore, we found that the percentage of REM sleep without atonia on polysomnography negatively correlates with the UPSIT score (P < 0.01). Conclusion: This study demonstrated a signifi cantly lower olfactory function in the iRBD group compared to controls. Souhrn Cíl: Porucha chování v REM (rapid eye movement) spánku (REM sleep behavior disorder; RBD) je parasomnie charakterizovaná nepřítomností fyziologické atonie a chováním uskutečňování snu v REM spánku. Jako idiopatická RBD (iRBD) je RBD označena v nepřítomnosti jiné nemoci, která RBD obvykle vyvolává. Idiopatická RBD je známkou prodromální fáze synukleinopatie a má vysokou míru fenokonverze do neurodegenerativních nemocí ze skupiny synukleinopatií. Cílem této průřezové studie bylo zjistit stav čichové funkce u pacientů s iRBD a její vztah k jiným symptomům. Materiál a metody: Do studie bylo zahrnuto 54 pacientů s iRBD s mediánem věku 67 (IQR 63-72) let a 37 kontrolních subjektů s mediánem věku 67 (57,5-70,0) let, které byly spárovány podle věku a pohlaví. Všichni účastníci studie absolvovali komplexní vyšetření, které obsahovalo Identifi kační čichový test Pensylvánské univerzity (University of Pennsylvania Identifaction Test; UPSIT). Výsledky: Úplnou ztrátu čichu anebo jeho těžkou dysfunkci mělo 62,9 % pacientů s iRBD, přitom u kontrolních subjektů to bylo pouze 8,1 %. Porucha atonie v REM spánku v polysomnografi i nepřímo korelovala se skóre UPSIT (p < 0,01). Závěr: Studie prokázala významně horší čich u pacientů s iRBD než u kontrolních osob.

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