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15.32 Repetitive transcranial magnetic stimulation (rTMS)improves freezing of gait (FOG) in patients with Parkinsonism
Chapter 15. Posture and gait in Parklnson ~' disease 7.9±0.9 s (fast). The UPDRS motor score predicted timed walking performance during both self-selected (r 0.579, p 0.049) and fast (r 0.688; p 0.019) speeds. Discussion and Conclusion: Correlational analyses demonstrate that the UPDRS motor score is a good predictor of walking speed in this cohort; however, the measure appears to be better at predicting performance when patients are working closer to their maximum movement capabilities.
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[1] Siderowf A, McDermott M, Kieburtz K et al. Mov Disord 2002; 17(4): 758 763.
and by assessing performance on the Timed Up and Go test (TUG). These two measures have been associated with fall risk. Results: In response to MPH treatment, EF scores increased (improved) from 98.9 to 103.2 (p<0.015) and attention scores increased from 103.6 to 107.2 (p<0.03). Memory scores were unchanged (p 0.63). There was a reduction in the stride time variability (2.2% to 1.9%, p <0.032) and a significant decrease (improvement) in TUG times (12.5 to 10.8 sec, p < 0.002). Gait speed improved from 1.08 to 1.13m/s (p <0.037). Discussion and Conclusions: MPH (Ritalin) treatment was associated with a differential improvement in executive function, attention and gait performance. This unique dual effect opens a new potential mode of intervention to decrease falls in PD.
[•2]
[15~
References
Repetitive transcranial magnetic stimulation (rTMS) improves freezing of gait (FOG) in patients with Parkinsonism
M. Tamaki 1'2'3, Y. Sawada 1'2'3, Y. Ichikawa 1'2'3, K. Arasaki 1'2'3,
K. Sudo 1'2'3. 1International University of Health and Welfare. Atami Hospital, 13 1 Higashikaigan-cho, Atami-City, Shizuoka, Japan," 2Kanto Medical Center NTT EC, Department of Neurology, Department of Rehabilitation, Tokyo, Japan," 3NTT Cyber Space Laboratories', Yokosuka, Japan Introduction: Freezing of gait (FOG) is very disturbing parkinsonian
symptom and responds only partially to currently available treatment. Several recent reports have suggested that rTMS has therapeutic potential in patients with parkinsonism through the modulation of cortical excitability. Patients and Methods: Fourteen patients with FOG were selected. 0.2-Hz 50 stimuli of rTMS were delivered. Six patients were applied over the FPa, FP2 for 7 days and other eight patients were applied over the O1, O2. Another 7 days stimuli were applied to know the additional effect. Gait parameters and time course of the changes in pressure given beneath the foot during ambulation were evaluated with gait analysis system. Results: 5 patients showed prominent improvement and a rapid shift of foot pressure to the big-toe after rTMS treatment. No difference in stimulus site or any increment of effectiveness after additional 7 days stimulus could be found. We could not find significant changes in the ECD-SPECT, Bereitschaft potentials, SEP or MEP after rTMS. Discussion and Conclusion: The possibility that rTMS improves FOG in parkinsonism through modulation of brain network was addressed.
[•3]
Methylphenidate treatment improves cognitive function and gait performance in patients with Parkinson's disease
E. Urihel 1 , T. Herman 1 , E.S. Simon 3, J.M. Hausdorff 1'4, N. Giladi 1'2. 1Movement Disorders Unit, Dept of Neurology, Tel-Aviv
Sourasky Medical Centeg Israel; 2Sackler Faculty of Medicine, Tel-Aviv University, Israel," 3 Department of Clinical Science, Neurotrax Corp., New York, NY, USA,"4 Division on Aging, Harvard Medical School, Boston, MA, USA
Postural control during sitting in Parkinson's disease
J.C.E. van der Burg 1, E.E.H. van Wegen 1, J.H. van DieEn2. 1Institute for fundamental and clinical human movements' sciences', Vrije Universiteit, Amsterdam, The Netherlands'," 2Department of Physical Therapy, Vrije Universiteit Medical Cente~ Amsterdam, The Netherlands' Introduction: Parkinson's disease (PD) is characterized by postural
instability and falls. As increased trunk sway in stance is an indicator of increased fall risk [1] control of trunk movements may play a role in postural instability in PD. However, in standing, movements in the lower extremities also contribute to trunk sway. In this study we investigated the control of trunk movements in isolation, by means of unstable sitting. Methods: Sixteen PD patients (Hoehn and Yahr stage 2 4) and 8 aged-match controls participated. Unstable sitting was accomplished by attaching an aluminium hemisphere to the bottom of a seat, providing a rigid but unstable surface with three rotational degrees of freedom. Increased instability of the seat was obtained by increasing the height of the seat. The seat was placed on a force platform, which measured center of pressure excursions. The angle between the pelvis and the thorax was recorded as well as the EMG activity of the main trunk muscles. Results and Discussion: Preliminary data analysis suggests that PD patients demonstrated poorer balance performance than controls, especially at the most difficult levels. In addition, the angular deviations between the pelvis and the thorax were smaller in PD patients than in controls. PD patients showed increased levels of cocontraction in trunk muscle activation patterns compared to controls. These findings suggest that balance impairments in PD may be related to changes in trunk control, perhaps associated with axial rigidity.
