Analysis of premovement components of movement-related cortical potentials in patients with Parkinson's disease or brain tumors

Intracerebral recording of readiness potential induced by a complex motor task

While exploring 11 epileptic patients with intracerebral electrodes, we recorded readiness potential (RP) preceding a complex motor task. Multilead depth electrodes were positioned stereotactically into the cortex. In three patients, it was also possible to record RP from the putamen. The movement triggering the recording was the turning of a page in an architectural book. The movement was performed under two conditions: in the first condition, without looking at the pictures on the page (typical self-pacing); and in the second condition, following the inspection of the pictures. There were no significant differences in the appearance of RP under these two conditions, neither in duration nor in amplitude. That could be explained by the fact that "self-paced" does not mean "spontaneous," but covers the internal non-conscious program related to a given task. RP were present in the contralateral primary sensorimotor cortex and the bilateral supplementary motor area (SMA), and in the anterior caudal cingulate cortex. No difference between the cortical topography of RP preceding a simple motor task and the topography of RP occurring in connection with complex movement was observed.

Impact of deep brain stimulation on upper limb akinesia in Parkinson's disease

Recent pathophysiological models of Parkinson's disease have led to new surgical approaches to treatment including deep brain stimulation (DBS) and lesioning of basal ganglia structures. Various measures of upper limb akinesia were assessed in 6 patients with bilateral DBS of the internal pallidum and 6 with DBS of the subthalamic nucleus. Stimulation improved a number of aspects of motor function, and particularly movement time, and force production. Time to initiate movements, and to perform repetitive movements also improved but less dramatically. Processes indicating preparatory motor processes showed no significant change. Few significant differences were found between the internal pallidum and subthalamic nucleus groups. In general, the effects of DBS closely parallel previous reports of the effects of dopaminergic medication. It is suggested that disrupted pallidal output in Parkinson's disease interferes with the rate, level, and coordination of force production but has little effect on preparatory processes. The similarity of the effects of subthalamic nucleus and internal pallidum stimulation suggests this disrupted outflow is the most important determinant of upper limb akinesia in Parkinson's disease. The effects of DBS were similar to the effects of unilateral pallidal lesions reported elsewhere.