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Effect of Therapy on Motor Cortical Excitability in Parkinson’s Disease

Published online by Cambridge University Press:  02 December 2014

Aysun Soysal ,
Ismail Sobe ,
Turan Atay ,
Aysu Sen  and
Baki Arpaci
Aysun Soysal
Affiliation:
Bakirkoy State Hospital for Psychiatric and Neurological Diseases, I. Neurology Department, Bakirkoy/Istanbul, Turkey
Ismail Sobe
Affiliation:
Bakirkoy State Hospital for Psychiatric and Neurological Diseases, I. Neurology Department, Bakirkoy/Istanbul, Turkey
Turan Atay
Affiliation:
Bakirkoy State Hospital for Psychiatric and Neurological Diseases, I. Neurology Department, Bakirkoy/Istanbul, Turkey
Aysu Sen
Affiliation:
Bakirkoy State Hospital for Psychiatric and Neurological Diseases, I. Neurology Department, Bakirkoy/Istanbul, Turkey
Baki Arpaci
Affiliation:
Bakirkoy State Hospital for Psychiatric and Neurological Diseases, I. Neurology Department, Bakirkoy/Istanbul, Turkey
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Abstract

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Objective:

To assess the impact of the disease stage and therapy on motor cortical excitability in Parkinson’s disease (PD).

Methods:

Twenty newly diagnosed and medication-free, early stage patients, 20 late stage patients under antiparkinsonian therapy and 20 normal healthy controls were included. Motor threshold (MT), amplitudes of motor evoked potential (MEP), motor evoked potential amplitude/compound muscle action potential amplitude (MEP/CMAP) ratio, central motor conduction time (CMCT) and cortical silent period (CSP) were measured by stimulation of the motor cortex using a 13.5 cm circular coil and recordings from abductor digiti minimi muscle. Following the first study protocol, early stage patients were given therapy and the same protocol was repeated three months later.

Results:

Motor threshold was lower; and the MEP/CMAP ratio was higher in early and late stage patients than normals. In early stage patients after proper therapy, the MTs became higher than before therapy, but still remained lower than normals. In late stage patients, the CMCTs were shorter than the early stage patients before therapy and normals, but there was no difference between the early stage patients and normals. In early stage patients after therapy, the CMCT became longer than before therapy and this difference was significant in both late stage patients and normals. Although more prominent in late stage patients, the CSP duration in both PD groups was found shorter than normals. In early stage patients, after therapy, the CSP durations became significantly longer compared with before therapy.

Conclusion:

These findings suggest that the motor cortical excitability increases in PD because of the impairment of the corticomotoneuronal inhibitory system.

Résumé:

<span class='bold'>RÉSUMÉ:</span><span class='bold'><span class='italic'>Objectif:</span></span>

Nous avons évalué l’impact du stade de la maladie et du traitement sur l’excitabilité motrice corticale dans la maladie de Parkinson (MP).

<span class='bold'><span class='italic'>Méthodes:</span></span>

Vingt patients dont le diagnostic était récent, qui étaient au début de la maladie et qui ne prenaient pas de médicament, ainsi que 20 patients à un stade avancé de la maladie et qui prenaient des médicaments antiparkinsoniens et 20 sujets témoins en bonne santé ont été inclus dans l’étude. Le seuil moteur (SM), les amplitudes des potentiels évoqués moteurs (PÉM), le ratio amplitude des potentiels évoqués moteurs/amplitude des potentiels d’action musculaire composés (PÉM/PAMC), le temps de conduction motrice centrale (TCMC) et la période de silence cortical (PSC) ont été mesurés par stimulation du cortex moteur au moyen d’une bobine circulaire de 13,5 cm et enregistrement au niveau du muscle abducteur du petit doigt. Après avoir effectué une première fois cette évaluation, les patients qui étaient au début de la maladie ont reçu un traitement et le même protocole a été répété trois mois plus tard.

<span class='bold'><span class='italic'>Résultats:</span></span>

Le SM était plus bas et le ratio PÉM/PAMC était plus élevé chez les patients au début et en phase tardive de la maladie que chez les sujets normaux. Chez les patients en phase précoce de la maladie, le SM a augmenté après un traitement adéquat, mais il est demeuré en deça de celui des sujets normaux. En phase avancée de la maladie, les TCMC étaient plus courts que chez les patients en phase précoce avant traitement et que chez les sujets normaux, mais il n’y avait pas de différence entre les patients en phase précoce et les sujets normaux. Le TCMC s’est allongé chez les patients en phase précoce après traitement par rapport à ce qu’il était avant traitement et cette différence était significative tant chez les patients en phase avancée que chez les sujets normaux. Bien que ce soit plus marqué chez les patients en phase avancée, la durée de la PSC chez les deux groupes de patients parkinsoniens était plus courte que chez les sujets normaux. Chez les patients en phase précoce de la maladie, après traitement, la durée de la PSC a augmenté significativement par rapport à ce qu’elle était avant traitement.

<span class='bold'><span class='italic'>Conclusion:</span></span>

Ces observations sont compatibles avec une augmentation de l’excitabilité motrice corticale dans la MP par suite d’une atteinte du système inhibiteur corticomotoneuronal.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 2 , May 2008 , pp. 166 - 172
Copyright
Copyright © The Canadian Journal of Neurological 2008

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