Effects of DBS, premotor rTMS, and levodopa on motor function and silent period in advanced Parkinson's disease
Identifieur interne : 002327 ( Main/Exploration ); précédent : 002326; suivant : 002328Effects of DBS, premotor rTMS, and levodopa on motor function and silent period in advanced Parkinson's disease
Auteurs : Tobias B Umer [Allemagne] ; Ute Hidding [Allemagne] ; Wolfgang Hamel [Allemagne] ; Carsten Buhmann [Allemagne] ; Christian K. E. Moll [Allemagne] ; Christian Gerloff [Allemagne] ; Michael Orth [Allemagne] ; Hartwig Roman Siebner [Allemagne] ; Alexander Münchau [Allemagne]Source :
- Movement Disorders [ 0885-3185 ] ; 2009-04-15.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
- Advanced stage, Aged, Antiparkinson Agents (therapeutic use), Chi-Square Distribution, Deep Brain Stimulation (methods), Deep brain stimulation, Electrodes, Implanted, Electromyography, Evoked Potentials, Motor (drug effects), Evoked Potentials, Motor (physiology), Female, Humans, Levodopa, Levodopa (therapeutic use), Longitudinal Studies, L‐dopa, Male, Middle Aged, Motor Activity (drug effects), Motor Activity (physiology), Motor Cortex (drug effects), Motor Cortex (physiopathology), Nervous system diseases, Parkinson, Parkinson Disease (pathology), Parkinson Disease (physiopathology), Parkinson Disease (therapy), Parkinson disease, Premotor cortex, Severity of Illness Index, Silent period, Subthalamic Nucleus (physiology), Transcranial Magnetic Stimulation (methods), deep brain stimulation, premotor cortex, rTMS.
- MESH :
- chemical , therapeutic use : Antiparkinson Agents, Levodopa.
- drug effects : Evoked Potentials, Motor, Motor Activity, Motor Cortex.
- methods : Deep Brain Stimulation, Transcranial Magnetic Stimulation.
- pathology : Parkinson Disease.
- physiology : Evoked Potentials, Motor, Motor Activity, Subthalamic Nucleus.
- physiopathology : Motor Cortex, Parkinson Disease.
- therapy : Parkinson Disease.
- Aged, Chi-Square Distribution, Electrodes, Implanted, Electromyography, Female, Humans, Longitudinal Studies, Male, Middle Aged, Severity of Illness Index.
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a widely used and highly effective treatment for patients with advanced Parkinson's disease (PD). Repetitive TMS (rTMS) applied to motor cortical areas has also been shown to improve symptoms in PD and modulate motor cortical excitability. Here, we compared clinical and neurophysiological effects of STN stimulation with those of 1 Hz rTMS given to the dorsal premotor cortex (PMd) and those following intake of levodopa in a group of PD patients with advanced disease. Ten PD patients were studied on 2 consecutive days before and after surgery. Clinical effects were determined using the UPDRS motor score. Motor thresholds, motor‐evoked potential (MEP) amplitudes during slight voluntary contraction, and the cortical silent periods (SP) were measured using TMS. Before surgery effects of levodopa and 1 Hz PMd rTMS and after surgery those of STN stimulation with or without additional levodopa were determined. Levodopa significantly improved clinical symptoms and increased the SP duration. STN stimulation improved clinical symptoms without changing the SP duration. In contrast, 1 Hz PMd rTMS was not effective clinically but normalized the SP duration. Whereas levodopa had widespread effects at different levels of an abnormally active motor network in PD, STN stimulation and PMd rTMS led to either clinical improvement or SP normalization, i.e., only partially reversed abnormal motor network activity. © 2009 Movement Disorder Society
Url:
DOI: 10.1002/mds.22417
Affiliations:
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Disord.</title><idno type="ISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2009-04-15">2009-04-15</date><biblScope unit="vol">24</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="672">672</biblScope><biblScope unit="page" to="676">676</biblScope></imprint><idno type="ISSN">0885-3185</idno></series><idno type="istex">3FB88501C5AC0C93DBA9F77FE9F42BDF269AA851</idno><idno type="DOI">10.1002/mds.22417</idno><idno type="ArticleID">MDS22417</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Advanced stage</term><term>Aged</term><term>Antiparkinson Agents (therapeutic use)</term><term>Chi-Square Distribution</term><term>Deep Brain Stimulation (methods)</term><term>Deep brain stimulation</term><term>Electrodes, Implanted</term><term>Electromyography</term><term>Evoked Potentials, Motor (drug effects)</term><term>Evoked Potentials, Motor (physiology)</term><term>Female</term><term>Humans</term><term>Levodopa</term><term>Levodopa (therapeutic use)</term><term>Longitudinal Studies</term><term>L‐dopa</term><term>Male</term><term>Middle Aged</term><term>Motor Activity (drug effects)</term><term>Motor Activity (physiology)</term><term>Motor