Jay L Alberts1, Michael Phillips2, Mark J Lowe2, Anneke Frankemolle3, Anil Thota3, Erik B Beall2, Mary Feldman4, Anwar Ahmed5, Angela L Ridgel3. 1. Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA; Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA; Cleveland FES Center, L. Stokes Cleveland VA Medical Center, Cleveland, OH, USA. Electronic address: albertj@ccf.org. 2. Department of Radiology, Cleveland Clinic, Cleveland, OH, USA. 3. Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA. 4. Geisel School of Medicine Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, NH 03756, Lebanon. Electronic address: Mary.S.Feldman@hitchcock.org. 5. Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA; Cleveland FES Center, L. Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
Abstract
INTRODUCTION: Studies in animal models of Parkinson's disease (PD) have suggested that the rate of exercise performance is important in treatment efficacy and neuroprotection. In humans with PD, lower-extremity forced-exercise (FE) produced global improvements in motor symptoms based on clinical ratings and biomechanical measures of upper extremity function. METHODS: fMRI was used to compare the underlying changes in brain activity in PD patients following the administration of anti-parkinsonian medication and following a session of FE. RESULTS: Nine individuals with PD completed fMRI scans under each condition: off anti-PD medication, on anti-PD medication, and off medication + FE. Unified Parkinson's Disease Rating Motor Scale scores improved by 50% in the FE condition compared to the off-medication condition. The pattern of fMRI activation after FE was similar to that seen with anti-PD medication. Direct comparison of the fMRI activation patterns showed high correlation between FE and anti-PD medication. CONCLUSION: These findings suggest that medication and FE likely utilize the same pathways to produce symptomatic relief in individuals with PD.
INTRODUCTION: Studies in animal models of Parkinson's disease (PD) have suggested that the rate of exercise performance is important in treatment efficacy and neuroprotection. In humans with PD, lower-extremity forced-exercise (FE) produced global improvements in motor symptoms based on clinical ratings and biomechanical measures of upper extremity function. METHODS: fMRI was used to compare the underlying changes in brain activity in PDpatients following the administration of anti-parkinsonian medication and following a session of FE. RESULTS: Nine individuals with PD completed fMRI scans under each condition: off anti-PD medication, on anti-PD medication, and off medication + FE. Unified Parkinson's Disease Rating Motor Scale scores improved by 50% in the FE condition compared to the off-medication condition. The pattern of fMRI activation after FE was similar to that seen with anti-PD medication. Direct comparison of the fMRI activation patterns showed high correlation between FE and anti-PD medication. CONCLUSION: These findings suggest that medication and FE likely utilize the same pathways to produce symptomatic relief in individuals with PD.
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