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P399 Assessment of central motor functions using magnetic stimulation in patients with Parkinson's disease
Poster Session: Motor Control ~9--~
THE EXECUTION OF BALLISTIC VS. CONTROLLED MOVEMENTS: PATHOLOGYOF MOVEMENT RELATED POTENTIALS IN PARKINSONS DISEASE
T. Dang, S. Schulze, K. B~tzel. Dept. of Neurolog3; Ladwig-Maximilians-Universitdit Munich, German3, Patients suffering from Parkinson's disease (PD) are disabled in performing voluntary, fast movements. We studied movement related potentials (MRP) during ballistic and controlled movements. Healthy volunteers and PD patients performed slow and fast arm movement tasks. EEG-recordings were obtained with De-amplifiers from 30 scalp electrodes. 1) Both movements elicited a negative potential (Bereitschaftspotential) starting around 1.3 s before movement onset (MO). The slope of the early part (BP) and that of the late component (NS) differed in either group between tasks without alterations between groups. 2) At frontal leads a negative peak after MO was recorded in all healthy subjects performing the fast task. This peak was significantly diminished in patients. The reduction of its amplitude correlated significantly with the reduction of movement velocity. In the slow movement this peak was not seen in either group. Our findings suggest the existence of different cerebral mechanisms for the initiation of ballistic and controlled movements. Furthermore the impairment of fast movement execution in PD patients was reflected by a reduced peak at MO. This might be a correlate of disrupted motor circuits depending on intact basal ganglia function.
[-P-~
INVOLUNTARYMOVEMENTS AND BRAIN DOMINANCE
G. Vu~i~vi6, S. Banit-Horvat, E. Atimovit. Dora zdravlja "Zmaj
Ognjena Vuka", Novi Sad, Yugoslavia Neurologic ethiopatogenesis of transient tic disorders and stuttering are emphasized by contemporary researches. Their connection to cortical organization is in focus, too. Transient tic disorders are single or multiple motor and/or vocal sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements and vocalizations. Stuttering is disturbance in the normal fluency and time pattering of speech inappropriate for the individual's age. Involuntary movements are caused by undefined hand preference as a result of brain dominance conflict. The aim of our research was to find correlation between involuntary movements on one side and hand preference and brain dominance on the other side. This research involved 50 children 5 to 16 years old with such problems. We examined hand pronation-supination movement, reciprocative coordination of the upper limbs, gestual lateralisation and hand preference and Bender's test. Electrocortical maturation was followed by EEG. We concluded that children with tics and stuttering: 1. are predominant in preschool and early school years, 2. have whole brain dominance (bi-lateral) or have slight preference toward the left or right, 3. were forced to be right-handers (cultural influence), 4. have disrhythmic EEG or signs of brain immaturity on EEG, 5. have other problems with motor and visuomotor organization. Thus, early estimation of brain dominance and professional advice in choosing an appropriate hand can be helpful in treating this pathology.
~9-~
GAIT IN PARKINSON'S DISEASE: ADAPTATIONTO EXTERNAL CONDITIONS
G. Fuss, U. Dillmann, D. Ohlmann, C, Krick, K. Schimrigk. Department
of Neurology; University Clinics, 66421 Homburg-Germany Objectives: To compare the EMG-pattern in lower extremities with different gait conditions between normal subjects and parldnsonian patients. Methods: We analysed the EMG-pattern of tibialis anterior (TA), medial head of gastrocnemius (GA), vastus medialis (VM), biceps femoris (BF), iliopsoas (IP) and glutaeus maximus (GM). During walking on a treadmill, 3 different velocities (normal, slow and fast) and 2 conditions (0% and 10% climb) were used. Different phases of step were characterized by pressure sensors at heel and ball of the foot. The begin of a step-cycle was defined as an increase of heel-pressure. 16 cycles were averaged. Results: Stance phase was significantly prolonged in parkinsonian patients. In both groups, TA and GC showed an antagonistic pattern and VM/BF and GM/IP synergistic activities. In parkinsonian patients, VM and BF were longer activated during stance phase, during swing phase BF was
369
activated later. Amplitudes of GM and VM were significantly increased. Altered activities of GM, VM and BF increase stance phase, the altered activity of BM and VM disturbs knee flexion and increased activity of GM detoriates hip flexion. Normal subjects increased velocity by increasing EMG-amplitudes, parkinsonian patients by shifting EMG-activity within the step cycle and increasing duration especially of VM. Climbing led to a shift within the step cycle and an increase of amplitudes more pronounced in normal than in parkinsonian. Conclusions: EMG-pattem during normal gait corresponds to the typical clinical signs of Parkinson's disease. Adaptation to different external conditions is clearly impaired.