References [1] Adkin AL et al, G&P 2005, in press.
[•5•
Learning a high-precision locomotor task in patients with Parkinson's disease
H.J.A. van Hedel 1, D. Waldvogel 2, V. Dietz 1. :Spinal Cord Injury
Introduction: Gait disturbances and falls are common in Parkinson's
Cente~ Balgrist University Hospital, Forchstrasse 340, CH-8008, Zurich, Switzerland; 2Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland
disease patients (PD) and cause disability and functional dependence. Cognitive decline, in particular, executive dysfunction, is also present and may exacerbate gait disturbances and fall risk. We hypothesized that methylphenidate (MPH, Ritalin) can improve executive function (EF) and attention, enhance gait steadiness, and reduce fall risk in these patients. Methods: 14 patients with PD (mean age 71 yrs) were studied before and 2 hours after administration of a single dose of MPH (20 mg). Cognitive function was tested using a computerized neuropsychological battery that evaluates multiple domains of cognitive function (e.g., EF, attention, memory). Gait was assessed by placing force sensitive insoles inside each subject's shoes and measuring the variability of the stride time during a two minute walk
The ability to adapt the walking pattern to the environment in subjects with Parkinson's disease (PD) is relative unknown. Our aim was to evaluate the acquisition and performance of an adaptive high-precision locomotor task in patients with Parkinson's disease. Methods: 10 patients with PD and 9 age-matched healthy subjects were instructed to step repetitively as low as possible over an obstacle, without touching it. They performed 3 bouts and each consisted of 50 steps over a randomly approaching obstacle. During the first and second bouts, the subjects had full vision and received an acoustic warning signal indicating the start of the obstacle and an acoustic feedback signal indicating foot clearance. During the third bout, vision Introduction:
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[1] Siderowf A, McDermott M, Kieburtz K et al. Mov Disord 2002; 17(4): 758 763.
and by assessing performance on the Timed Up and Go test (TUG). These two measures have been associated with fall risk. Results: In response to MPH treatment, EF scores increased (improved) from 98.9 to 103.2 (p<0.015) and attention scores increased from 103.6 to 107.2 (p<0.03). Memory scores were unchanged (p 0.63). There was a reduction in the stride time variability (2.2% to 1.9%, p <0.032) and a significant decrease (improvement) in TUG times (12.5 to 10.8 sec, p < 0.002). Gait speed improved from 1.08 to 1.13m/s (p <0.037). Discussion and Conclusions: MPH (Ritalin) treatment was associated with a differential improvement in executive function, attention and gait performance. This unique dual effect opens a new potential mode of intervention to decrease falls in PD.
[•2]
[15~
References
Repetitive transcranial magnetic stimulation (rTMS) improves freezing of gait (FOG) in patients with Parkinsonism
M. Tamaki 1'2'3, Y. Sawada 1'2'3, Y. Ichikawa 1'2'3, K. Arasaki 1'2'3,
K. Sudo 1'2'3. 1International University of Health and Welfare. Atami Hospital, 13 1 Higashikaigan-cho, Atami-City, Shizuoka, Japan," 2Kanto Medical Center NTT EC, Department of Neurology, Department of Rehabilitation, Tokyo, Japan," 3NTT Cyber Space Laboratories', Yokosuka, Japan Introduction: Freezing of gait (FOG) is very disturbing parkinsonian
symptom and responds only partially to currently available treatment. Several recent reports have suggested that rTMS has therapeutic potential in patients with parkinsonism through the modulation of cortical excitability. Patients and Methods: Fourteen patients with FOG were selected. 0.2-Hz 50 stimuli of rTMS were delivered. Six patients were applied over the FPa, FP2 for 7 days and other eight patients were applied over the O1, O2. Another 7 days stimuli were applied to know the additional effect. Gait parameters and time course of the changes in pressure given beneath the foot during ambulation were evaluated with gait analysis system. Results: 5 patients showed prominent improvement and a rapid shift of foot pressure to the big-toe after rTMS treatment. No difference in stimulus site or any increment of effectiveness after additional 7 days stimulus could be found. We could not find significant changes in the ECD-SPECT, Bereitschaft potentials, SEP or MEP after rTMS. Discussion and Conclusion: The possibility that rTMS improves FOG in parkinsonism through modulation of brain network was addressed.
