Decreased and increased cortical activation coexist in de novo Parkinson's disease

Tessa, Carlo; Lucetti, Claudio; Diciotti, Stefano; Baldacci, Filippo; Paoli, Lorenzo De; Cecchi, Paolo; Giannelli, Marco; Ginestroni, Andrea; Dotto, Paolo Del; Ceravolo, Roberto; Vignali, Claudio; Bonuccelli, Ubaldo; Mascalchi, Mario

doi:10.1016/j.expneurol.2010.04.005

Cited by 32 publications

(30 citation statements)

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“…However, these studies analyzed PD patients in a resting state while we refer to microlesion-related subcortical and cortical hypoactivation during movements in comparison to rest. fMRI studies analyzing movements in PD in the OFF medication state usually found decreased [64], [65], [66], [67], [68], [69] or unchanged [15], [16], [39], [70], [71], [72] activity in basal ganglia with cortical motor regions being variably involved in comparison to control subjects perhaps due to various stages of PD and different aspects of movement tasks. As the control group was missing in our study we can only compare our results with fMRI studies focusing on effects of treatment like DBS or levodopa.…”

Section: Discussionmentioning

confidence: 99%

“…As performance during motor tasks may affect the fMRI results [39], [40], [41], [42] and frequency of tapping varies in PD [43], each “tap” was individually triggered to ensure low individual variability in motor performance. Each patient was instructed to make a single “tap” consisting in touch of the thumb and index finger of the same hand whenever the “go” signal (yellow square) appeared on the screen.…”

Section: Methodsmentioning

confidence: 99%

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The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

et al. 2012

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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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

et al. 2012

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“…The hyperactivation was refuted by the studies performed in de novo PD patients, where M1 showed hypoactivation (Buhmann et al, 2003;Tessa et al, 2010Tessa et al, , 2012. The hyperactivation was assumed to reflect reorganization of the M1 in virtue of compensatory mechanism caused by L-dopa treatment (Haslinger et al, 2001;Eckert et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Decreased and increased cerebral regional homogeneity in early Parkinson's disease

et al. 2013

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“…Neuroimaging studies have revealed several cortical areas whose activities were different in PD patients from those in healthy people. Although it is generally assumed that cortical activity is decreased under dopaminergic neuron degeneration (Alexander et al 1986 ;DeLong and Wichmann 2007 ), different patterns of brain activation were reported Jenkins et al 1992 ;Rascol et al 1992 ;Sabatini et al 2000 ;Yu et al 2007 ;Tessa et al 2010 ). The M1 and prefrontal cortex have been two common target sites, and studies on other premotor areas were also published.…”

Section: Rtms Therapy For Motor Symptoms Of Pdmentioning

confidence: 99%

“…A classical model for the pathophysiology of PD postulated decreased activity in the motor thalamus and resulting hypoactivation in the cerebral cortex including the M1 (Alexander et al 1986 ;DeLong and Wichmann 2007 ). Some neuroimaging studies supported this notion by showing decreased activity in the M1 (Rascol et al 1992 ;Buhmann et al 2003 ;Tessa et al 2010 ), whereas others demonstrated hyperactivity in the M1 (Haslinger Eckert et al 2006 ;Yu et al 2007 ). As mentioned in Sect.…”

Section: Rtms Over the Primary Motor Cortex (M1)mentioning

confidence: 99%

Clinical Applications of rTMS in Parkinson’s Disease

Shirota

Hamada

Ugawa³

2015

Therapeutic rTMS in Neurology

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Parkinson's disease (PD) has wide-ranging clinical features, and repetitive transcranial magnetic stimulation (rTMS) therapy has been tried for many aspects of PD. Underlying mechanism of rTMS therapy in PD remains unclear, but several possibilities are proposed such as endogenous dopamine release or restoration of neural plasticity or network activity. Motor symptoms are a cardinal feature of PD, for which evidence suggested moderate effi cacy of rTMS. High-frequency (HF) rTMS over the M1 including less focal stimulation (e.g., leg and bilateral hand M1 rTMS) or over the DLPFC, and low-frequency (LF) rTMS over the SMA were most favorable. Long-term administration of levodopa, a major agent for medical therapy of PD, can induce a motor complication called levodopainduced dyskinesia (LID). Several types of rTMS were reported to be effective for the LID. rTMS has also been tried for non-pharmacological treatment of nonmotor symptoms of PD including depression. A "weak recommendation" in favor of HF rTMS of the left DLPFC can be given for the treatment of depressive symptoms associated with PD. These are examples of growing application of rTMS therapy to PD for symptoms other than the classical motor symptoms. As such, rTMS has a potential to become an important adjunctive treatment for PD. Well-designed large clinical trials are needed to establish its utility in the clinical settings.

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Decreased and increased cortical activation coexist in de novo Parkinson's disease

Cited by 32 publications

References 51 publications

The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

Decreased and increased cerebral regional homogeneity in early Parkinson's disease

Clinical Applications of rTMS in Parkinson’s Disease

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