~-9-]
ASSESSMENT OF CENTRAL MOTOR FUNCTIONS USING MAGNETIC STIMULATION IN PATIENTSWITH PARKINSON'S DISEASE
P. Di6szeghy, F. Mechler. Dept. Neurology, Med. School, Univ. of
Debrecen, Hungary The transcranial and spinal magnetic stimulation provides useful data on the functional state of motor output of the central motor structures and on the functional condition of the intraoerebral motor network. Analysis of abnormalities of the central motor functions and the modifying effect of L-dopa treatment were the objective of our study. Eighteen patients with Parkinson's disease were examined before and after L-dopa substitution. Transcranial and spinal magnetic stimulation was performed and the latency and amplitude of the motor potentials from the first dorsal interosseal muscle, the central motor conduction time and the duration of cortical inhibition were measured. The motor latency, the central conduction time and the silent period of patients before the treatment were significandy shorter than that of the age matched healthy controls. After L-dopa substitution of six months both the motor latencies and the silent periods increased and achieved the normal values. The variability of amplitude values was high and the changes were not significant. The findings are thought to be in relation to the mechanisms originating in the basal ganglia and acting through inhibitory thalamo-cortical connections at cortical level and through rubro-, reticulospinal pathways at the level of spinal inhibitory neurons.
~--0~
THE CHANGES OF LONG LATENCY RESPONSES IN PATIENTS WITH PARKINSON'S DISEASE
N.C. Isik. G~iztepeHospital, Istanbul, Turkey," O. Us, Marmara
Universit3, Medical School, Istanbul, Turkey It's a well known subject that electrical stimulation of median nerve at the wrist evokes several distinct reflexes in voluntarily activated thenar muscles. The first response is the Hoffmann Reflex. There is a second reflex group called Long-Latency Reflexes (LLR). It's also known that only LLR-II constantly present following Hoffmann Reflex in a mean latency of almost 50 msec. This study was planned to investigate the LLR changes in 30 patients with Parkinson's Disease. 40 healthy person were used as control group. Because Parkinson's Disease goes with the neurodegeneration in basal ganglions and with neurotransmitter defects we tried to document if there is any relation between the wanscortical LLR pathway and supraspinal dopaminergic system. In results we found that basal ganglion pathologies like Parkinson's Disease effect LLR-pattern. Persistency of a peak with a mean latency of almost 40 msec. -probably LLR-I -was found significantly increased. We also found abnormal LLR-II, mostly absence, when compare with normal values
[•-•
SILENT PERIOD, LONG-LATENCY REFLEXES, AND RIGIDITY IN PATIENTSWITH PARKINSON'S DISEASE
Th. Paduch i, W. Greulich 2, W. Gehlen 3. i Neurosurgical Department,
University Clinic of Freiburg, Germany; 2 Neurological Clinic Hagen-Ambrock, University of Witten/Herdecke, Germany; 3 Neurological Department, Knappschaftskrankenhaus, University of Bochum, Germany The evidence of the silent period and long-latency reflexes for diagnosis and therapy control of patients with Parkinson's disease should be proofed. Clinical evaluation and neurophysiologic examinations for silent pc-
THE EXECUTION OF BALLISTIC VS. CONTROLLED MOVEMENTS: PATHOLOGYOF MOVEMENT RELATED POTENTIALS IN PARKINSONS DISEASE
T. Dang, S. Schulze, K. B~tzel. Dept. of Neurolog3; Ladwig-Maximilians-Universitdit Munich, German3, Patients suffering from Parkinson's disease (PD) are disabled in performing voluntary, fast movements. We studied movement related potentials (MRP) during ballistic and controlled movements. Healthy volunteers and PD patients performed slow and fast arm movement tasks. EEG-recordings were obtained with De-amplifiers from 30 scalp electrodes. 1) Both movements elicited a negative potential (Bereitschaftspotential) starting around 1.3 s before movement onset (MO). The slope of the early part (BP) and that of the late component (NS) differed in either group between tasks without alterations between groups. 