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The effect of Deep Brain Stimulation on Corticomuscular Coherence in Parkinson's Disease

(2017) Dijks, J.G.

Background: In advanced Parkinson’s disease (PD), deep brain stimulation (DBS) is considered as an ultimate treatment; however inefficacy and side-effects remain a challenge. A reliable, non-invasive neurophysiological biomarker could be valuable enabling the application of DBS in a highly selective way. Corticomuscular coherence (CMC) could be used as a potential biomarker. CMC is seen as a representation of the co-operation between brain areas and muscles in motor tasks and is present in PD symptoms of tremor (tremor frequency range) and akinesia-rigidity (beta range).
Aim: To test CMC, measured by electroencephalography (cortex) and electromyography (muscles), as a potential biomarker for improvement in tremor and akinesia-rigidity after DBS.
Methods: In this single center prospective cohort pilot study, five tremor-dominant and five akinetic-rigid PD DBS candidates of the University Medical Centre Groningen (UMCG) were included. In the akinetic-rigid PD group, beta CMC was measured during a flexion, pinching and resting task; symptoms were assessed by the MDS-UPDRS III upper body akinetic-rigid items. In the tremor-dominant PD group, tremor CMC was retrieved during a maximal tremor task; symptoms by use of a clinical tremor score and accelerometer. Change in CMC after DBS was tested and correlations were performed between CMC and symptom severity. Thereafter, correlations between change in CMC and improvement in symptoms; and pre-DBS CMC and improvement in symptoms were made.
Results: Tremor CMC decreased significantly after DBS (p=0.01) and significantly correlated with tremor severity (p<0.01). No relation between the decrease in tremor CMC and tremor reduction; and between pre-DBS CMC and tremor reduction was found. No significant increase in akinetic-rigid PD total beta CMC was detected after DBS and no relation with severity and improvement in akinesia-rigidity was seen. However, high beta CMC during flexion did correlate with severity (rs =-0.45; p<0.05), and improvement in akinesia-rigidity correlated with the percentage increase in high beta CMC and high beta CMC pre-DBS (rs =0.75, p=0.01; rs =-0.71, p=0.02).
Conclusion: Correlations between high beta CMC with symptom severity and clinical effect during flexion in the akinetic-rigid PD group were found; in the tremor-dominant PD group, CMC did decrease significantly and was associated with symptom severity. However, the beta CMC was insignificantly increased after DBS in the akinetic-rigid PD group and there were lack of correlations between tremor CMC and clinical effect in the tremor-dominant PD group. Further, due to the small sample size in this pilot study, utility of CMC as a potential biomarker cannot be recommended yet and further research on a larger scale is strongly advised.





