MovDisordV3, PascalFrancis, Corpus, bibRecord, 000F21

Effects of DBS, Premotor rTMS, and Levodopa on Motor Function and Silent Period in Advanced Parkinson's Disease

Identifieur interne : 000F21 ( PascalFrancis/Corpus ); précédent : 000F20; suivant : 000F22

Effects of DBS, Premotor rTMS, and Levodopa on Motor Function and Silent Period in Advanced Parkinson's Disease

Auteurs : Tobias B Umer ; Ute Hidding ; Wolfgang Hamel ; Carsten Buhmann ; Christian K. E. Moll ; Christian Gerloff ; Michael Orth ; Hartwig Roman Siebner ; Alexander Münchau

Source :

Movement disorders [ 0885-3185 ] ; 2009.

RBID : Pascal:09-0218141

Descripteurs français

Pascal (Inist)
- Maladie de Parkinson, Pathologie du système nerveux, Lévodopa, Stade avancé, Cortex prémoteur, Période muette, Stimulation cérébrale profonde.

English descriptors

KwdEn :
- Advanced stage, Deep brain stimulation, Levodopa, Nervous system diseases, Parkinson disease, Premotor cortex, Silent period.

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.

Notice en format standard (ISO 2709)

Pour connaître la documentation sur le format Inist Standard.

