A medial to lateral shift in pre-movement cortical activity in hemi-Parkinson's disease

Preliminary Neurophysiological Evidence of Altered Cortical Activity and Connectivity With Neurologic Music Therapy in Parkinson's Disease

Neurologic Music Therapy (NMT) is a novel impairment-focused behavioral intervention system whose techniques are based on the clinical neuroscience of music perception, cognition, and production. Auditory Stimulation (RAS) is one of the NMT techniques, which aims to develop and maintain a physiological rhythmic motor activity through rhythmic auditory cues. In a series of breakthrough studies beginning in the mid-nineties, we discovered that RAS durably improves gait velocity, stride length, and cadence in Parkinson's disease (PD). No study to date reports the neurophysiological evidence of auditory-motor frequency entrainment after a NMT intervention in the Parkinson's community. We hypothesized that NMT-related motor improvements in PD are due to entrainment-related coupling between auditory and motor activity resulting from an increased functional communication between the auditory and the motor cortices. Spectral analysis in the primary motor and auditory cortices during a cued finger tapping task showed a simultaneous increase in evoked power in the beta-range along with an increased functional connectivity after a course of NMT in a small sample of three older adults with PD. This case study provides preliminary evidence that NMT-based motor rehabilitation may enhance cortical activation in the auditory and motor areas in a synergic manner. With a lack of both control subjects and control conditions, this neuroimaging case-proof of concept series of visible changes suggests potential mechanisms and offers further education on the clinical applications of musical interventions for motor impairments.

Behavioral, Cognitive, and Motor Preparation Deficits in a Visual Cued Spatial Attention Task in Autism Spectrum Disorder

Abnormalities in motor skills have been regarded as part of the symptomatology characterizing autism spectrum disorder (ASD). It has been estimated that 80 % of subjects with autism display "motor dyspraxia" or clumsiness that are not readily identified in a routine neurological examination. In this study we used behavioral measures, event-related potentials (ERP), and lateralized readiness potential (LRP) to study cognitive and motor preparation deficits contributing to the dyspraxia of autism. A modified Posner cueing task was used to analyze motor preparation abnormalities in children with autism and in typically developing children (N = 30/per group). In this task, subjects engage in preparing motor response based on a visual cue, and then execute a motor movement based on the subsequent imperative stimulus. The experimental conditions, such as the validity of the cue and the spatial location of the target stimuli were manipulated to influence motor response selection, preparation, and execution. Reaction time and accuracy benefited from validly cued targets in both groups, while main effects of target spatial position were more obvious in the autism group. The main ERP findings were prolonged and more negative early frontal potentials in the ASD in incongruent trials in both types of spatial location. The LRP amplitude was larger in incongruent trials and had stronger effect in the children with ASD. These effects were better expressed at the earlier stages of LRP, specifically those related to response selection, and showed difficulties at the cognitive phase of stimulus processing rather that at the motor execution stage. The LRP measures at different stages reflect the chronology of cognitive aspects of movement preparation and are sensitive to manipulations of cue correctness, thus representing very useful biomarker in autism dyspraxia research. Future studies may use more advance and diverse manipulations of movement preparation demands in testing more refined specifics of dyspraxia symptoms to investigate functional connectivity abnormalities underlying motor skills deficits in autism.

Effects of rhythmic stimulus presentation on oscillatory brain activity: the physiology of cueing in Parkinson's disease

