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Differential effects of levodopa and subthalamic nucleus deep brain stimulation on bradykinesia in Parkinson's disease
Author(s) -
Timmermann Lars,
Braun Martin,
Groiss Stefan,
Wojtecki Lars,
Ostrowski Stefan,
Krause Holger,
Pollok Bettina,
Südmeyer Martin,
Ploner Markus,
Gross Joachim,
Maarouf Mohammad,
Voges Jürgen,
Sturm Volker,
Schnitzler Alfons
Publication year - 2008
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.21808
Subject(s) - levodopa , deep brain stimulation , subthalamic nucleus , parkinson's disease , psychology , neuroscience , medicine , physical medicine and rehabilitation , disease
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 (ON MED /ON STIM ), STN‐DBS only (OFF MED /ON STIM) , levodopa only (ON MED /OFF STIM ), without STN‐DBS/levodopa (OFF MED /OFF STIM ). 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 OFF MED /OFF STIM , all parameters were worser than in all other conditions. In proximal diadochokinesia, OFF MED /ON STIM significantly improved the amplitude and frequency, whereas ON MED /OFF STIM had no significant effect. In contrast, we found a stronger effect of levodopa (ON MED /OFF STIM ) on amplitudes of distal finger movement than on amplitudes of diadochokinesia. Combination of treatments during ON MED /ON STIM further improved both movements. However, maximum frequency remained lower in PD‐patients during ON MED /ON STIM 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