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A03		`1`		`@0 Mov. disord.`
A05				`@2 24`
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A08	`01`	`1`	`ENG`	`@1 Effects of DBS, Premotor rTMS, and Levodopa on Motor Function and Silent Period in Advanced Parkinson's Disease`
A11	`01`	`1`		`@1 BÄUMER (Tobias)`
A11	`02`	`1`		`@1 HIDDING (Ute)`
A11	`03`	`1`		`@1 HAMEL (Wolfgang)`
A11	`04`	`1`		`@1 BUHMANN (Carsten)`
A11	`05`	`1`		`@1 MOLL (Christian K. E.)`
A11	`06`	`1`		`@1 GERLOFF (Christian)`
A11	`07`	`1`		`@1 ORTH (Michael)`
A11	`08`	`1`		`@1 SIEBNER (Hartwig Roman)`
A11	`09`	`1`		`@1 MÜNCHAU (Alexander)`
A14	`01`			`@1 Department of Neurology, University Medical Centre Hamburg-Eppendorf @2 Hamburg @3 DEU @Z 1 aut. @Z 2 aut. @Z 4 aut. @Z 6 aut. @Z 7 aut. @Z 9 aut.`
A14	`02`			`@1 Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf @2 Hamburg @3 DEU @Z 3 aut.`
A14	`03`			`@1 Institute of Neurophysiology and Pathophysiology, University Medical Centre Hamburg-Eppendorf @2 Hamburg @3 DEU @Z 5 aut.`
A14	`04`			`@1 Neurolmage Nord @2 Hamhurg-Kiel-Lübeck @3 DEU @Z 8 aut.`
A14	`05`			`@1 Department of Neurology, Christian-Albrechts-University @2 Kiel @3 DEU @Z 8 aut.`
A20				`@1 672-676`
A21				`@1 2009`
A23	`01`			`@0 ENG`
A43	`01`			`@1 INIST @2 20953 @5 354000186090170060`
A44				`@0 0000 @1 © 2009 INIST-CNRS. All rights reserved.`
A45				`@0 26 ref.`
A47	`01`	`1`		`@0 09-0218141`
A60				`@1 P`
A61				`@0 A`
A64	`01`	`1`		`@0 Movement disorders`
A66	`01`			`@0 USA`
C01	`01`		`ENG`	@0 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.
C02	`01`	`X`		`@0 002B17`
C02	`02`	`X`		`@0 002B17G`
C03	`01`	`X`	`FRE`	`@0 Maladie de Parkinson @2 NM @5 01`
C03	`01`	`X`	`ENG`	`@0 Parkinson disease @2 NM @5 01`
C03	`01`	`X`	`SPA`	`@0 Parkinson enfermedad @2 NM @5 01`
C03	`02`	`X`	`FRE`	`@0 Pathologie du système nerveux @5 02`
C03	`02`	`X`	`ENG`	`@0 Nervous system diseases @5 02`
C03	`02`	`X`	`SPA`	`@0 Sistema nervioso patología @5 02`
C03	`03`	`X`	`FRE`	`@0 Lévodopa @2 NK @2 FR @5 09`
C03	`03`	`X`	`ENG`	`@0 Levodopa @2 NK @2 FR @5 09`
C03	`03`	`X`	`SPA`	`@0 Levodopa @2 NK @2 FR @5 09`
C03	`04`	`X`	`FRE`	`@0 Stade avancé @5 10`
C03	`04`	`X`	`ENG`	`@0 Advanced stage @5 10`
C03	`04`	`X`	`SPA`	`@0 Estadio avanzado @5 10`
C03	`05`	`X`	`FRE`	`@0 Cortex prémoteur @5 11`
C03	`05`	`X`	`ENG`	`@0 Premotor cortex @5 11`
C03	`05`	`X`	`SPA`	`@0 Corteza premotora @5 11`
C03	`06`	`X`	`FRE`	`@0 Période muette @4 CD @5 96`
C03	`06`	`X`	`ENG`	`@0 Silent period @4 CD @5 96`
C03	`07`	`X`	`FRE`	`@0 Stimulation cérébrale profonde @4 CD @5 97`
C03	`07`	`X`	`ENG`	`@0 Deep brain stimulation @4 CD @5 97`
C07	`01`	`X`	`FRE`	`@0 Pathologie de l'encéphale @5 37`
C07	`01`	`X`	`ENG`	`@0 Cerebral disorder @5 37`
C07	`01`	`X`	`SPA`	`@0 Encéfalo patología @5 37`
C07	`02`	`X`	`FRE`	`@0 Syndrome extrapyramidal @5 38`
C07	`02`	`X`	`ENG`	`@0 Extrapyramidal syndrome @5 38`
C07	`02`	`X`	`SPA`	`@0 Extrapiramidal síndrome @5 38`
C07	`03`	`X`	`FRE`	`@0 Maladie dégénérative @5 39`
C07	`03`	`X`	`ENG`	`@0 Degenerative disease @5 39`
C07	`03`	`X`	`SPA`	`@0 Enfermedad degenerativa @5 39`
C07	`04`	`X`	`FRE`	`@0 Pathologie du système nerveux central @5 40`
C07	`04`	`X`	`ENG`	`@0 Central nervous system disease @5 40`
C07	`04`	`X`	`SPA`	`@0 Sistema nervosio central patología @5 40`
C07	`05`	`X`	`FRE`	`@0 Encéphale @5 42`
C07	`05`	`X`	`ENG`	`@0 Encephalon @5 42`
C07	`05`	`X`	`SPA`	`@0 Encéfalo @5 42`
C07	`06`	`X`	`FRE`	`@0 Système nerveux central @5 43`
C07	`06`	`X`	`ENG`	`@0 Central nervous system @5 43`
C07	`06`	`X`	`SPA`	`@0 Sistema nervioso central @5 43`
C07	`07`	`X`	`FRE`	`@0 Voie motrice @5 44`
C07	`07`	`X`	`ENG`	`@0 Motor pathway @5 44`
C07	`07`	`X`	`SPA`	`@0 Vía motora @5 44`
N21				`@1 159`
N44	`01`			`@1 OTO`
N82				`@1 OTO`

Format Inist (serveur)