Cortex (drug effects)</term><term>Motor Cortex (physiopathology)</term><term>Nervous system diseases</term><term>Parkinson</term><term>Parkinson Disease (pathology)</term><term>Parkinson Disease (physiopathology)</term><term>Parkinson Disease (therapy)</term><term>Parkinson disease</term><term>Premotor cortex</term><term>Severity of Illness Index</term><term>Silent period</term><term>Subthalamic Nucleus (physiology)</term><term>Transcranial Magnetic Stimulation (methods)</term><term>deep brain stimulation</term><term>premotor cortex</term><term>rTMS</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiparkinson Agents</term><term>Levodopa</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>Evoked Potentials, Motor</term><term>Motor Activity</term><term>Motor Cortex</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Deep Brain Stimulation</term><term>Transcranial Magnetic Stimulation</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Evoked Potentials, Motor</term><term>Motor Activity</term><term>Subthalamic Nucleus</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Motor Cortex</term><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Chi-Square Distribution</term><term>Electrodes, Implanted</term><term>Electromyography</term><term>Female</term><term>Humans</term><term>Longitudinal Studies</term><term>Male</term><term>Middle Aged</term><term>Severity of Illness Index</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Cortex prémoteur</term><term>Lévodopa</term><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</term><term>Période muette</term><term>Stade avancé</term><term>Stimulation cérébrale profonde</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a widely used and highly effective treatment for patients with advanced Parkinson's disease (PD). Repetitive TMS (rTMS) applied to motor cortical areas has also been shown to improve symptoms in PD and modulate motor cortical excitability. Here, we compared clinical and neurophysiological effects of STN stimulation with those of 1 Hz rTMS given to the dorsal premotor cortex (PMd) and those following intake of levodopa in a group of PD patients with advanced disease. Ten PD patients were studied on 2 consecutive days before and after surgery. Clinical effects were determined using the UPDRS motor score. Motor thresholds, motor‐evoked potential (MEP) amplitudes during slight voluntary contraction, and the cortical silent periods (SP) were measured using TMS. Before surgery effects of levodopa and 1 Hz PMd rTMS and after surgery those of STN stimulation with or without additional levodopa were determined. Levodopa significantly improved clinical symptoms and increased the SP duration. STN stimulation improved clinical symptoms without changing the SP duration. In contrast, 1 Hz PMd rTMS was not effective clinically but normalized the SP duration. Whereas levodopa had widespread effects at different levels of an abnormally active motor network in PD, STN stimulation and PMd rTMS led to either clinical improvement or SP normalization, i.e., only partially reversed abnormal motor network activity. © 2009 Movement Disorder Society</div></front></TEI><affiliations><list><country><li>Allemagne</li></country><region><li>Hambourg</li><li>Schleswig-Holstein</li></region><settlement><li>Hambourg</li><li>Kiel</li></settlement></list><tree><country name="Allemagne"><region name="Hambourg"><name sortKey="B Umer, Tobias" sort="B Umer, Tobias" uniqKey="B Umer T" first="Tobias" last="B Umer">Tobias B Umer</name></region><name sortKey="Buhmann, Carsten" sort="Buhmann, Carsten" uniqKey="Buhmann C" first="Carsten" last="Buhmann">Carsten Buhmann</name><name sortKey="Gerloff, Christian" sort="Gerloff, Christian" uniqKey="Gerloff C" first="Christian" last="Gerloff">Christian Gerloff</name><name sortKey="Hamel, Wolfgang" sort="Hamel, Wolfgang" uniqKey="Hamel W" first="Wolfgang" last="Hamel">Wolfgang Hamel</name><name sortKey="Hidding, Ute" sort="Hidding, Ute" uniqKey="Hidding U" first="Ute" last="Hidding">Ute Hidding</name><name sortKey="Moll, Christian K E" sort="Moll, Christian K E" uniqKey="Moll C" first="Christian K. E." last="Moll">Christian K. E. Moll</name><name sortKey="Munchau, Alexander" sort="Munchau, Alexander" uniqKey="Munchau A" first="Alexander" last="Münchau">Alexander Münchau</name><name sortKey="Orth, Michael" sort="Orth, Michael" uniqKey="Orth M" first="Michael" last="Orth">Michael Orth</name><name sortKey="Siebner, Hartwig Roman" sort="Siebner, Hartwig Roman" uniqKey="Siebner H" first="Hartwig Roman" last="Siebner">Hartwig Roman Siebner</name><name sortKey="Siebner, Hartwig Roman" sort="Siebner, Hartwig Roman" uniqKey="Siebner H" first="Hartwig Roman" last="Siebner">Hartwig Roman Siebner</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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