The basal ganglia play an important role in beat perception and patients with Parkinson’s disease (PD) are impaired in perception of beat-based rhythms. Rhythmic cues are nonetheless beneficial in gait rehabilitation, raising the question how rhythm improves movement in PD. We addressed this question with magnetoencephalography recordings during a choice response task with rhythmic and non-rhythmic modes of stimulus presentation. Analyses focused on (i) entrainment of slow oscillations, (ii) the depth of beta power modulation, and (iii) whether a gain in modulation depth of beta power, due to rhythmicity, is of predictive or reactive nature. The results show weaker phase synchronisation of slow oscillations and a relative shift from predictive to reactive movement-related beta suppression in PD. Nonetheless, rhythmic stimulus presentation increased beta modulation depth to the same extent in patients and controls. Critically, this gain selectively increased the predictive and not reactive movement-related beta power suppression. Operation of a predictive mechanism, induced by rhythmic stimulation, was corroborated by a sensory gating effect in the sensorimotor cortex. The predictive mode of cue utilisation points to facilitation of basal ganglia-premotor interactions, contrasting with the popular view that rhythmic stimulation confers a special advantage in PD, based on recruitment of alternative pathways.

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We investigate how rhythmic cues improve movement in Parkinson’s disease

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MEG-recorded slow and fast oscillatory activity was analysed

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Predictive modulation of beta oscillations was reduced in PD patients

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Yet rhythmicity promoted a predictive mode of cue utilization and beta modulation

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Results point to a facilitation of basal ganglia-cortical interaction in rhythmic cueing

Dopamine-mediated learning and switching in cortico-striatal circuit explain behavioral changes in reinforcement learning

The basal ganglia are thought to play a crucial role in reinforcement learning. Central to the learning mechanism are dopamine (DA) D1 and D2 receptors located in the cortico-striatal synapses. However, it is still unclear how this DA-mediated synaptic plasticity is deployed and coordinated during reward-contingent behavioral changes. Here we propose a computational model of reinforcement learning that uses different thresholds of D1- and D2-mediated synaptic plasticity which are antagonized by DA-independent synaptic plasticity. A phasic increase in DA release caused by a larger-than-expected reward induces long-term potentiation (LTP) in the direct pathway, whereas a phasic decrease in DA release caused by a smaller-than-expected reward induces a cessation of long-term depression, leading to LTP in the indirect pathway. This learning mechanism can explain the robust behavioral adaptation observed in a location-reward-value-association task where the animal makes shorter latency saccades to reward locations. The changes in saccade latency become quicker as the monkey becomes more experienced. This behavior can be explained by a switching mechanism which activates the cortico-striatal circuit selectively. Our model also shows how D1- or D2-receptor blocking experiments affect selectively either reward or no-reward trials. The proposed mechanisms also explain the behavioral changes in Parkinson's disease.

The supplementary motor area contributes to the timing of the anticipatory postural adjustment during step initiation in participants with and without Parkinson's disease

The supplementary motor area (SMA) is thought to contribute to the generation of anticipatory postural adjustments (APAs, which act to stabilize supporting body segments prior to movement), but its precise role remains unclear. In addition, participants with Parkinson's disease (PD) exhibit impaired function of the SMA as well as decreased amplitudes and altered timing of the APA during step initiation, but the contribution of the SMA to these impairments also remains unclear. To determine how the SMA contributes to generating the APA and to the impaired APAs of participants with PD, we examined the voluntary steps of eight participants with PD and eight participants without PD, before and after disrupting the SMA and dorsolateral premotor cortex (dlPMC), in separate sessions, with 1-Hz repetitive transcranial magnetic stimulation (rTMS). Both groups exhibited decreased durations of their APAs after rTMS over the SMA but not over the dlPMC. Peak amplitudes of the APAs were unaffected by rTMS to either site. The symptom severity of the participants with PD positively correlated with the extent that rTMS over the SMA affected the durations of their APAs. The results suggest that the SMA contributes to the timing of the APA and that participants with PD exhibit impaired timing of their APAs, in part, due to progressive dysfunction of circuits associated with the SMA.

