Levodopa normalizes exercise related cortico-motoneuron excitability abnormalities in Parkinson's disease.
OBJECTIVE
To measure exercise induced changes in cortico-motoneuron excitability in Parkinson's disease (PD) before and after levodopa.


METHODS
Transcranial magnetic stimulation was delivered at 10% above resting motor threshold in 9 PD and 8 control subjects. Each subject performed repetitive isometric wrist extension at 50% of the baseline maximal voluntary contraction (MVC) for 30s with 3s rest between extensions until fatigued, defined as the inability to generate force at more than 25% of the baseline MVC. We recorded motor evoked potentials (MEPs) from the resting extensor carpi radialis muscle before (baseline), during, and after fatiguing exercise. Baseline electromyographic activity was closely monitored. We compared absolute MEP amplitudes between PD and controls, before and after levodopa, during baseline, exercise, and recovery periods. We correlated absolute MEP amplitudes with an objective measure of fatigability.


RESULTS
PD subjects in the "off" state had increased absolute MEP amplitudes compared with controls. The effect was present in all 3 exercise periods. These differences disappeared after levodopa. Post-exercise facilitation was clear for PD subjects before and after levodopa, but post-exercise depression was not significant. Absolute MEP amplitude showed negative correlation with objective fatigability for PD subjects before levodopa.


CONCLUSIONS
Levodopa normalized the increased cortico-motoneuron excitability in PD patients before, during, and after fatiguing exercise.


CONCLUSIONS
This study demonstrated the abnormal cortico-motoneuron excitability associated with motor fatigue in PD.
Lou
Jau-Shin
JS
Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CR120, Portland 97201, USA. Louja@ohsu.edu
Benice
Theodore
T
Kearns
Greg
G
Sexton
Gary
G
Nutt
John
J
D000368:Aged; D000704:Analysis of Variance; D019540:Area Under Curve; D002540:Cerebral Cortex / Q000187:drug effects* / Q000502:physiology; D019054:Evoked Potentials, Motor / Q000187:drug effects / Q000502:physiology; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000494:pharmacology* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology
D007980:Levodopa