Brain atrophy in Parkinson's disease with polysomnography-confirmed REM sleep behavior disorder.

We aimed to investigate cortical and subcortical brain alterations in people with Parkinson's disease with polysomnography-confirmed rapid eye movement (REM) sleep behavior disorder (RBD). Thirty people with Parkinson's disease, including 15 people with RBD, were recruited and compared with 41 healthy controls. Surface-based cortical and subcortical analyses were performed on T1-weighted images to investigate thickness and shape abnormalities between groups, and voxel-based and deformation-based morphometry were performed to investigate local volume. Correlations were performed in patients to investigate the structural correlates of motor activity during REM sleep. People with RBD showed cortical thinning in the right perisylvian and inferior temporal cortices and shape contraction in the putamen compared with people without RBD. Compared with controls, people with RBD had extensive cortical thinning and volume loss, brainstem volume was reduced, and shape contraction was found in the basal ganglia and hippocampus. In comparison to controls, people without RBD showed more restricted thinning in the sensorimotor, parietal, and occipital cortices, reduced volume in the brainstem, temporal and more posterior areas, and shape contraction in the pallidum and hippocampus. In Parkinson's disease, higher tonic and phasic REM sleep motor activity was associated with contraction of the thalamic surface, extensive cortical thinning, and subtle volume reduction in the middle temporal gyrus. In Parkinson's disease, the presence of RBD is associated with extensive cortical and subcortical abnormalities, suggesting more severe neurodegeneration in people with RBD. This provides potential neuroanatomical correlates for the more severe clinical phenotype reported in people with Parkinson's disease with RBD.

The effect of Trager therapy on the level of evoked stretch responses in patients with Parkinson's disease and rigidity.

OBJECTIVE: To quantify changes of evoked stretch responses (ESR) in the most rigid arm of patients with Parkinson's disease (PD) after Trager therapy. METHODS: Gentle rocking motion associated with this type of manual therapy was imparted to the upper limbs and body of 30 patients for 20 minutes. A pretest and 2 posttests (at 1 and 11 minutes after the treatment, respectively) were performed, consisting of electromyographic (EMG) recordings of the flexor carpi radialis and extensor digitorum communis while the patient's wrist was passively flexed and extended with an amplitude of 60 degrees and a frequency of 1 Hz. Patients received the treatment on the most rigid side of their bodies (ipsi-group) or on the contralateral side (contra-group). Half of patients in each group received the treatment while lying supine on a massage table (ipsi- and contra-supine) or sitting in a chair (ipsi- and contra-sitting). RESULTS: In general, the level of ESR were reduced by 36% immediately after treatment and remained 32% lower than pretest values 11 minutes after treatment (F = 41.45, P <.05). Patients who received the treatment lying supine benefited from a 42% reduction of ESR (F = 4.07, P <.05). The side on which the treatment was performed did not significantly influence the outcome of the treatment (F = 0.50, P >.05). However, post hoc analysis of the triple interaction (test x side x position) indicated that the sitting position was much less efficient for sustained contralateral effect (P >.05). CONCLUSIONS: Results from the present study strongly suggest that it is possible to modify the level of ESR by using Trager therapy. This stretch reflex inhibition may induce a reduction of the muscle rigidity seen in these patients. The present results may eventually lead to the development of a specific complementary therapy for patients with Parkinson's disease and rigidity.