Premotor Gray Matter Volume is Associated with Clinical Findings in Idiopathic and Genetically Determined Parkinson's Disease

In the present voxel-based morphometric study, we investigated whether the severity and duration of disease are associated with alterations in gray matter volume (GMV) in symptomatic Parkin mutation carriers (sPARKIN-MC) and patients with idiopathic Parkinson’s disease (iPD). Regression analyses revealed different negative correlations between GMV in cortical motor areas and the severity as well as the disease duration in sPARKIN-MC and iPD patients. SPARKIN-MC showed a less involvement of cortical motor areas, in particular in the supplementary motor area (SMA) than iPD patients. Specifically, in iPD patients, but not in sPARKIN-MC, there was a negative correlation between the SMA degeneration and the UPDRS-II item freezing. The different degeneration patterns may mirror diverse kinetics of the disease progress in these two groups of PD patients with different underlying etiologies.

Levels of error processing in Huntington's disease: a combined study using event-related potentials and voxel-based morphometry

Huntington's Disease (HD) is a neurogenetic disorder accompanied by an atrophy of the striatum and hence of the dopaminergic (DA) system. Neural processes subserving error processing presumably depend on the DA system. We assessed error processing in manifest HD and in presymptomatic HD-gene-mutation-carriers (pHD) with event-related potentials reflecting error processing (the error negativity or error-related negativity and the error positivity derived from a flanker-task. We found a reduction of the Ne in the case of HD compared to pHD reflecting dopamine system pathology. Despite the Ne being reduced in HD, behavioral adaptation was possible. In addition, the error-rates did not differ between the groups. Optimized voxel-based morphometry revealed that grey matter volume in the medial frontal gyrus is correlated with the Ne amplitude in symptomatic patients. In addition, the effect of a Ne-reduction was related to the grey matter underneath the medial frontal gyrus, which is in line with two theories of the Ne. In contrast, the Pe did not differ between the groups, suggesting that the Pe is decoupled from the DA system. Interestingly we found a reduction of a late slow negativity on correct responses, which possibly reflects decreased preparatory processes in HD compared to pHD as induced by the DA alterations in HD. In conclusion a deterioration in error processing in HD compared to pHD is mainly reflected by the Ne. The deterioration might rely on two factors: a neurofunctional and a neuroanatomical.

Extrastriatal monoamine neuron function in Parkinson's disease: an 18F-dopa PET study

The early motor manifestations of Parkinson's disease (PD) reflect degeneration of nigrostriatal dopamine neurons projecting to the caudal putamen. However, extrastriatal dopamine and other monoamine systems are also involved, particularly in later disease. We used (18)F-dopa PET in a cross-sectional study to characterize extrastriatal monoamine neuronal dysfunction in PD. 16 Controls and 41 patients underwent investigation. We found that (18)F-dopa uptake was decreased in cortical motor areas, particularly the motor cortex, even in early disease. Frontal association areas were also affected in later disease but limbic areas were spared except for hypothalamus. The substantia nigra, midbrain raphe and locus coeruleus showed normal or increased (18)F-dopa uptake until PD was advanced, indicating compensatory responses in intact monoamine neuron perikarya. The red nucleus, subthalamus, ventral thalamus and pineal gland were also eventually involved. These findings provide a further basis for understanding the complex pathophysiology of PD in vivo and complement pathological studies.

Chronic epidural motor cortical stimulation for movement disorders

Recent data suggest that epidural chronic motor cortical stimulation could improve movement disorders. Because the procedure is safe, it might be a valuable therapeutic option. Although the therapeutic effects of cortical stimulation still need to be assessed in controlled studies, we discuss its rationale and the possible physiological mechanisms involved. There are several factors that support the use of chronic cortical stimulation in patients with movement disorders, including the strategic position of the motor cortex, the improvement induced in some motor disorders by cortical lesions, the functional imaging findings documenting widespread cortical dysfunction in movement disorders, and the improvement induced in patients with Parkinson's disease and dystonia by repetitive transcranial magnetic stimulation. Among the possible mechanisms of action of chronic motor cortex stimulation, besides modifications in the motor cortex itself, the most probable is that of eliciting distant bilateral changes through efferents and afferents that bilaterally connect the motor cortex with other cortical and subcortical structures.

