Disturbance of verticality perception and postural dysfunction in Parkinson's disease.

OBJECTIVES: Verticality perception is known to be abnormal in Parkinson's disease (PD), but in which stage respective dysfunctions arise and how they relate to postural disorders remains to be settled. These issues were studied with respect to different dimensions of the subjective visual vertical (SVV) in relation to clinical parameters of postural control. MATERIALS & METHODS: All participants had to orientate a luminous line at random planar orientations to a strictly vertical position using an automated operator system. The SVV was analyzed in 58 PD patients and 28 control subjects with respect to (i) the angle between true and subjective vertical (deviation) and (ii) the variability of this across five measurements (variability). Results were referred to the subjective upright head position (SUH), the disease stage, and clinical gait/balance features assessed by the MDS-UPDRS and the Tinetti test. RESULTS: Parkinson's disease patients had significantly higher SVV deviation and variability than controls. With respect to disease stage, deviation developed before abnormal variability. SVV variability was associated with poor balance and gait performance, as well as postural instability. Deficits in SUH and SVV deviation were correlated and mostly unidirectional, but did not correspond to the side of motor symptom dominance. CONCLUSIONS: Visual verticality perception in PD is deviated already in early stages, conceivably as a relatively static internal misrepresentation of object orientation. Variability about verticality perception emerges in more advanced stages and is associated with postural and balance abnormalities.

Effects of subthalamic deep brain stimulation on dysarthrophonia in Parkinson's disease.

BACKGROUND: Motor deficits in Parkinson's disease (PD) are reduced by deep brain stimulation (DBS) of the subthalamic nucleus (STN), but the impact of this therapy on dysarthrophonic problems in PD remains controversial. We therefore aimed to disentangle the effects of STN DBS on the speech skills of long-term treated patients. METHODS: Under continued medication, speech and motor functions of 19 patients with PD with bilateral STN DBS were studied when their therapeutic stimulation was active (STIM-ON) versus switched off (STIM-OFF). Per condition, perceptual speech ratings were given by: (i) the patients themselves, (ii) the treating physician, and (iii) professional speech therapists. Furthermore, single speech parameters were measured with a battery of technical exams in both STIM-ON and STIM-OFF. RESULTS: STN DBS significantly worsened speech performance according to all perceptual rating methods applied. In contrast, technical measures showed DBS-induced improvements of single speech dimensions affected by the PD-specific motor disorder. These changes occurred independently of the reduction of motor impairment, which was consistently effectuated by STN DBS. CONCLUSION: In parallel to the beneficial effects on the motor symptoms of PD, STN DBS reduces designated disease-inherent dysarthrophonic symptoms, such as glottic tremor. However, these actions on speech are predominantly outweighed by the general dysarthrogenic effects of STN DBS, probably based on a decline of complex (eg, prosodic) functions. Thus, stimulation-induced speech impairment should be considered a likely problem in the course of this treatment.

Neural correlates of lexical decisions in Parkinson's disease revealed with multivariate extraction of cortico-subthalamic interactions.

OBJECTIVE: Neural interactions between cortex and basal ganglia are pivotal for sensorimotor processing. Specifically, coherency between cortex and subthalamic structures is a frequently studied phenomenon in patients with Parkinson's disease. However, it is unknown whether cortico-subthalamic coherency might also relate to cognitive aspects of task performance, e.g., language processing. Furthermore, standard coherency studies are challenged by how to efficiently handle multi-channel recordings. METHODS: In eight patients with Parkinson's disease treated with deep brain stimulation, simultaneous recordings of surface electroencephalography and deep local field potentials were obtained from bilateral subthalamic nuclei, during performing a lexical decision task. A recent multivariate coherency measure (maximized imaginary part of coherency, MIC) was applied, simultaneously accounting for multi-channel recordings. RESULTS: Cortico-subthalamic synchronization (MIC) in 14-35Hz oscillations positively correlated with accuracy in lexical decisions across patients, but not in 7-13Hz oscillations. In contrast to multivariate MIC, no significant correlation was obtained when extracting cortico-subthalamic synchronization by "standard" bivariate coherency. CONCLUSIONS: Cortico-subthalamic synchronization may relate to non-motor aspects of task performance, here reflected in lexical accuracy. SIGNIFICANCE: The results tentatively suggest the relevance of cortico-subthalamic interactions for lexical decisions. Multivariate coherency might be effective to extract neural synchronization from multi-channel recordings.

Correlation between cortical and subcortical neural dynamics on multiple time scales in Parkinson's disease.

Complex amplitude dynamics of dominant alpha oscillations (8-13 Hz) in the cortex can be captured with long-range temporal correlations (LRTC) in healthy subjects and in various diseases. In patients with Parkinson's disease (PD), intra-nuclear coherence was demonstrated in dominant beta rhythms (10-30 Hz) in the basal ganglia. However, so far the relation between cortical LRTC (across tens of seconds) and subcortical coherence (millisecond scale) is unknown. We addressed these "multiscale interactions" by simultaneous recordings of surface electroencephalography (EEG) and deep local field potentials (LFP) from the bilateral subthalamic nucleus (STN) in eight patients with severe PD eligible for deep brain stimulation, who performed a lexical decision task on medication. In the continuous data set LRTC up to 20s were calculated in the amplitude envelope of 8-13-Hz EEG oscillations (across whole scalp), and subcortical coherence was assessed with measures being insensitive to volume conduction artifacts (imaginary part of coherency; iCOH) in 10-20 and 21-30-Hz oscillations in STN-LFP. We showed a significant positive correlation across patients between cortical LRTC (8-13Hz) and subcortical iCOH selectively in 10-20-Hz oscillations in the left STN. Our results suggest a relation between neural dynamics in the most dominant rhythms in the cortex and basal ganglia in PD, extending across multiple time scales (milliseconds vs. tens of seconds). Furthermore, the investigation of multiscale interactions might contribute to our understanding of cortical-subcortical neural coupling in PD.