Saccadic Eye Movements in Young-Onset Parkinson's Disease - A BOLD fMRI Study.

The objective of the present study was to understand control of saccadic eye movements in patients with young onset Parkinson's disease (YOPD) where onset of disease symptoms appears early in life (<40 years of age). Functional magnetic resonance imaging (fMRI) was performed in patients with YOPD and control subjects while they performed saccadic tasks, which consisted of a reflexive task and another task that required inhibitory control of eye movements (Go-NoGo task). Functional imaging related to saccadic eye movements in this group of patients has not been widely reported. A 1.5T MR scanner was used for structural and functional imaging. Analysis of blood-oxygen-level-dependent (BOLD) fMRI was performed using Statistical Parametric Mapping (SPM) software and compared in patients and controls. In patients with YOPD greater activation was seen significantly in the middle frontal gyrus, medial frontal gyrus, angular gyrus, cingulate gyrus, precuneus and cerebellum, when compared with the control group, during the saccadic tasks. Gap and overlap protocols revealed differential activation patterns. The abnormal activation during reflexive saccades was observed in the overlap condition, while during Go-NoGo saccades in the gap condition. The results suggest that impaired circuitry in patients with YOPD results in recruitment of more cortical areas. This increased frontal and parietal cortical activity possibly reflects compensatory mechanisms for impaired cognitive and saccadic circuitry.

Mechanism of selective attention: fMRI study of face-word Stroop task performance.

Selective attention is the cognitive process of selecting and processing the task relevant information and ignoring the task irrelevant information. Though the neural substrates involved in this cognitive process are well established, the mechanism of selection process is the point of contention. To study the effect of selection process on the information processing we performed functional neuroimaging on 23 healthy righthanded male subjects while performing a modified face word stroop task. The word processing area did not show any attention dependent changes in the level of activity whereas the activity of face processing area was higher when the faces were target, but there was no decrease in baseline activity when faces were distractors. Our results suggest that during selective attention there is no biasing of sensory processing for automatically processed stimuli like words whereas there is amplification of task relevant information when stimuli are processed in controlled manner.

Cortical Potentials Prior to Movement in Parkinson's Disease.

INTRODUCTION: Recording cortical potentials prior to movement (bereitschaftspotentials, BP) offer a good non invasive method for studying activity of motor related cortices in Parkinson's Disease (PD). Dopaminergic medications provide some symptomatic relief in advanced stages but they do not stop the progression of the disease. Assessing BP may be a good idea to see the response of anti PD drugs. It remains unclear whether the anti PD medications also improve cortical activity prior to movement even in advanced stages of the disease. AIM: In this study we recorded scalp BP in patients with varying grades of severity to study the relationship between disease severity and various components of BP. MATERIALS AND METHODS: We successfully recorded BP at Cz, C3 and C4 sites during self-initiated 100 right wrist movements in 12 male patients with PD having severity Hoehn and Yahn (H&Y) scale 4 (PD3 group). These potentials were compared with age matched patients with H&Y scale 2 (PD1) and scale 3 (PD2) and also with age matched healthy controls. RESULTS: We found flatter waveforms with increasing severity of disease. Amplitude is first to be affected in mild severity as compared to controls (p=0.011); while with increasing severity early as well as late part of potentials is affected. Such changes are prominently seen at Cz site across the groups. CONCLUSION: These findings imply that there is increasing defect in cortical activity during movement especially in supplementary motor area with increasing severity in PD in spite of dopaminergic medications. This dynamic nature of dysfunction in supplementary motor cortices must be taken in account while treating advanced cases using newer stimulation techniques.

Mechanism(s) of deep brain stimulation and insights into cognitive outcomes in Parkinson's disease.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor, cognitive, neuropsychiatric, autonomic, and other nonmotor symptoms. Deep brain stimulation (DBS) at high frequency is now considered the most effective neurosurgical therapy for movement disorders, especially PD. An electrode is chronically implanted in a particular area of the brain and, when continuously stimulated, it significantly alleviates motor symptoms. In Parkinson's disease, the common target nuclei of high frequency stimulation (HFS) are the basal ganglia nuclei, such as the internal segment of the pallidum and the subthalamic nucleus (STN), with a preference for the STN in recent years. Two fundamental mechanisms have been proposed to underlie the beneficial effects of HFS: either silencing or excitation of STN neurons. This article highlights the recent views concerned with the mechanisms of DBS. Although the efficacy of DBS for the motor symptoms of advanced PD is well established, the effects of DBS on the cognitive and neuropsychiatric symptoms are less clear. The cognitive aspects of DBS for PD have recently been of considerable clinical and pathophysiological interest. This article also reviews the published literature on the cognitive aspects of DBS for PD.

Effect of acute deep brain stimulation of the subthalamic nucleus on auditory event-related potentials in Parkinson's disease.

OBJECTIVE: The analysis of long-latency event-related potentials (ERPs) is an important approach in the evaluation of certain cognitive functions, particularly selective attention, and in following their subsequent changes. Auditory P300 has previously been reported to be abnormal in patients with Parkinson's disease (PD). The aim of this study was to investigate whether acute deep brain stimulation (DBS) of the subthalamic nucleus (STN) itself can cause changes in the configuration of ERPs. METHOD: Using a standard auditory oddball paradigm, we elicited ERPs in 10 patients with PD (in both DBS-ON and DBS-OFF conditions). The patients acted as their own controls. The N100, P200, N200 and P300 latencies, amplitudes and areas were compared between DBS-ON and DBS-OFF states. The motor reaction times were also recorded and compared between the two states. RESULTS: Comparison of the DBS-ON and DBS-OFF states revealed that neither amplitudes nor areas of the ERP components changed significantly; however, significant changes were observed in the latency of N100 potential when the target stimulus was applied, although there was no significant change in the latency of the P300 potential. No significant changes were noted in the latencies of the other observed ERP components. There was a marked improvement in the reaction time after the DBS electrode was turned ON. CONCLUSION: Our data indicate that DBS might have varied impacts on electrophysiological parameters during the auditory oddball paradigm. Moreover, it may also worsen the orientation response as reflected by the increase in the N100 latency after the DBS electrode is turned ON.