Abnormal proprioceptive-motor integration contributes to hypometric postural responses of subjects with Parkinson's disease

Subjects with Parkinson's disease exhibit abnormally short compensatory steps in response to external postural perturbations. We examined whether: (1) Parkinson's disease subjects exhibit short compensatory steps due to abnormal central proprioceptive-motor integration, (2) this proprioceptive-motor deficit can be overcome by visual-motor neural circuits using visual targets, (3) the proprioceptive-motor deficit relates to the severity of Parkinson's disease, and (4) the dysfunction of central dopaminergic circuits contributes to the Parkinson's disease subjects' proprioceptive-motor deficit. Ten Parkinson's disease subjects and 10 matched control subjects performed compensatory steps in response to backward surface translations in five conditions: with eyes closed, with eyes open, to a remembered visual target, to a target without seeing their legs, and to a target while seeing their legs. Parkinson's disease subjects were separated into a moderate group and a severe group based on scores from the Unified Parkinson's Disease Rating Scale and were tested off and on their dopamine medication. Parkinson's disease subjects exhibited shorter compensatory steps than did the control subjects, but all subjects increased their step length when stepping to targets. Compared with the other subject groups, the severe Parkinson's disease subjects made larger accuracy errors when stepping to targets, and the severe Parkinson's disease subjects' step accuracy worsened the most when they were unable to see their legs. Thus, Parkinson's disease subjects exhibited short compensatory steps due to abnormal proprioceptive-motor integration and used visual input to take longer compensatory steps when a target was provided. In severe Parkinson's disease subjects, however, visual input does not fully compensate because, even with a target and unobstructed vision, they still exhibited poor step accuracy. Medication did not consistently improve the length and accuracy of the Parkinson's disease subjects' compensatory steps, suggesting that degeneration of dopamine circuits within the basal ganglia is not responsible for the proprioceptive-motor deficit that degrades compensatory steps in Parkinson's disease subjects.

Repetitive transcranial magnetic stimulation (rTMS): insights into the treatment of Parkinson’s disease by cortical stimulation

Repetitive transcranial magnetic stimulation (rTMS) is a potent tool that can be used to modify activity of targeted cortical areas. Significant clinical effects have been obtained in patients with Parkinson's disease (PD) by stimulating different cortical regions with rTMS at inhibitory (low) or excitatory (high) frequency. These effects were thought to result from plastic changes in motor cortical networks. Actually cortical dysfunction has been documented in PD by neuroimaging and neurophysiologic studies showing either hypo- or hyper-activation of various brain areas. In addition, cortical excitability studies using transcranial magnetic stimulation disclosed significant alterations in intracortical facilitatory or inhibitory processes according to the resting state or to phases of movement preparation or execution. These observations clearly support the therapeutic potential of cortical neuromodulation in PD. Motor cortex stimulation could impact on any station within the cortico-basal ganglia-thalamo-cortical loops that are involved in motor control, providing alleviation of parkinsonian symptoms. Depending on the target, cortical stimulation might improve motor performance or other symptoms associated with PD, like depression. Clinical application of rTMS to treat PD patients is limited by the short duration of the effects beyond the time of stimulation, even if long-lasting improvements have been observed after repeated rTMS sessions. In any case, the place of cortical stimulation in the therapeutic management of PD patients remains to be determined, as an alternative or a complementary technique to deep brain stimulation. The rTMS technique could be used to better define the targets and the parameters of stimulation subsequently applied in chronic epidural stimulation.

