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Responses to Dynamic Head-and-Body Tilts are Enhanced in Parkinson's Disease

Published online by Cambridge University Press:  18 September 2015

Nicole Paquet  and
Christina W.Y. Hui-Chan
Nicole Paquet*
Affiliation:
School of Physical and Occupational Therapy and Physiology Department, Faculty of Medicine, McGill University, Montreal.
Christina W.Y. Hui-Chan
Affiliation:
School of Physical and Occupational Therapy and Physiology Department, Faculty of Medicine, McGill University, Montreal. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
*
Aerospace Medical Research Unit, McGill University, 3655 Drummond, Room 1220, Montreal, Quebec, Canada H3G 1Y6
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Abstract:

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Background:

Previous studies demonstrated that destabilizing responses to slow perturbations were enhanced in patients with Parkinson's disease (PD). Our objectives were to investigate the influence of PD on responses to faster whole head-and-body tilts in the standing position, and to establish whether any modification of tilt-evoked responses in PD patients was related to possible changes in the modulation of soleus (SO) H-reflex.

Methods:

Ten PD patients and 10 age-matched normal subjects assumed a standing position on an L-shaped tilting apparatus. Their head and shoulders were firmly attached to the back support of the apparatus, while their feet were fixated to the standing platform. With their vision occluded, the subject's whole head-and-body was suddenly tilted forward to 20°, at a peak head acceleration of 0.7g ± 0.lg. Tilt-evoked responses were recorded from the lower limb muscles bilaterally. In addition, 40 H-reflexes were elicited in the SO muscle at 30-190 ms intervals after the onset of head acceleration. The M response amplitude was kept within ±15% of its control value.

Results:

PD patients demonstrated an abnormally high responsiveness to whole head-and-body tilts in comparison with age-matched normal subjects. This was shown by the significantly larger proportion of PD patients manifesting responses in the SO, biceps femoris and vastus lateralis muscles (p<0.05), as well as their significantly larger SO response area (413%; p<0.01). In contrast, the amplitude of the SO H-reflex was significantly increased by only 14% (p<0.05) in these patients, and only at 30-70 ms after head acceleration onset.

Conclusion:

The overexcitable tilt-evoked responses of PD patients could originate from a reduced ability to suppress responses when the body is supported. This enhanced excitability of tilt-evoked responses was probably not due to motoneuronal hyperexcitability or decreased presynaptic inhibition of the group la terminals involved in the mainly monosynaptic H-reflex pathway. Thus, we hypothesize that the control of spinal interneurons involved in the tilt-evoked responses may be defective in PD.

Résumé:

RÉSUMÉ:But:

Des études antérieures ont démontré que les réponses déstabilisatrices à des perturbations lentes étaient augmentées chez les patients atteints de la maladie de Parkinson (MP). Nos objectifs étaient d'étudier l'influence de la MP sur les réponses à des basules plus rapides de l'ensemble tête-corps, et d'établir si des modifications des réponses à la bascule étaient reliées à des changements possibles de la modulation du réflexe-H du muscle soleaire (SO).

Méthode:

Dix patients atteints de la MP et 10 sujets normaux appariés pour l'âge étaient placés debout sur une structure basculante en forme de “L”. Leur tête et leurs épaules étaient fermement attachées au support dorsal de la structure, et leurs pieds à la plate-forme de support. L'ensemble tête-corps était soudainement basculé vers l'avant de 20°, en l'absence de vision, à un pic moyen d'accélération de la tête de 0.7g ± 0.lg. Les réponses à la bascule étaient enregistrées au niveau des muscles des jambes des deux côtés. De plus, 40 réflexes-H ont été élicités dans le muscle SO à intervalles 30 de 190 ms après le début de l'accélération de la tête. L'amplitude de la réponse M était gardée a ±15% de la valeur contrôle.

Résultats:

Les patients atteints de la MP ont démontré une réactivité anormalement élévée aux bascules en comparaison avec les sujets âgés normaux. Une proportion significativement plus grande de patients atteints de la MP ont manifesté des réponses à la bascule dans les muscles SO, biceps fémoral et vaste externe (p<0.05), et l'aire de la réponse dans leur muscle SO était significativement plus grande (413%; p<0.01). Au contraire, l'amplitude du réflexe-H des patients atteints de la MP n'était significativement augmentée que de 14% (p<0.05), et seulement entre 30 et 70 ms après le début de l'accélération de la tête.

Conclusions:

L'hyperexcitabilité des réponses à la bascule des patients atteints de la MP pourrait provenir d'une capacité réduite à atténuer les réponses lorsque le corps est supporté. Cette excitabilité augmentee ne semblait pas due à une hyperexcitabilité des motoneurones ou une diminution de l'inhibition présynaptique des terminaisons du groupe la impliquées dans la voie principalement monosynaptique du réflèxe-H. Ainsi, nous posons l'hypothèse que le contrôle des interneurones spinaux impliqués dans les réponses à la bascule puisse être défectueux dans la MP.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 24 , Issue 1 , February 1997 , pp. 44 - 52
Copyright
Copyright © Canadian Neurological Sciences Federation 1997

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