2) At frontal leads a negative peak after MO was recorded in all healthy subjects performing the fast task. This peak was significantly diminished in patients. The reduction of its amplitude correlated significantly with the reduction of movement velocity. In the slow movement this peak was not seen in either group. Our findings suggest the existence of different cerebral mechanisms for the initiation of ballistic and controlled movements. Furthermore the impairment of fast movement execution in PD patients was reflected by a reduced peak at MO. This might be a correlate of disrupted motor circuits depending on intact basal ganglia function.
[-P-~
INVOLUNTARYMOVEMENTS AND BRAIN DOMINANCE
G. Vu~i~vi6, S. Banit-Horvat, E. Atimovit. Dora zdravlja "Zmaj
Ognjena Vuka", Novi Sad, Yugoslavia Neurologic ethiopatogenesis of transient tic disorders and stuttering are emphasized by contemporary researches. Their connection to cortical organization is in focus, too. Transient tic disorders are single or multiple motor and/or vocal sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements and vocalizations. Stuttering is disturbance in the normal fluency and time pattering of speech inappropriate for the individual's age. Involuntary movements are caused by undefined hand preference as a result of brain dominance conflict. The aim of our research was to find correlation between involuntary movements on one side and hand preference and brain dominance on the other side. This research involved 50 children 5 to 16 years old with such problems. We examined hand pronation-supination movement, reciprocative coordination of the upper limbs, gestual lateralisation and hand preference and Bender's test. Electrocortical maturation was followed by EEG. We concluded that children with tics and stuttering: 1. are predominant in preschool and early school years, 2. have whole brain dominance (bi-lateral) or have slight preference toward the left or right, 3. were forced to be right-handers (cultural influence), 4. have disrhythmic EEG or signs of brain immaturity on EEG, 5. have other problems with motor and visuomotor organization. Thus, early estimation of brain dominance and professional advice in choosing an appropriate hand can be helpful in treating this pathology.
~9-~
GAIT IN PARKINSON'S DISEASE: ADAPTATIONTO EXTERNAL CONDITIONS
G. Fuss, U. Dillmann, D. Ohlmann, C, Krick, K. Schimrigk. Department
of Neurology; University Clinics, 66421 Homburg-Germany Objectives: To compare the EMG-pattern in lower extremities with different gait conditions between normal subjects and parldnsonian patients. Methods: We analysed the EMG-pattern of tibialis anterior (TA), medial head of gastrocnemius (GA), vastus medialis (VM), biceps femoris (BF), iliopsoas (IP) and glutaeus maximus (GM). During walking on a treadmill, 3 different velocities (normal, slow and fast) and 2 conditions (0% and 10% climb) were used. Different phases of step were characterized by pressure sensors at heel and ball of the foot. The begin of a step-cycle was defined as an increase of heel-pressure. 16 cycles were averaged. Results: Stance phase was significantly prolonged in parkinsonian patients. In both groups, TA and GC showed an antagonistic pattern and VM/BF and GM/IP synergistic activities. In parkinsonian patients, VM and BF were longer activated during stance phase, during swing phase BF was
369
activated later. Amplitudes of GM and VM were significantly increased. Altered activities of GM, VM and BF increase stance phase, the altered activity of BM and VM disturbs knee flexion and increased activity of GM detoriates hip flexion. Normal subjects increased velocity by increasing EMG-amplitudes, parkinsonian patients by shifting EMG-activity within the step cycle and increasing duration especially of VM. Climbing led to a shift within the step cycle and an increase of amplitudes more pronounced in normal than in parkinsonian. Conclusions: EMG-pattem during normal gait corresponds to the typical clinical signs of Parkinson's disease. Adaptation to different external conditions is clearly impaired.
