Exercise-induced neuroplasticity in human Parkinson's disease: What is the evidence telling us?

INTRODUCTION: While animal models of exercise and PD have pushed the field forward, few studies have addressed exercise-induced neuroplasticity in human PD. METHOD: As a first step toward promoting greater international collaboration on exercise-induced neuroplasticity in human PD, we present data on 8 human PD studies (published between 2008 and 2015) with 144 adults with PD of varying disease severity (Hoehn and Yahr stage 1 to stage 3), using various experimental (e.g., randomized controlled trial) and quasi-experimental designs on the effects of cognitive and physical activity on brain structure or function in PD. We focus on plasticity mechanisms of intervention-induced increases in maximal corticomotor excitability, exercise-induced changes in voxel-based gray matter volume changes and increases in exercise-induced serum levels of brain derived neurotrophic factor (BDNF). Finally, we provide a future perspective for promoting international, collaborative research on exercise-induced neuroplasticity in human PD. CONCLUSION: An emerging body of evidence suggests exercise triggers several plasticity related events in the human PD brain including corticomotor excitation, increases and decreases in gray matter volume and changes in BDNF levels.

Unilateral GPi-DBS as a treatment for levodopa-induced respiratory dyskinesia in Parkinson disease.

BACKGROUND: Respiratory dyskinesia is a rare but disabling complication of levodopa therapy for Parkinson disease; however, its treatment has been limited to medication optimization. CASE REPORT: A 72-year-old woman with a 6-year history of Parkinson disease presented with severe and debilitating levodopa-induced respiratory dyskinesia, which manifested with a short and shallow breathing pattern and panting. These symptoms were observed coincident with limb and truncal dyskinesias. Both respiratory and limb/trunk dyskinesias were addressed by the implantation of a unilateral globus pallidus interna deep brain stimulator (GPi-DBS). CONCLUSIONS: Although the mechanism of involvement of the respiratory system in dyskinesia is unknown, GPi-DBS seems to be a potentially viable treatment option for these patients.

Promoting exercise in Parkinson's disease through community-based participatory research.

Parkinson's disease (PD) is a chronic, progressive, as-of-yet incurable, neurodegenerative condition affecting the nigro-striatal dopaminergic system. Emerging evidence suggests the importance of exercise in improving the trajectory of PD. Yet few people with PD are physically active. One challenge that healthcare professionals face in the 21st century is how to deliver physical activity programs to the population of individuals living with PD. A novel approach to delivering physical activity to people with PD is introduced - termed community-based participatory research (CBPR) - which engages people with PD and patient advocates as co-researchers in the development and implementation of community-based exercise programs. The authors describe the CBPR approach and provide several recent examples of community exercise programs that are steps in the direction of developing the CBPR model. This is followed by a discussion of what a more fully realized CBPR model might look like. Finally, the authors describe some obstacles to conducting CBPR and suggest strategies for overcoming them. It is argued that people with PD are an integral component of delivering the exercise intervention.

Throat clicking as the initial symptom of Parkinson's disease.

The presenting manifestations of Parkinson's disease (PD) are variable, but a majority of patients note tremor as the initial symptom. Others complain of slowing of movements, loss of dexterity, fatigue, or changes in handwriting as initial symptoms. We describe a patient who developed an unusual clicking sound emanating from his throat as the initial manifestation of PD.