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Effects of DBS, premotor rTMS, and levodopa on motor function and silent period in advanced Parkinson's disease.
Mov Disord. 2009 Apr 15; 24(5):672-6.MD

Abstract

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a widely used and highly effective treatment for patients with advanced Parkinson's disease (PD). Repetitive TMS (rTMS) applied to motor cortical areas has also been shown to improve symptoms in PD and modulate motor cortical excitability. Here, we compared clinical and neurophysiological effects of STN stimulation with those of 1 Hz rTMS given to the dorsal premotor cortex (PMd) and those following intake of levodopa in a group of PD patients with advanced disease. Ten PD patients were studied on 2 consecutive days before and after surgery. Clinical effects were determined using the UPDRS motor score. Motor thresholds, motor-evoked potential (MEP) amplitudes during slight voluntary contraction, and the cortical silent periods (SP) were measured using TMS. Before surgery effects of levodopa and 1 Hz PMd rTMS and after surgery those of STN stimulation with or without additional levodopa were determined. Levodopa significantly improved clinical symptoms and increased the SP duration. STN stimulation improved clinical symptoms without changing the SP duration. In contrast, 1 Hz PMd rTMS was not effective clinically but normalized the SP duration. Whereas levodopa had widespread effects at different levels of an abnormally active motor network in PD, STN stimulation and PMd rTMS led to either clinical improvement or SP normalization, i.e., only partially reversed abnormal motor network activity.

Authors+Show Affiliations

Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. baeumer@uke.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19185021

Citation

Bäumer, Tobias, et al. "Effects of DBS, Premotor rTMS, and Levodopa On Motor Function and Silent Period in Advanced Parkinson's Disease." Movement Disorders : Official Journal of the Movement Disorder Society, vol. 24, no. 5, 2009, pp. 672-6.
Bäumer T, Hidding U, Hamel W, et al. Effects of DBS, premotor rTMS, and levodopa on motor function and silent period in advanced Parkinson's disease. Mov Disord. 2009;24(5):672-6.
Bäumer, T., Hidding, U., Hamel, W., Buhmann, C., Moll, C. K., Gerloff, C., Orth, M., Siebner, H. R., & Münchau, A. (2009). Effects of DBS, premotor rTMS, and levodopa on motor function and silent period in advanced Parkinson's disease. Movement Disorders : Official Journal of the Movement Disorder Society, 24(5), 672-6. https://doi.org/10.1002/mds.22417
Bäumer T, et al. Effects of DBS, Premotor rTMS, and Levodopa On Motor Function and Silent Period in Advanced Parkinson's Disease. Mov Disord. 2009 Apr 15;24(5):672-6. PubMed PMID: 19185021.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of DBS, premotor rTMS, and levodopa on motor function and silent period in advanced Parkinson's disease. AU - Bäumer,Tobias, AU - Hidding,Ute, AU - Hamel,Wolfgang, AU - Buhmann,Carsten, AU - Moll,Christian K E, AU - Gerloff,Christian, AU - Orth,Michael, AU - Siebner,Hartwig Roman, AU - Münchau,Alexander, PY - 2009/2/3/entrez PY - 2009/2/3/pubmed PY - 2009/7/29/medline SP - 672 EP - 6 JF - Movement disorders : official journal of the Movement Disorder Society JO - Mov Disord VL - 24 IS - 5 N2 - Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a widely used and highly effective treatment for patients with advanced Parkinson's disease (PD). Repetitive TMS (rTMS) applied to motor cortical areas has also been shown to improve symptoms in PD and modulate motor cortical excitability. Here, we compared clinical and neurophysiological effects of STN stimulation with those of 1 Hz rTMS given to the dorsal premotor cortex (PMd) and those following intake of levodopa in a group of PD patients with advanced disease. Ten PD patients were studied on 2 consecutive days before and after surgery. Clinical effects were determined using the UPDRS motor score. Motor thresholds, motor-evoked potential (MEP) amplitudes during slight voluntary contraction, and the cortical silent periods (SP) were measured using TMS. Before surgery effects of levodopa and 1 Hz PMd rTMS and after surgery those of STN stimulation with or without additional levodopa were determined. Levodopa significantly improved clinical symptoms and increased the SP duration. STN stimulation improved clinical symptoms without changing the SP duration. In contrast, 1 Hz PMd rTMS was not effective clinically but normalized the SP duration. Whereas levodopa had widespread effects at different levels of an abnormally active motor network in PD, STN stimulation and PMd rTMS led to either clinical improvement or SP normalization, i.e., only partially reversed abnormal motor network activity. SN - 1531-8257 UR - https://www.unboundmedicine.com/medline/citation/19185021/Effects_of_DBS_premotor_rTMS_and_levodopa_on_motor_function_and_silent_period_in_advanced_Parkinson's_disease_ L2 - https://doi.org/10.1002/mds.22417 DB - PRIME DP - Unbound Medicine ER -