[•3]
Methylphenidate treatment improves cognitive function and gait performance in patients with Parkinson's disease
E. Urihel 1 , T. Herman 1 , E.S. Simon 3, J.M. Hausdorff 1'4, N. Giladi 1'2. 1Movement Disorders Unit, Dept of Neurology, Tel-Aviv
Sourasky Medical Centeg Israel; 2Sackler Faculty of Medicine, Tel-Aviv University, Israel," 3 Department of Clinical Science, Neurotrax Corp., New York, NY, USA,"4 Division on Aging, Harvard Medical School, Boston, MA, USA
Postural control during sitting in Parkinson's disease
J.C.E. van der Burg 1, E.E.H. van Wegen 1, J.H. van DieEn2. 1Institute for fundamental and clinical human movements' sciences', Vrije Universiteit, Amsterdam, The Netherlands'," 2Department of Physical Therapy, Vrije Universiteit Medical Cente~ Amsterdam, The Netherlands' Introduction: Parkinson's disease (PD) is characterized by postural
instability and falls. As increased trunk sway in stance is an indicator of increased fall risk [1] control of trunk movements may play a role in postural instability in PD. However, in standing, movements in the lower extremities also contribute to trunk sway. In this study we investigated the control of trunk movements in isolation, by means of unstable sitting. Methods: Sixteen PD patients (Hoehn and Yahr stage 2 4) and 8 aged-match controls participated. Unstable sitting was accomplished by attaching an aluminium hemisphere to the bottom of a seat, providing a rigid but unstable surface with three rotational degrees of freedom. Increased instability of the seat was obtained by increasing the height of the seat. The seat was placed on a force platform, which measured center of pressure excursions. The angle between the pelvis and the thorax was recorded as well as the EMG activity of the main trunk muscles. Results and Discussion: Preliminary data analysis suggests that PD patients demonstrated poorer balance performance than controls, especially at the most difficult levels. In addition, the angular deviations between the pelvis and the thorax were smaller in PD patients than in controls. PD patients showed increased levels of cocontraction in trunk muscle activation patterns compared to controls. These findings suggest that balance impairments in PD may be related to changes in trunk control, perhaps associated with axial rigidity.
References [1] Adkin AL et al, G&P 2005, in press.
[•5•
Learning a high-precision locomotor task in patients with Parkinson's disease
H.J.A. van Hedel 1, D. Waldvogel 2, V. Dietz 1. :Spinal Cord Injury
Introduction: Gait disturbances and falls are common in Parkinson's
Cente~ Balgrist University Hospital, Forchstrasse 340, CH-8008, Zurich, Switzerland; 2Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland
disease patients (PD) and cause disability and functional dependence. Cognitive decline, in particular, executive dysfunction, is also present and may exacerbate gait disturbances and fall risk. We hypothesized that methylphenidate (MPH, Ritalin) can improve executive function (EF) and attention, enhance gait steadiness, and reduce fall risk in these patients. Methods: 14 patients with PD (mean age 71 yrs) were studied before and 2 hours after administration of a single dose of MPH (20 mg). Cognitive function was tested using a computerized neuropsychological battery that evaluates multiple domains of cognitive function (e.g., EF, attention, memory). Gait was assessed by placing force sensitive insoles inside each subject's shoes and measuring the variability of the stride time during a two minute walk
The ability to adapt the walking pattern to the environment in subjects with Parkinson's disease (PD) is relative unknown. Our aim was to evaluate the acquisition and performance of an adaptive high-precision locomotor task in patients with Parkinson's disease. Methods: 10 patients with PD and 9 age-matched healthy subjects were instructed to step repetitively as low as possible over an obstacle, without touching it. They performed 3 bouts and each consisted of 50 steps over a randomly approaching obstacle. During the first and second bouts, the subjects had full vision and received an acoustic warning signal indicating the start of the obstacle and an acoustic feedback signal indicating foot clearance. During the third bout, vision Introduction: