Letizzia DALL’AGNOL ◽  
Alice Medeiros de SOUZA ◽  
Lilian Campos AMADEU ◽  
Fernanda Ishida CORRÊA

Parkinson’s disease (PD) is a central nervous system neurodegenerative disorder that primarily affects the motor system, decreasing motor coordination, balance and generating tremors, and a progressive loss of everyday mobility, including walking. This study was conducted to verify the effects of Transcranial Direct Current Stimulation (tDCS) on balance, motor control, and the quality of life in Parkinson’s disease patients. The patient received three treatments consisting of 10 sessions of 20 minutes each and a one-week interval between treatments. Active stimulation was applied on the primary motor cortex (M1), the dorsolateral prefrontal cortex (DLPFC), and the dorsolateral prefrontal cortex (D Sham-tDCS. DLPFC stimulation produced the best improvements in terms of motor control, balance, gait, and overall PD symptoms, as evaluated by different scales and questionnaires. As a result, active stimulation of the DLPFC produced superior outcomes and may contribute to treating Parkinson’s disease.

Brain ◽  
2020 ◽  
Ruxue Gong ◽  
Mirko Wegscheider ◽  
Christoph Mühlberg ◽  
Richard Gast ◽  
Christopher Fricke ◽  

Abstract Abnormal phase-amplitude coupling between β and broadband-γ activities has been identified in recordings from the cortex or scalp of patients with Parkinson’s disease. While enhanced phase-amplitude coupling has been proposed as a biomarker of Parkinson’s disease, the neuronal mechanisms underlying the abnormal coupling and its relationship to motor impairments in Parkinson’s disease remain unclear. To address these issues, we performed an in-depth analysis of high-density EEG recordings at rest in 19 patients with Parkinson’s disease and 20 age- and sex-matched healthy control subjects. EEG signals were projected onto the individual cortical surfaces using source reconstruction techniques and separated into spatiotemporal components using independent component analysis. Compared to healthy controls, phase-amplitude coupling of Parkinson’s disease patients was enhanced in dorsolateral prefrontal cortex, premotor cortex, primary motor cortex and somatosensory cortex, the difference being statistically significant in the hemisphere contralateral to the clinically more affected side. β and γ signals involved in generating abnormal phase-amplitude coupling were not strictly phase-phase coupled, ruling out that phase-amplitude coupling merely reflects the abnormal activity of a single oscillator in a recurrent network. We found important differences for couplings between the β and γ signals from identical components as opposed to those from different components (originating from distinct spatial locations). While both couplings were abnormally enhanced in patients, only the latter were correlated with clinical motor severity as indexed by part III of the Movement Disorder Society Unified Parkinson’s Disease Rating Scale. Correlations with parkinsonian motor symptoms of such inter-component couplings were found in premotor, primary motor and somatosensory cortex, but not in dorsolateral prefrontal cortex, suggesting motor domain specificity. The topography of phase-amplitude coupling demonstrated profound differences in patients compared to controls. These findings suggest, first, that enhanced phase-amplitude coupling in Parkinson’s disease patients originates from the coupling between distinct neural networks in several brain regions involved in motor control. Because these regions included the somatosensory cortex, abnormal phase-amplitude coupling is not exclusively tied to the hyperdirect tract connecting cortical regions monosynaptically with the subthalamic nucleus. Second, only the coupling between β and γ signals from different components appears to have pathophysiological significance, suggesting that therapeutic approaches breaking the abnormal lateral coupling between neuronal circuits may be more promising than targeting phase-amplitude coupling per se.

2016 ◽  
Vol 41 (8) ◽  
pp. 2171-2177 ◽  
Robin J Borchert ◽  
Timothy Rittman ◽  
Luca Passamonti ◽  
Zheng Ye ◽  
Saber Sami ◽  

Abstract Cognitive impairment is common in Parkinson’s disease (PD), but often not improved by dopaminergic treatment. New treatment strategies targeting other neurotransmitter deficits are therefore of growing interest. Imaging the brain at rest (‘task-free’) provides the opportunity to examine the impact of a candidate drug on many of the brain networks that underpin cognition, while minimizing task-related performance confounds. We test this approach using atomoxetine, a selective noradrenaline reuptake inhibitor that modulates the prefrontal cortical activity and can facilitate some executive functions and response inhibition. Thirty-three patients with idiopathic PD underwent task-free fMRI. Patients were scanned twice in a double-blind, placebo-controlled crossover design, following either placebo or 40-mg oral atomoxetine. Seventy-six controls were scanned once without medication to provide normative data. Seed-based correlation analyses were used to measure changes in functional connectivity, with the right inferior frontal gyrus (IFG) a critical region for executive function. Patients on placebo had reduced connectivity relative to controls from right IFG to dorsal anterior cingulate cortex and to left IFG and dorsolateral prefrontal cortex. Atomoxetine increased connectivity from the right IFG to the dorsal anterior cingulate. In addition, the atomoxetine-induced change in connectivity from right IFG to dorsolateral prefrontal cortex was proportional to the change in verbal fluency, a simple index of executive function. The results support the hypothesis that atomoxetine may restore prefrontal networks related to executive functions. We suggest that task-free imaging can support translational pharmacological studies of new drug therapies and provide evidence for engagement of the relevant neurocognitive systems.

