Ashlesh Laxman Patil1, Sanjay Kumar Sood2, Vinay Goyal3, Kanwal Preet Kochhar4. 1. Senior Resident, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India. 2. Professor, Department of Physiology, RAK College of Medical Sciences (RAKMHSU), Ras Al Khaimah, United Arab Emirates. 3. Professor, Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. 4. Professor, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.
Abstract
INTRODUCTION: Recording cortical potentials prior to movement (bereitschaftspotentials, BP) offer a good non invasive method for studying activity of motor related cortices in Parkinson's Disease (PD). Dopaminergic medications provide some symptomatic relief in advanced stages but they do not stop the progression of the disease. Assessing BP may be a good idea to see the response of anti PD drugs. It remains unclear whether the anti PD medications also improve cortical activity prior to movement even in advanced stages of the disease. AIM: In this study we recorded scalp BP in patients with varying grades of severity to study the relationship between disease severity and various components of BP. MATERIALS AND METHODS: We successfully recorded BP at Cz, C3 and C4 sites during self-initiated 100 right wrist movements in 12 male patients with PD having severity Hoehn and Yahn (H&Y) scale 4 (PD3 group). These potentials were compared with age matched patients with H&Y scale 2 (PD1) and scale 3 (PD2) and also with age matched healthy controls. RESULTS: We found flatter waveforms with increasing severity of disease. Amplitude is first to be affected in mild severity as compared to controls (p=0.011); while with increasing severity early as well as late part of potentials is affected. Such changes are prominently seen at Cz site across the groups. CONCLUSION: These findings imply that there is increasing defect in cortical activity during movement especially in supplementary motor area with increasing severity in PD in spite of dopaminergic medications. This dynamic nature of dysfunction in supplementary motor cortices must be taken in account while treating advanced cases using newer stimulation techniques.
INTRODUCTION: Recording cortical potentials prior to movement (bereitschaftspotentials, BP) offer a good non invasive method for studying activity of motor related cortices in Parkinson's Disease (PD). Dopaminergic medications provide some symptomatic relief in advanced stages but they do not stop the progression of the disease. Assessing BP may be a good idea to see the response of anti PD drugs. It remains unclear whether the anti PD medications also improve cortical activity prior to movement even in advanced stages of the disease. AIM: In this study we recorded scalp BP in patients with varying grades of severity to study the relationship between disease severity and various components of BP. MATERIALS AND METHODS: We successfully recorded BP at Cz, C3 and C4 sites during self-initiated 100 right wrist movements in 12 male patients with PD having severity Hoehn and Yahn (H&Y) scale 4 (PD3 group). These potentials were compared with age matched patients with H&Y scale 2 (PD1) and scale 3 (PD2) and also with age matched healthy controls. RESULTS: We found flatter waveforms with increasing severity of disease. Amplitude is first to be affected in mild severity as compared to controls (p=0.011); while with increasing severity early as well as late part of potentials is affected. Such changes are prominently seen at Cz site across the groups. CONCLUSION: These findings imply that there is increasing defect in cortical activity during movement especially in supplementary motor area with increasing severity in PD in spite of dopaminergic medications. This dynamic nature of dysfunction in supplementary motor cortices must be taken in account while treating advanced cases using newer stimulation techniques.
Entities:
Keywords:
Bereitschaftspotentials; Hoehn & Yahn scale; Levodopa; Motor planning
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