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Altered activation and connectivity of the supplementary motor cortex at motor initiation in Parkinson’s disease patients with freezing
Clinical Neurophysiology ( IF 3.7 ) Pub Date : 2020-09-01 , DOI: 10.1016/j.clinph.2020.05.023
Florian Brugger 1 , Regina Wegener 2 , Julia Walch 3 , Marian Galovic 4 , Stefan Hägele-Link 3 , Stephan Bohlhalter 5 , Georg Kägi 3
Affiliation  

OBJECTIVE Motor initiation failure is a key feature of freezing of gait (FOG) due to Parkinson's disease (PD). The supplementary motor cortex (SMC) plays a central role in its pathophysiology. We aimed at investigating SMC activation, connectivity and plasticity with regard to motor initiation in FOG. METHODS Twelve patients with FOG and eleven without FOG underwent a multimodal electrophysiological evaluation of SMC functioning including the Bereitschaftspotential and movement-related desynchronisation of cortical beta oscillations. SMC plasticity was modulated by intermittent theta burst stimulation (iTBS) and its impact on gait initiation was assessed by a three-dimensional gait analysis. RESULTS Prior to volitional movements the Bereitschaftspotential was smaller and beta power was less strongly attenuated over the SMC in patients with FOG compared to those without. Pre-motor coherence between the SMC and the primary motor cortex in the beta frequency range was also stronger in patients with FOG. iTBS resulted in a relative deterioration of gait initiation. CONCLUSIONS Reduced activation of the SMC along with increased SMC connectivity in the beta frequency range hinder a flexible shift of the motor set as it is required for gait initiation. SIGNIFICANCE Altered SMC functioning plays an important role for motor initiation failure in PD-related FOG.

中文翻译:

帕金森病患者在运动开始时辅助运动皮层的激活和连通性改变

目的 运动启动失败是帕金森病 (PD) 导致步态冻结 (FOG) 的一个关键特征。辅助运动皮层 (SMC) 在其病理生理学中起着核心作用。我们旨在研究与 FOG 中运动启动相关的 SMC 激活、连接性和可塑性。方法 12 名有 FOG 的患者和 11 名没有 FOG 的患者接受了 SMC 功能的多模式电生理评估,包括 Bereitschaftspotential 和运动相关的皮质 β 振荡不同步。SMC 可塑性受间歇性 theta 脉冲刺激 (iTBS) 的调节,其对步态启动的影响通过三维步态分析进行评估。结果 在有意志力运动之前,与没有 FOG 的患者相比,FOG 患者的 Bereitschaftspotential 更小,并且 SMC 上的 β 功率减弱的强度也较小。FOG 患者的 SMC 和初级运动皮层之间在 β 频率范围内的运动前一致性也更强。iTBS 导致步态起始的相对恶化。结论 SMC 激活的减少以及 SMC 连接在 beta 频率范围内的增加阻碍了电机组的灵活移动,因为它是步态启动所必需的。意义 改变的 SMC 功能对 PD 相关 FOG 中的运动启动失败起着重要作用。iTBS 导致步态起始的相对恶化。结论 SMC 激活的减少以及 SMC 连接在 beta 频率范围内的增加阻碍了电机组的灵活移动,因为它是步态启动所必需的。意义 改变的 SMC 功能对 PD 相关 FOG 中的运动启动失败起着重要作用。iTBS 导致步态起始的相对恶化。结论 SMC 激活的减少以及 SMC 连接在 beta 频率范围内的增加阻碍了电机组的灵活移动,因为它是步态启动所必需的。意义 改变的 SMC 功能对 PD 相关 FOG 中的运动启动失败起着重要作用。
更新日期:2020-09-01
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