Neural network involved in time perception: an fMRI study comparing long and short interval estimation

In this study, long ( approximately 1,300 ms) and short duration ( approximately 450 ms) estimation trials in an event-related functional MRI (fMRI) study were contrasted in order to reveal the regions within a time estimation network yielding increased activation with the increase of the duration to be estimated. In accordance with numerous imaging studies, our results showed that the presupplementary motor area (preSMA), the anterior cingulate, the prefrontal and parietal cortices, and the basal ganglia were involved in the estimation trials whatever the duration to be estimated. Moreover, only a subset of the regions within this distributed cortical and subcortical network yielded increased activation with increasing time, namely, the preSMA, the anterior cingulate cortex, the right inferior frontal gyrus (homolog to Broca's area), the bilateral premotor cortex, and the right caudate nucleus. This suggests that these regions are directly involved in duration estimation. We propose that the caudate-preSMA circuit, the anterior cingulate, and the premotor-inferior frontal regions may support a clock mechanism, decision and response-related processes, and active maintenance of temporal information, respectively.

Motor cortex dysfunction revealed by cortical excitability studies in Parkinson's disease: influence of antiparkinsonian treatment and cortical stimulation

Single or paired pulse paradigms of transcranial magnetic stimulation (TMS) provide several parameters to test motor cortex excitability, such as motor threshold (MT), motor evoked potential (MEP) amplitude, electromyographic silent period to cortical stimulation (CSP) and intracortical facilitation (ICF) or inhibition (ICI). Various changes in TMS parameters, revealing motor cortex dysfunction, were found in patients with Parkinson's disease (PD). For instance, low MT and increased MEP size disclosed an enhanced corticospinal motor output at rest, while reduced ICF and failure of MEP size increase during contraction suggested defective facilitatory cortical inputs, particularly for movement execution. Inhibitory cortical pathways were also found less excitable at rest (reduced ICI) and sometimes during contraction (shortened CSP). By restoring cortical inhibition, dopaminergic drugs and deep brain stimulation probably overcome the difficulty to focus neuronal activity onto the appropriate network required for a specific motor task. The application of repetitive TMS trains over motor cortical areas also showed some effect on cortical excitability, opening perspectives to consider the motor cortex as a target for therapeutic neuromodulation in PD. However, systematic studies of cortical excitability remained to be performed in large series of patients with PD, taking into account disease stage, clinical symptoms and medication influence.

Malfunctions of Central Control of Movement Studied with Slow Brain Potentials in Neurological Patients

Abstract Studies are reviewed that used movement-related EEG potentials to investigate impairments of movement control in neurological patients. The EEG potentials reviewed are the Bereitschaftspotential (BP), Contingent Negative Variation (CNV), and components of the lateralized readiness potential (LRP). Patient groups included in this review are patients with infarction of the middle cerebral artery, Parkinson's disease, cerebellar disease, and amyotrophic lateral sclerosis. A rich body of evidence has been collected on Parkinson's disease, and somewhat less on cerebellar atrophy, contributing to an understanding of the impairments caused by these diseases. In contrast, not much research has been done in amyotrophic lateral sclerosis and in infarction patients. The latter is particularly striking since utility of this method for assessing residual capacities of affected motor areas seems rather obvious.

Neurophysiological correlate of clinical signs in Parkinson's disease

Clinical diagnosis of Parkinson's disease (PD) is not always coincident with pathological findings. A better characterization of the disease from the results of studies in various areas of neuroscience can help in improving the rate of diagnostic certainty. Neurophysiology is among the techniques with better chances to furnish specific diagnostic cues on motor aspects of the disease. Neurophysiology provides quantifiable data using non-invasive, relatively inexpensive, methods. Neurophysiological tests can be applied with no previous preparation, and repeated many times without dangerous consequences. To be rewarding, however, neurophysiological examination should be done in close cooperation between the clinician who detects relevant specific signs, and the neurophysiologist who devises the most demonstrative methods to document those signs. In this review, we describe the neurophysiological correlate of symptoms and signs in patients with PD, and particularly their pathophysiological meaning, with special focus on those that could be more helpful to the neurologists in establishing differences with respect to other diseases presenting with parkinsonism.