The impact of subthalamic deep brain stimulation on bradykinesia of proximal and distal upper limb muscles in Parkinson's disease
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Abstract
Objective
To assess the differential effects of bilateral deep brain stimulation of the subthalamic nucleus on proximal and distal muscle groups of the upper limb in Parkinson's disease.
Methods
Eight parkinsonian subjects with chronic bilateral stimulation of the subthalamic nucleus performed index finger tapping (differentially drawing upon distal arm muscles), horizontal pointing (differentially drawing upon proximal arm muscles) and a complex reach-to-grasp task with cubes of different sizes, which involved both proximal and distal arm muscles. An ultrasound based system was used for kinematic motion analysis. Subjects were investigated in two clinical conditions: on and off subthalamic nucleus stimulation. Clinical symptom severity was rated with the Unified Parkinson's Disease Rating Scale (UPDRS) motor subscore.
Results
Stimulation of the subthalamic nucleus improved the UPDRS motor subscore (68 %). Bradykinesia of index finger tapping and horizontal pointing were equally improved by subthalamic nucleus stimulation. In contrast, in a complex reach-tograsp task bradykinesia was differentially ameliorated for the grasp component.
Conclusion
The data suggest that bilateral stimulation of the subthalamic nucleus improves bradykinesia of both distal and proximal muscles of the arm and hand in Parkinson's disease; however, dependent upon task complexity proximal and distal movement components may be affected differentially. Kinematic motion analysis is an efficient tool to objectively evaluate the beneficial effects of subthalamic nucleus stimulation on dexterity in Parkinson's disease.
Key words
deep brain stimulation reach to grasp movements Parkinson's disease subthalamic nucleusPreview
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References
- 1.Stern MB (1988) The clinical characteristics of Parkinson's disease and Parkinsonian syndromes: Diagnosis and assessment. In: Stern MB, Hurtig HI (eds) The comprehensive management of Parkinson's disease. New York: PMA publishingGoogle Scholar
- 2.Mouradian MM, Heuser IJ, Baronti F, Chase TN (1990) Modification of central dopaminergic mechanisms by continuous levodopa therapy for advanced Parkinson's disease. Ann Neurol 27:18–23PubMedCrossRefGoogle Scholar
- 3.Nutt JG, Holford NH (1996) The response to levodopa in Parkinson's disease: imposing pharmacological law and order. Ann Neurol 39:561–573PubMedCrossRefGoogle Scholar
- 4.The deep-brain stimulation for Parkinson's disease study group: deepbrain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease (2001) N Engl J Med 345:956–963CrossRefGoogle Scholar
- 5.Fahn S, Elton RL (1987) The Unified Parkinson's Disease Rating Scale. In: Fahn S, Marsden CD, Calne D, Goldstein M (eds) Recent developments in Parkinson's disease. Florham Park, NJ: Mac-Millan Health Care Information, pp 153–163Google Scholar
- 6.Stebbins GT, Goetz CG, Lang AE, Cubo E (1999) Factor analysis of the motor section of the unified Parkinson's disease rating scale during the off-state. Mov Disord 14:585–589PubMedCrossRefGoogle Scholar
- 7.Jeannerod M (1984) The timing of natural prehension movements. J Mot Behav 16:235–254PubMedGoogle Scholar
- 8.Alberts JL, Saling M, Alder CH, Stelmach GE (2000) Disruptions in the reach-to-grasp actions of Parkinson's patients. Exp Brain Res 134:353–362PubMedCrossRefGoogle Scholar
- 9.Castiello U, Bennett K, Bonfiglioli C, Peppard R (2000) The reach-to-grasp movement in Parkinson's disease before and after dopaminergic medication. Neuropsychologia 38:46–59PubMedCrossRefGoogle Scholar
- 10.Negrotti A, Secchi C, Gentilucci M (2005) Effects of disease progression and L-dopa therapy on the control of reaching-grasping in Parkinson's disease. Neuropsychologia 43:450–459PubMedCrossRefGoogle Scholar
- 11.Majsak MJ, Kaminski T, Gentile AM, Flanagan JR (1998) The reaching movements of patients with Parkinson's disease under self-determined maximal speed and visual cued conditions. Brain 121:755–766PubMedCrossRefGoogle Scholar
- 12.Schenk T, Baur B, Steude U, Bötzel K (2003) Effects of deep brain stimulation on prehensile movements in PD patients are less pronounced when external timing cues are provided. Neuropsychologia 41:783–794PubMedCrossRefGoogle Scholar
- 13.Defer GL, Widner H, Marié RM, Rémy P, Levivier M (1999) Core Assessment Program for Surgical Interventional Therapies in Parkinson's Disease (CAPSIT-PD). Mov Disord 14:572–584PubMedCrossRefGoogle Scholar
- 14.Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184PubMedCrossRefGoogle Scholar
- 15.Marquardt C, Mai N (1994) A computational procedure for movement analysis in handwriting. J Neurosci Meth 52:39–45CrossRefGoogle Scholar
- 16.Keppel G (1991) Design and analysis: a researcher’s handbook. Englewood Cliffs, NJ: Prentice HallGoogle Scholar
- 17.Romanelli P, Esposito V, Schaal DW, Heit G (2005) Somatotopy in the basal ganglia: experimental and clinical evidence for segregated sensorimotor channels. Brain Res Brain Res Rev 48:112–128PubMedCrossRefGoogle Scholar
- 18.Wenzelburger R, Kopper F, Zhang BR, Witt K, Hamel W, Weinert D, Kuhtz-Buschbeck J, Gölge M, Illert M, Deuschl G, Krack P (2003) Subthalamic nucleus stimulation for Parkinson's disease preferentially improves akinesia of proximal arm movements compared to finger movements. Mov Disord 18:1162–1169PubMedCrossRefGoogle Scholar
- 19.Nowak DA, Topka H, Tisch S, Hariz M, Limousin P, Rothwell JC (2005) The beneficial effects of subthalamic nucleus stimulation on manipulative finger force control in Parkinson's disease. Exp Neurol 193:427–436PubMedCrossRefGoogle Scholar
- 20.Rizzolatti G, Luppino G, Matelli M (1998) The organization of the cortical motor system: New concepts. Eletroencephal Clin Neurophysiol 106:283–296CrossRefGoogle Scholar
- 21.Rand MK, Smiley-Oyen AL, Shimansky YP, Bloedel JR, Stelmach GE (2006) Control of aperture closure during reach-to-grasp movements in Parkinson's disease. Exp Brain Res 168:131–142PubMedCrossRefGoogle Scholar
- 22.Nowak DA, Tisch S, Hariz M, Limousin P, Topka H, Rothwell JC (2006) Sensory timing cues improve akinesia of grasping movements in Parkinson's disease: a comparison to the effects of subthalamic nucleus stimulation. Mov Disord 21:166–172PubMedCrossRefGoogle Scholar
- 23.Temperli P, Ghika J,Villemure JG, Burkhard PR, Bogousslavsky J, Vingerhoets FJ (2003) How do parkinsonian signs return after discontinuation of subthalamic DBS? Neurology 14:78–81Google Scholar