NO :	PASCAL 09-0218141 INIST
ET :	Effects of DBS, Premotor rTMS, and Levodopa on Motor Function and Silent Period in Advanced Parkinson's Disease
AU :	BÄUMER (Tobias); HIDDING (Ute); HAMEL (Wolfgang); BUHMANN (Carsten); MOLL (Christian K. E.); GERLOFF (Christian); ORTH (Michael); SIEBNER (Hartwig Roman); MÜNCHAU (Alexander)
AF :	Department of Neurology, University Medical Centre Hamburg-Eppendorf/Hamburg/Allemagne (1 aut., 2 aut., 4 aut., 6 aut., 7 aut., 9 aut.); Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf/Hamburg/Allemagne (3 aut.); Institute of Neurophysiology and Pathophysiology, University Medical Centre Hamburg-Eppendorf/Hamburg/Allemagne (5 aut.); Neurolmage Nord/Hamhurg-Kiel-Lübeck/Allemagne (8 aut.); Department of Neurology, Christian-Albrechts-University/Kiel/Allemagne (8 aut.)
DT :	Publication en série; Niveau analytique
SO :	Movement disorders; ISSN 0885-3185; Etats-Unis; Da. 2009; Vol. 24; No. 5; Pp. 672-676; Bibl. 26 ref.
LA :	Anglais
EA :	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.
CC :	002B17; 002B17G
FD :	Maladie de Parkinson; Pathologie du système nerveux; Lévodopa; Stade avancé; Cortex prémoteur; Période muette; Stimulation cérébrale profonde
FG :	Pathologie de l'encéphale; Syndrome extrapyramidal; Maladie dégénérative; Pathologie du système nerveux central; Encéphale; Système nerveux central; Voie motrice
ED :	Parkinson disease; Nervous system diseases; Levodopa; Advanced stage; Premotor cortex; Silent period; Deep brain stimulation
EG :	Cerebral disorder; Extrapyramidal syndrome; Degenerative disease; Central nervous system disease; Encephalon; Central nervous system; Motor pathway
SD :	Parkinson enfermedad; Sistema nervioso patología; Levodopa; Estadio avanzado; Corteza premotora
LO :	INIST-20953.354000186090170060
ID :	09-0218141

