Effect of transcranial magnetic stimulation on clinical and electrophysiological parameters in Parkinson's disease patients

Beograd : [A. S. Kačar]

PDF/A (143 lista)

Medicina / Medicine

REZIME Cilj rada. Cilj ovog rada je analiza promena ekscitabilnosti i kortikalnog plasticiteta kod pacijenata obolelih od Parkinsonove bolesti (PB) uslovljenih primenom facilitatornog PAS 25 protokola u zavisnosti od primenjene terapije. Materijal i metode. Pregledano je 30 pacijenta obolelih od PB, i to po 10 pacijenata sa novonastalom PB, 10 pacijenata sa DKPB, bez i sa terapijom i po 10 pacijenata sa Ldopa indukovanim diskinezijama, bez i sa terapijom. Kontrolnu grupu je činilo 10 zdravih ispitanika koji su upareni sa pacijentima po starosti i polu. Plasticitet i stepen ekscitabilnosti je ispitivan na više zahvaćenoj strani u u regionu za šaku motornog korteksa primenom uparene asocijativne stimulacije, kao modela transkranijalne magnetne stimulacije (TMS). Rezultati. Sve grupe pacijenata su, u odnosu na KG, pokazale postojanje deficita LTP – sličnog plasticiteta. Manji nagib krive regrutacije na višim intenzitetima TMS stimulacije je bio prisutan u svim grupama, kratka intrakortikalna inhibicija je bila manja u grupi pacijenata sa novonastom PB i grupi sa diskinezijama, dok je kratka aferentna inhibicija bila oštećena na početku bolesti. LTP plasticitet koji je narušen i na početku bolesti, ostaje oslabljen nezavisno od primenjene terapije. Zaključak. Redukovana ekscitabilnost uslovljena PAS protokolom može biti fiziološki marker prisustva patoloških promena kod PB. Takođe, dugotrajno lečenje ne menja bitno patofiziološke procese koji su u osnovi ove bolesti.

Objective. Analyze changes of cortical excitability and plasticity in patients with Parkinson's disease (PD) according to the applied therapy using PAS 25 protocol. Methods. We examined 30 patients with PD: 10 patients with drug naive PD, 10 patients who had been on dopaminergic medication without any complications and side effect (“off” and “on” state) and 10 patients with L-dopa induced dyskinesia (LID) (“off” and “on” state). The control group (CG) consisted of 10 healthy subjects who were matched to the patients by age and sex. Plasticity and excitability of the hand primary motor cortex of the more affected side were evaluated using transcranial magnetic stimulation (TMS) techniques. Results. All patient groups had deficits LTP – like plasticity in comparison to controls: diminished slope of input-output curves at higher TMS intensities, impaired shortinterval intracortical inhibition (SICI) in de novo PD group and group with dyskinesias and decreased facilitatory sensory-motor plasticity (as measured by paired associative stimulation [PAS] protocol). LTP plasticity that has been damaged at the beginning of the disease, remains disrupted independently of medical treatment. Conclusions. There is little interaction between plasticity and excitability features of motor cortex in PD. Reduced response to facilitatory PAS protocol, reduced SICI, and reduced slope of the input - output curve at higher TMS pulse intensities, seem to be physiological markers for the presence of the pathological disease process in PD. Long term treatment does not seem to change the underlying physiology of the disease.

Parkinsonova bolest, TMS, PAS, plasticitet

Parkinson's disease, TMS, PAS, plasticity

616.8

Tekst