~-9-]
ASSESSMENT OF CENTRAL MOTOR FUNCTIONS USING MAGNETIC STIMULATION IN PATIENTSWITH PARKINSON'S DISEASE
P. Di6szeghy, F. Mechler. Dept. Neurology, Med. School, Univ. of
Debrecen, Hungary The transcranial and spinal magnetic stimulation provides useful data on the functional state of motor output of the central motor structures and on the functional condition of the intraoerebral motor network. Analysis of abnormalities of the central motor functions and the modifying effect of L-dopa treatment were the objective of our study. Eighteen patients with Parkinson's disease were examined before and after L-dopa substitution. Transcranial and spinal magnetic stimulation was performed and the latency and amplitude of the motor potentials from the first dorsal interosseal muscle, the central motor conduction time and the duration of cortical inhibition were measured. The motor latency, the central conduction time and the silent period of patients before the treatment were significandy shorter than that of the age matched healthy controls. After L-dopa substitution of six months both the motor latencies and the silent periods increased and achieved the normal values. The variability of amplitude values was high and the changes were not significant. The findings are thought to be in relation to the mechanisms originating in the basal ganglia and acting through inhibitory thalamo-cortical connections at cortical level and through rubro-, reticulospinal pathways at the level of spinal inhibitory neurons.
~--0~
THE CHANGES OF LONG LATENCY RESPONSES IN PATIENTS WITH PARKINSON'S DISEASE
N.C. Isik. G~iztepeHospital, Istanbul, Turkey," O. Us, Marmara
Universit3, Medical School, Istanbul, Turkey It's a well known subject that electrical stimulation of median nerve at the wrist evokes several distinct reflexes in voluntarily activated thenar muscles. The first response is the Hoffmann Reflex. There is a second reflex group called Long-Latency Reflexes (LLR). It's also known that only LLR-II constantly present following Hoffmann Reflex in a mean latency of almost 50 msec. This study was planned to investigate the LLR changes in 30 patients with Parkinson's Disease. 40 healthy person were used as control group. Because Parkinson's Disease goes with the neurodegeneration in basal ganglions and with neurotransmitter defects we tried to document if there is any relation between the wanscortical LLR pathway and supraspinal dopaminergic system. In results we found that basal ganglion pathologies like Parkinson's Disease effect LLR-pattern. Persistency of a peak with a mean latency of almost 40 msec. -probably LLR-I -was found significantly increased. We also found abnormal LLR-II, mostly absence, when compare with normal values
[•-•
SILENT PERIOD, LONG-LATENCY REFLEXES, AND RIGIDITY IN PATIENTSWITH PARKINSON'S DISEASE
Th. Paduch i, W. Greulich 2, W. Gehlen 3. i Neurosurgical Department,
University Clinic of Freiburg, Germany; 2 Neurological Clinic Hagen-Ambrock, University of Witten/Herdecke, Germany; 3 Neurological Department, Knappschaftskrankenhaus, University of Bochum, Germany The evidence of the silent period and long-latency reflexes for diagnosis and therapy control of patients with Parkinson's disease should be proofed. Clinical evaluation and neurophysiologic examinations for silent pc-