2008 ◽  
Vol 2008 ◽  
pp. 1-6 ◽  
I. Rektorova ◽  
S. Sedlackova ◽  
S. Telecka ◽  
A. Hlubocky ◽  
I. Rektor

We studied whether five sessions of 10 Hz repetitive transcranial magnetic stimulation (rTMS treatment) applied over the dorsolateral prefrontal cortex (DLPFC) or the primary motor cortex (MC) in advanced Parkinson's disease (PD) patients would have any effect on L-dopa-induced dyskinesias and cortical excitability. We aimed at a randomised, controlled study. Single-pulse transcranial magnetic stimulation (TMS), paired-pulse transcranial magnetic stimulation, and the Unified Parkinson's Disease Rating Scale (UPDRS parts III and IV) were performed prior to, immediately after, and one week after an appropriate rTMS treatment. Stimulation of the left DLPFC induced a significant motor cortex depression and a trend towards the improvement of L-dopa-induced dyskinesias.

2021 ◽  
pp. 1-17
Camila Beatriz da Silva Machado ◽  
Letícia Maria da Silva ◽  
Alessandra Feitosa Gonçalves ◽  
Palloma Rodrigues de Andrade ◽  
Cristina Katya Torres Teixeira Mendes ◽  

BACKGROUND: Parkinson’s Disease (PD) is a progressive neurodegenerative disorder, characterized by cardinal motor symptoms in addition to cognitive impairment. New insights concerning multisite non-invasive brain stimulation effects have been gained, which can now be used to develop innovative treatment approaches. OBJECTIVE: Map the researchs involving multisite non-invasive brain stimulation in PD, synthesize the available evidence and discuss future directions. METHODS: The databases PubMed, PsycINFO, CINAHL, LILACS and The Cochrane Library were searched from inception until April 2020, without restrictions on the date of publication or the language in which it was published. The reviewers worked in pairs and sequentially evaluated the titles, abstracts and then the full text of all publications identified as potentially relevant. RESULTS: Twelve articles met the inclusion criteria. The target brain regions included mainly the combination of a motor and a frontal area, such as stimulation of the primary motor córtex associated with the dorsolateral prefrontal cortex. Most of the trials showed that this modality was only more effective for the motor component, or for the cognitive and/or non-motor, separately. CONCLUSIONS: Despite the results being encouraging for the use of the multisite aproach, the indication for PD management should be carried out with caution and deserves scientific deepening.

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 162-169 ◽  
Jonathan A. Hyam ◽  
Sarah L.F. Owen ◽  
Morten L. Kringelbach ◽  
Ned Jenkinson ◽  
John F. Stein ◽  

Abstract BACKGROUND Targeting of the motor thalamus for the treatment of tremor has traditionally been achieved by a combination of anatomical atlases and neuroimaging, intraoperative clinical assessment, and physiological recordings. OBJECTIVE To evaluate whether thalamic nuclei targeted in tremor surgery could be identified by virtue of their differing connections with noninvasive neuroimaging, thereby providing an extra factor to aid successful targeting. METHODS Diffusion tensor tractography was performed in 17 healthy control subjects using diffusion data acquired at 1.5-T magnetic resonance imaging (60 directions, b value = 1000 s/mm2, 2 × 2 × 2-mm3 voxels). The ventralis intermedius (Vim) and ventralis oralis posterior (Vop) nuclei were identified by a stereotactic neurosurgeon, and these sites were used as seeds for probabilistic tractography. The expected cortical connections of these nuclei, namely the primary motor cortex (M1) and contralateral cerebellum for the Vim and M1, the supplementary motor area, and dorsolateral prefrontal cortex for the Vop, were determined a priori from the literature. RESULTS Tractogram signal intensity was highest in the dorsolateral prefrontal cortex and supplementary motor area after Vop seeding (P > .001, Wilcoxon signed-rank tests). High intensity was seen in M1 after seeding of both nuclei but was greater with Vim seeding (P > .001). Contralateral cerebellar signal was highest with Vim seeding (P > .001). CONCLUSION Probabilistic tractography can depict differences in connectivity between intimate nuclei within the motor thalamus. These connections are consistent with published anatomical studies; therefore, tractography may provide an important adjunct in future targeting in tremor surgery.

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