Links to Exploration step

Pascal:09-0218141

Le document en format XML

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<author><name sortKey="Munchau, Alexander" sort="Munchau, Alexander" uniqKey="Munchau A" first="Alexander" last="Münchau">Alexander Münchau</name>
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<author><name sortKey="Siebner, Hartwig Roman" sort="Siebner, Hartwig Roman" uniqKey="Siebner H" first="Hartwig Roman" last="Siebner">Hartwig Roman Siebner</name>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Advanced stage</term>
<term>Deep brain stimulation</term>
<term>Levodopa</term>
<term>Nervous system diseases</term>
<term>Parkinson disease</term>
<term>Premotor cortex</term>
<term>Silent period</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Maladie de Parkinson</term>
<term>Pathologie du   système nerveux</term>
<term>Lévodopa</term>
<term>Stade avancé</term>
<term>Cortex prémoteur</term>
<term>Période muette</term>
<term>Stimulation cérébrale profonde</term>
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<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.</div>
</front>
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<fA08 i1="01" i2="1" l="ENG"><s1>Effects of DBS, Premotor rTMS, and Levodopa on Motor Function and Silent Period in Advanced Parkinson's Disease</s1>
</fA08>
<fA11 i1="01" i2="1"><s1>BÄUMER (Tobias)</s1>
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<fA11 i1="02" i2="1"><s1>HIDDING (Ute)</s1>
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<fA11 i1="03" i2="1"><s1>HAMEL (Wolfgang)</s1>
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<fA11 i1="04" i2="1"><s1>BUHMANN (Carsten)</s1>
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<fA11 i1="05" i2="1"><s1>MOLL (Christian K. E.)</s1>
</fA11>
<fA11 i1="06" i2="1"><s1>GERLOFF (Christian)</s1>
</fA11>
<fA11 i1="07" i2="1"><s1>ORTH (Michael)</s1>
</fA11>
<fA11 i1="08" i2="1"><s1>SIEBNER (Hartwig Roman)</s1>
</fA11>
<fA11 i1="09" i2="1"><s1>MÜNCHAU (Alexander)</s1>
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<fA14 i1="01"><s1>Department of Neurology, University Medical Centre Hamburg-Eppendorf</s1>
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<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>9 aut.</sZ>
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<fA14 i1="02"><s1>Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf</s1>
<s2>Hamburg</s2>
<s3>DEU</s3>
<sZ>3 aut.</sZ>
</fA14>
<fA14 i1="03"><s1>Institute of Neurophysiology and Pathophysiology, University Medical Centre Hamburg-Eppendorf</s1>
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<s3>DEU</s3>
<sZ>5 aut.</sZ>
</fA14>
<fA14 i1="04"><s1>Neurolmage Nord</s1>
<s2>Hamhurg-Kiel-Lübeck</s2>
<s3>DEU</s3>
<sZ>8 aut.</sZ>
</fA14>
<fA14 i1="05"><s1>Department of Neurology, Christian-Albrechts-University</s1>
<s2>Kiel</s2>
<s3>DEU</s3>
<sZ>8 aut.</sZ>
</fA14>
<fA20><s1>672-676</s1>
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<fA21><s1>2009</s1>
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<fA23 i1="01"><s0>ENG</s0>
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<fA43 i1="01"><s1>INIST</s1>
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<s5>354000186090170060</s5>
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<s1>© 2009 INIST-CNRS. All rights reserved.</s1>
</fA44>
<fA45><s0>26 ref.</s0>
</fA45>
<fA47 i1="01" i2="1"><s0>09-0218141</s0>
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<fA60><s1>P</s1>
</fA60>
<fA61><s0>A</s0>
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<fA64 i1="01" i2="1"><s0>Movement disorders</s0>
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<fA66 i1="01"><s0>USA</s0>
</fA66>
<fC01 i1="01" l="ENG"><s0>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.</s0>
</fC01>
<fC02 i1="01" i2="X"><s0>002B17</s0>
</fC02>
<fC02 i1="02" i2="X"><s0>002B17G</s0>
</fC02>
<fC03 i1="01" i2="X" l="FRE"><s0>Maladie de Parkinson</s0>
<s2>NM</s2>
<s5>01</s5>
</fC03>
<fC03 i1="01" i2="X" l="ENG"><s0>Parkinson disease</s0>
<s2>NM</s2>
<s5>01</s5>
</fC03>
<fC03 i1="01" i2="X" l="SPA"><s0>Parkinson enfermedad</s0>
<s2>NM</s2>
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<s5>02</s5>
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</fC03>
<fC03 i1="03" i2="X" l="FRE"><s0>Lévodopa</s0>
<s2>NK</s2>
<s2>FR</s2>
<s5>09</s5>
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<fC03 i1="03" i2="X" l="ENG"><s0>Levodopa</s0>
<s2>NK</s2>
<s2>FR</s2>
<s5>09</s5>
