To identify neurophysiological mechanisms (e.g. synchronisation / desynchronisation) and brain areas (i.e. localization) involved in the performance of cued movements in PD.
ID
Source
Brief title
Condition
- Neuromuscular disorders
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Group and condition differences in 1) localization, latency and amplitude of
evoked cortical potentials, 2) spectral power over different frequency bands,
3) cortico-cortical synchronization patterns (e.g. interregional coupling or
correlation, synchronization likelihood, coherence ), 4) blood oxygen
level-dependent (BOLD) MRI signal changes.
Secondary outcome
Group differences in changes in performance on motor paradigm after rTMS (hand
movement speed, timing of hand movement to cues and walking speed, cadence and
stride length).
Background summary
See protocol.
Rationale:
External rhythmic cues have a positive effect on movement and specifically gait
and gait-related activities in patients with Parkinson*s disease (PD,
(www.rescueproject.org). Cueing can be defined as *applying temporal or spatial
stimuli associated with the initiation or ongoing facilitation of motor
activity (e.g. gait)*. However, the underlying mechanisms are largely unknown.
The current project is designed to investigate the following research question:
which neurophysiological mechanisms and brain areas are involved when patients
with PD adapt to external rhythmic cueing conditions? In a first experimental
series, magnetoencephalography (MEG) and combined
electroencephalography/functional magnetic resonance imaging (EEG/fMRI) will be
used to record brain activity during motor tasks in the recumbent position. In
a second experimental series repetitive transcranial magnetic stimulation
(rTMS) will be used to alter the excitability of selected brain areas (e.g.
supplementary motor area, SMA).
It is hypothesized that rhythmic external cues act 1) by resetting pathological
oscillatory neural activity and/or 2) through bypassing of the defective basal
ganglia circuitry via alternative neural pathways. Resetting of pathological
oscillatory activity is thought to result from coupling processes between brain
area*s induced by external rhythms through, for example, attentional processes.
It is further hypothesized that following selective transient inhibition of the
SMA using rTMS, cued motor activity will show degraded performance. It is
anticipated that knowledge about these mechanisms will be useful in optimizing
the effectiveness of rehabilitation therapy using rhythmic external cues
Study objective
To identify neurophysiological mechanisms (e.g. synchronisation /
desynchronisation) and brain areas (i.e. localization) involved in the
performance of cued movements in PD.
Study design
cross-sectional, observational study.
Intervention: in a first session (1 day), subjects perform an experimental
motor paradigm (hand-squeezing movements) in a MEG and MRI apparatus. Brain
activity will be recorded during, as well as before and after the cued motor
paradigm. In addition, rTMS will be applied in a second session (on a second
day) prior to a hand motor paradigm, as well as a number of walking tests.
Study burden and risks
Overall, the risks associated with participation are minimal and estimated to
be acceptable bij the investigators, when compyling with the exclusioncriteria.
The burden of time-investment and physical performance of the motor paradigm in
the MEG and MRI as well as before and after rTMS are recognized and will be
explained in detail to prospective participants. Subjects will receive a set of
8 questionnaires to be completed at home by regular mail. The number of site
visits to the Outpatient department of the VU University Medical Center will be
2, one for each experimental series. The interval between the sessions will
depend on completion of the first session for all participants.
The first visit will entail : 1) short motor examination (incl. motor section
of the Unified Parkinson*s Disease Rating Scale [UPDRS]), 2) performance of a
motor paradigm (cued hand-movements) in the MEG apparatus and 3) a motor
paradigm (cued hand-movements) in the MRI apparatus. These measurements of
brain activity are non-invasive, safe and applied on a routine basis in the
VUmc. The physical and physiological discomfort is recognized, but estimated to
be at an acceptable level, and subjects will receive adequate rest periods an
breaks between assessments and conditions.
The second visit will entail: Assessment of motor performance before and after
a 15 minute rTMS session. Application of rTMS is non-invasive, safe and applied
routinely in the VUmc.
Boelelaan 1117
1081 HV Amsterdam
Nederland
Boelelaan 1117
1081 HV Amsterdam
Nederland
Listed location countries
Age
Inclusion criteria
Patients: 1) Modified Hoehn and Yahr stage ranging from 2 to 4; 2) a stable medication regime;
All: 3) age under 70 years; 4) sufficient orientation in time and place (Minimal Mental State Examination (MMSE) * 26) , 5) completion of an informed consent for participation, and 6) able to walk 10 meter independently.
Exclusion criteria
Patients: 1) Presence of severe dyskinesia (Modified Dyskinesia Scale score >1),
All: 2) any (other) neurological, cardiovascular or orthopaedic disorder or other co-morbidity that may influence mobility and would interfere with participation ,3) presence of medical implants such as pacemakers, 4) inability to communicate (written of verbally) in the Dutch language and 5) history fo epilepsy
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL13811.029.06 |