ID 3355
Moeder ID 3084
Volgorde Dijks, J.G.
Naam DijksJG
Publiceren yes
OAI-naam Student_thesis
Path root/geneeskunde/2016/DijksJG/
Gemaakt op: 2017-03-07 10:36:53
Gemodificeerd op: 2017-03-07 10:36:53
Digitaal ID 58be8d4480651
Afstudeerrichting opleiding/afstudeerrichting 1
Studierichting Studierichting 1
Titel The effect of Deep Brain Stimulation on Corticomuscular Coherence in Parkinson's Disease
Ruilverkeer mogelijk no
Printen in opdracht no
Publicatiejaar 2017
Taal nl
Engelse samenvatting Background: In advanced Parkinson’s disease (PD), deep brain stimulation (DBS) is considered as an ultimate treatment; however inefficacy and side-effects remain a challenge. A reliable, non-invasive neurophysiological biomarker could be valuable enabling the application of DBS in a highly selective way. Corticomuscular coherence (CMC) could be used as a potential biomarker. CMC is seen as a representation of the co-operation between brain areas and muscles in motor tasks and is present in PD symptoms of tremor (tremor frequency range) and akinesia-rigidity (beta range).
Aim: To test CMC, measured by electroencephalography (cortex) and electromyography (muscles), as a potential biomarker for improvement in tremor and akinesia-rigidity after DBS.
Methods: In this single center prospective cohort pilot study, five tremor-dominant and five akinetic-rigid PD DBS candidates of the University Medical Centre Groningen (UMCG) were included. In the akinetic-rigid PD group, beta CMC was measured during a flexion, pinching and resting task; symptoms were assessed by the MDS-UPDRS III upper body akinetic-rigid items. In the tremor-dominant PD group, tremor CMC was retrieved during a maximal tremor task; symptoms by use of a clinical tremor score and accelerometer. Change in CMC after DBS was tested and correlations were performed between CMC and symptom severity. Thereafter, correlations between change in CMC and improvement in symptoms; and pre-DBS CMC and improvement in symptoms were made.
Results: Tremor CMC decreased significantly after DBS (p=0.01) and significantly correlated with tremor severity (p<0.01). No relation between the decrease in tremor CMC and tremor reduction; and between pre-DBS CMC and tremor reduction was found. No significant increase in akinetic-rigid PD total beta CMC was detected after DBS and no relation with severity and improvement in akinesia-rigidity was seen. However, high beta CMC during flexion did correlate with severity (rs =-0.45; p<0.05), and improvement in akinesia-rigidity correlated with the percentage increase in high beta CMC and high beta CMC pre-DBS (rs =0.75, p=0.01; rs =-0.71, p=0.02).
Conclusion: Correlations between high beta CMC with symptom severity and clinical effect during flexion in the akinetic-rigid PD group were found; in the tremor-dominant PD group, CMC did decrease significantly and was associated with symptom severity. However, the beta CMC was insignificantly increased after DBS in the akinetic-rigid PD group and there were lack of correlations between tremor CMC and clinical effect in the tremor-dominant PD group. Further, due to the small sample size in this pilot study, utility of CMC as a potential biomarker cannot be recommended yet and further research on a larger scale is strongly advised.
Nederlandse samenvatting Introductie: In een gevorderd stadium van de ziekte van Parkinson (ZvP) wordt diepe hersenkernstimulatie (DBS) gezien als een goede behandeling, echter blijven doeltreffendheid en bijwerkingen een uitdaging. Een betrouwbare, non-invasieve neurofysiologische biomarker kan waardevol zijn om DBS op selectieve wijze toe te passen. Corticomusculaire coherentie (CMC) zou gebruikt kunnen worden als biomarker. CMC wordt beschouwd als een afspiegeling van samenwerking tussen cortex en spieren tijdens motorische taken, en is aanwezig bij de symptomen tremor (tremorfrequentie) en akinesie-rigiditeit (bètafrequentie).
Onderzoeksdoel: Door middel van elektro-encefalografie (cortex) en elektromyografie (spieren) werd CMC getest als potentiële biomarker voor verbetering van tremor en akinesie-rigiditeit na DBS.
Methoden: In deze monocentrische, prospectieve pilot cohortstudie werden vijf tremor-dominante en vijf akinetisch-rigide DBS kandidaten van het Universitair Medisch Centrum Groningen (UMCG) geïncludeerd. Bij de akinetisch-rigide patiëntengroep werd bèta-CMC gemeten tijdens een flexie-, knijp- en rusttaak; symptomen werden beoordeeld met de akinesie-rigiditeitsitems van het motorisch onderzoek van de gestandaardiseerde Parkinsonschaal (MDS-UPDRS III). Bij de tremor-dominante patiëntengroep werd tremor-CMC gemeten tijdens een maximale tremortaak; symptomen werden beoordeeld middels een klinische tremor score en accelerometrie. Verandering in CMC na DBS, en correlaties tussen CMC en de ernst van symptomen werden getest. Vervolgens werden correlaties tussen verandering in CMC en verbetering van de symptomen; en pre-DBS CMC en verbetering van symptomen onderzocht.
Resultaten: Tremor-CMC daalde aanzienlijk na DBS (p=0.01) en correleerde significant met de ernst van de tremor (p<0.01). Geen verbanden tussen de afname in tremor-CMC en tremorreductie; en tussen pre-DBS CMC en tremorreductie werden aangetoond. Er werd geen significante toename in de totale bèta-CMC van de akinetisch-rigide patiëntengroep gedetecteerd en er was geen relatie met de ernst van akinesie-rigiditeit en de verbetering van deze symptomen. Echter, hoge bèta-CMC correleerde met de ernst van de akinesie-rigiditeit (rs =-0.45; p<0.05). De verbetering van deze symptomen was gecorreleerd met het percentage toename in hoge bèta-CMC en met hoge bèta-CMC pre-DBS (rs = 0.75, p=0.01;
rs =-0.71, p=0.02).
Conclusie: Correlaties tussen hoge bèta-CMC met de ernst van symptomen en het beoogde klinisch effect van DBS in de akinetisch-rigide patiëntengroep werden aangetoond tijdens de flexietaak. In de tremor-dominante patiëntengroep daalde de tremor-CMC significant en werd tremor-CMC geassocieerd met de ernst van symptomen. Echter was er een geringe toename van bèta-CMC in de akinetisch-rigide patiëntengroep en gebrek aan correlaties tussen tremor-CMC en klinisch effect bij de tremor-dominante patiëntengroep. Daarnaast was er sprake van een kleine patiëntenpopulatie in deze pilotstudie. Hierdoor kan CMC voor beide patiëntengroepen nog niet als potentiële biomarker worden aanbevolen; verder onderzoek op grotere schaal wordt aangeraden.
Onderwijsinstelling Medical Sciences
Type embargo abstract openbaar, scriptie op aanvraag
Auteur(s) Dijks, J.G.
UMCG begeleider(s) Faculty supervisor; Koning-Tijssen, Prof. Dr. M.A.J. de, Neurologist,; Second supervisor; Zijl, Drs. J.C. van; Other supervisor(s); Beudel, Dr. M. Neurologist; Elting, Dr. J.W.J.Neurologist & Clinical Neurophysiologist
Auteur(s) Dijks, J.G.
UMCG begeleider(s) Faculty supervisor; Koning-Tijssen, Prof. Dr. M.A.J. de, Neurologist,; Second supervisor; Zijl, Drs. J.C. van; Other supervisor(s); Beudel, Dr. M. Neurologist; Elting, Dr. J.W.J.Neurologist & Clinical Neurophysiologist


 
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