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<fC03 i1="03" i2="X" l="SPA"><s0>Levodopa</s0>
<s2>NK</s2>
<s2>FR</s2>
<s5>09</s5>
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<fC03 i1="04" i2="X" l="FRE"><s0>Stade avancé</s0>
<s5>10</s5>
</fC03>
<fC03 i1="04" i2="X" l="ENG"><s0>Advanced stage</s0>
<s5>10</s5>
</fC03>
<fC03 i1="04" i2="X" l="SPA"><s0>Estadio avanzado</s0>
<s5>10</s5>
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<fC03 i1="05" i2="X" l="FRE"><s0>Cortex prémoteur</s0>
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<fC03 i1="05" i2="X" l="ENG"><s0>Premotor cortex</s0>
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<fC03 i1="05" i2="X" l="SPA"><s0>Corteza premotora</s0>
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<fC03 i1="06" i2="X" l="FRE"><s0>Période muette</s0>
<s4>CD</s4>
<s5>96</s5>
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<fC03 i1="06" i2="X" l="ENG"><s0>Silent period</s0>
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<fC03 i1="07" i2="X" l="FRE"><s0>Stimulation cérébrale profonde</s0>
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<s5>97</s5>
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<fC07 i1="04" i2="X" l="FRE"><s0>Pathologie du   système nerveux central</s0>
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<fC07 i1="04" i2="X" l="ENG"><s0>Central nervous system disease</s0>
<s5>40</s5>
</fC07>
<fC07 i1="04" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0>
<s5>40</s5>
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<fC07 i1="05" i2="X" l="FRE"><s0>Encéphale</s0>
<s5>42</s5>
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<fC07 i1="05" i2="X" l="ENG"><s0>Encephalon</s0>
<s5>42</s5>
</fC07>
<fC07 i1="05" i2="X" l="SPA"><s0>Encéfalo</s0>
<s5>42</s5>
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<fC07 i1="06" i2="X" l="FRE"><s0>Système nerveux central</s0>
<s5>43</s5>
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<s5>44</s5>
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<s5>44</s5>
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<fC07 i1="07" i2="X" l="SPA"><s0>Vía motora</s0>
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<fN21><s1>159</s1>
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<server><NO>PASCAL 09-0218141 INIST</NO>
<ET>Effects of DBS, Premotor rTMS, and Levodopa on Motor Function and Silent Period in Advanced Parkinson's Disease</ET>
<AU>BÄUMER (Tobias); HIDDING (Ute); HAMEL (Wolfgang); BUHMANN (Carsten); MOLL (Christian K. E.); GERLOFF (Christian); ORTH (Michael); SIEBNER (Hartwig Roman); MÜNCHAU (Alexander)</AU>
<AF>Department of Neurology, University Medical Centre Hamburg-Eppendorf/Hamburg/Allemagne (1 aut., 2 aut., 4 aut., 6 aut., 7 aut., 9 aut.); Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf/Hamburg/Allemagne (3 aut.); Institute of Neurophysiology and Pathophysiology, University Medical Centre Hamburg-Eppendorf/Hamburg/Allemagne (5 aut.); Neurolmage Nord/Hamhurg-Kiel-Lübeck/Allemagne (8 aut.); Department of Neurology, Christian-Albrechts-University/Kiel/Allemagne (8 aut.)</AF>
<DT>Publication en série; Niveau analytique</DT>
<SO>Movement disorders; ISSN 0885-3185; Etats-Unis; Da. 2009; Vol. 24; No. 5; Pp. 672-676; Bibl. 26 ref.</SO>
<LA>Anglais</LA>
<EA>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.</EA>
<CC>002B17; 002B17G</CC>
<FD>Maladie de Parkinson; Pathologie du   système nerveux; Lévodopa; Stade avancé; Cortex prémoteur; Période muette; Stimulation cérébrale profonde</FD>
<FG>Pathologie de l'encéphale; Syndrome extrapyramidal; Maladie dégénérative; Pathologie du   système nerveux central; Encéphale; Système nerveux central; Voie motrice</FG>
<ED>Parkinson disease; Nervous system diseases; Levodopa; Advanced stage; Premotor cortex; Silent period; Deep brain stimulation</ED>
<EG>Cerebral disorder; Extrapyramidal syndrome; Degenerative disease; Central nervous system disease; Encephalon; Central nervous system; Motor pathway</EG>
<SD>Parkinson enfermedad; Sistema nervioso patología; Levodopa; Estadio avanzado; Corteza premotora</SD>
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	Movement Disorders (revue)
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Movement Disorders (revue)

Effects of DBS, Premotor rTMS, and Levodopa on Motor Function and Silent Period in Advanced Parkinson's Disease

Effects of DBS, Premotor rTMS, and Levodopa on Motor Function and Silent Period in Advanced Parkinson's Disease

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