Differential effects of levodopa and subthalamic nucleus deep brain stimulation on bradykinesia in Parkinson's disease |
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| Authors: | Lars Timmermann MD Martin Braun MD Stefan Groiss MD Lars Wojtecki MD Stefan Ostrowski MA Holger Krause MA Bettina Pollok PhD Martin Südmeyer MD Markus Ploner MD Joachim Gross PhD Mohammad Maarouf MD Jürgen Voges MD Volker Sturm MD Alfons Schnitzler MD |
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| Affiliation: | 1. Department of Neurology, University of Cologne, Cologne, Germany;2. Department of Neurology, Heinrich‐Heine University, Duesseldorf, Germany;3. Department of Neurology, Technical University Munich, Munich, Germany;4. Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany |
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| Abstract: | Cardinal symptoms of Parkinson's disease (PD) respond well to treatment with levodopa and deep brain stimulation (DBS) of the subthalamic nucleus (STN). However, it has remained unclear whether levodopa and STN‐DBS have differential effects on bradykinesia. We investigated 8 PD‐patients with STN‐electrodes in four conditions: STN‐DBS and levodopa (ONMED/ONSTIM), STN‐DBS only (OFFMED/ONSTIM), levodopa only (ONMED/OFFSTIM), without STN‐DBS/levodopa (OFFMED/OFFSTIM). Fourteen volunteers served as controls. Subjects performed fastest possible (1) pronation/supination of the forearm (diadochokinesia) and (2) flexion and extension of the index finger (finger movements). Movements were recorded using a 3D‐ultrasound‐system. Maximum frequency, amplitude, and smoothness of movements were determined. During OFFMED/OFFSTIM, all parameters were worser than in all other conditions. In proximal diadochokinesia, OFFMED/ONSTIM significantly improved the amplitude and frequency, whereas ONMED/OFFSTIM had no significant effect. In contrast, we found a stronger effect of levodopa (ONMED/OFFSTIM) on amplitudes of distal finger movement than on amplitudes of diadochokinesia. Combination of treatments during ONMED/ONSTIM further improved both movements. However, maximum frequency remained lower in PD‐patients during ONMED/ONSTIM compared with controls. This study demonstrates a better effect of levodopa on distal finger movements and STN‐DBS on proximal diadochokinesia. Furthermore, a complementary effect of both therapies on brain areas involved in bradykinesia can be assumed. © 2007 Movement Disorder Society |
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| Keywords: | Parkinson's disease bradykinesia deep brain stimulation
L‐dopa motion detection |
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