title: Effects of motor imagery on motor cortical output topography in Parkinson's disease.
abstract: BACKGROUND
  The motor impairment in Parkinson's disease (PD) could partly reflect a failure to activate processes of motor imagery.
  
  
  OBJECTIVE
  To verify any selective changes of motor output during motor imagery, lateralized to the hemisphere contralateral to the clinically affected side of hemiparkinsonian patients.
  
  
  METHODS
  Transcranial magnetic stimulation (TMS) was used to map the cortical representations of the contralateral abductor digiti minimi muscle (ADM) during rest, contraction, and motor imagery in a group of patients with hemi-PD and in a group of healthy volunteers. Seven patients with hemi-PD and seven healthy subjects were examined. Focal TMS was applied over a grid of 20 scalp positions on each hemiscalp. Maps were characterized by area (number of excitable positions), volume (the sum of motor evoked potential amplitudes at all scalp positions), and center of gravity (a map position representing an amplitude-weighted calculation of the excitable area).
  
  
  RESULTS
  In healthy control subjects, the area of cortical representation of ADM was symmetrically increased in both hemispheres by mental simulation of movement and real muscle contraction. In patients with hemi-PD, there was a hemispheric asymmetry in the area of cortical representation elicited by motor imagery. The area was reduced in the clinically affected hemisphere. The volume of cortical representation was increased under all conditions and in both hemispheres in patients with PD. However, largely because the volume was so high at rest in patients, the increment in volume associated with contraction was smaller than in control subjects.
  
  
  CONCLUSIONS
  This study demonstrates the presence of a tonic hyperactivation of motor cortical circuitry in PD in conjunction with an abnormality of either motor imagery or the process by which motor imagery engages the sensorimotor cortices in the clinically affected hemisphere.
authors.affiliation: AFaR CRCCS Ospedale Fatebenefratelli, Isola Tiberina, Roma, Italy.
authors.forename: M M
authors.initials: MM
authors.lastname: Filippi
authors.forename: M
authors.initials: M
authors.lastname: Oliveri
authors.forename: P
authors.initials: P
authors.lastname: Pasqualetti
authors.forename: P
authors.initials: P
authors.lastname: Cicinelli
authors.forename: R
authors.initials: R
authors.lastname: Traversa
authors.forename: F
authors.initials: F
authors.lastname: Vernieri
authors.forename: M G
authors.initials: MG
authors.lastname: Palmieri
authors.forename: P M
authors.initials: PM
authors.lastname: Rossini
mesh_terms: D001931:Brain Mapping; D004056:Differential Threshold; D004292:Dominance, Cerebral; D004576:Electromyography; D019054:Evoked Potentials, Motor; D005260:Female; D005385:Fingers / Q000503:physiopathology; D006801:Humans; D007092:Imagination; D008280:Magnetics; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D009068:Movement; D009119:Muscle Contraction; D018482:Muscle, Skeletal / Q000503:physiopathology; D010300:Parkinson Disease / Q000503:physiopathology*; D010812:Physical Stimulation; D012016:Reference Values