Document Detail


Axial kinesthesia is impaired in Parkinson's disease: effects of levodopa.
MedLine Citation:
PMID:  20599976     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Integration of sensory and motor inputs has been shown to be impaired in appendicular muscles and joints of Parkinson's disease (PD) patients. As PD advances, axial symptoms such as gait and balance impairments appear, which often progresses to complete inability stand or walk unaided. The current study evaluates kinesthesia in the axial musculature of PD patients during active postural control to determine whether impairments similar to those found in the appendages are also present in the hip and trunk. Using axial twisting, we quantified the detection threshold and directional accuracy of the hip relative to the feet (i.e. Hip Kinesthesia) and the hip relative to the shoulders (i.e. Trunk Kinesthesia). The relation of kinesthetic threshold to disease progression as measured by UPDRS and the effect of levodopa treatment on kinesthesia were assessed in 12 PD compared to age-matched controls. Subjects stood unaided while passively twisted at a very low constant rotational velocity (1 degrees /s). The results showed that accuracy in determining the direction of axial twisting was reduced in PD relative to healthy control subjects in the hip (PD-ON: 81%; PD-OFF: 91%; CTL=96%) and trunk (PD-ON: 81%; PD-OFF: 88%; CTL=95%). Thresholds for perception of axial twisting were increased when PD subjects were ON levodopa versus OFF in both the hip (p<0.01) and the trunk (p<0.05). The magnitude of decrease in sensitivity due to being ON levodopa was significantly correlated with the increase in UPDRS motor scores (Hip: r=0.90, p<0.01 and Trunk: r=0.60, p<0.05). This effect was not significantly correlated with equivalent levodopa dosage. PD subjects with disease onset on the left side of their body showed significantly higher axial thresholds than subjects with right PD onset (p<0.05). In conclusion, deficits in axial kinesthesia seem to contribute to the functional impairments of posture and locomotion in PD. Although levodopa has been shown to improve appendicular kinesthesia, we observed the opposite in the body axis. These findings underscore the dissociable neurophysiological circuits and dopaminergic pathways that are known to innervate these functionally distinct muscle groups.
Authors:
W G Wright; V S Gurfinkel; L A King; J G Nutt; P J Cordo; F B Horak
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-07-01
Journal Detail:
Title:  Experimental neurology     Volume:  225     ISSN:  1090-2430     ISO Abbreviation:  Exp. Neurol.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-16     Completed Date:  2010-10-20     Revised Date:  2011-09-13    
Medline Journal Info:
Nlm Unique ID:  0370712     Medline TA:  Exp Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  202-9     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Physical Therapy, Temple University, Philadelphia, PA 19140, USA. wrightw@temple.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Dopamine Agents / adverse effects
Female
Functional Laterality / drug effects,  physiology
Humans
Kinesthesis / drug effects*,  physiology
Levodopa / adverse effects*
Male
Middle Aged
Muscle, Skeletal / innervation,  physiopathology
Parkinson Disease / complications*,  drug therapy,  physiopathology*
Somatosensory Disorders / chemically induced*,  physiopathology*
Grant Support
ID/Acronym/Agency:
AG006457/AG/NIA NIH HHS; R01 AG006457-18/AG/NIA NIH HHS; R37 AG006457-26/AG/NIA NIH HHS
Chemical
Reg. No./Substance:
0/Dopamine Agents; 0/Levodopa
Comments/Corrections

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