title: The sequence effect in de novo Parkinson's disease.
abstract: OBJECTIVE
  The sequence effect (SE) in Parkinson's disease (PD) denotes progressive slowness in speed or progressive decrease in amplitude of repetitive movements. It is a well-known feature of bradykinesia and is considered unique in PD. Until now, it was well-documented in advanced PD, but not in drug-naïve PD. The aim of this study is to know whether the SE can also be measured in drug-naïve PD.
  
  
  METHODS
  We measured the SE with a computer-based, modified Purdue pegboard in 4 drug-naïve PD patients, which matched our previous study with advanced PD patients.
  
  
  RESULTS
  We observed progressive slowness during movement, that is, SE. Statistical analysis showed a strong statistical trend toward the SE with the right hand, but no significance with the left hand. There was no statistical significance of SE with either the more or less affected hands.
  
  
  CONCLUSIONS
  These results indicate that the SE can be identified in drug-naïve PD, as well as in advanced PD, with objective measurements and support the idea that the SE is a feature in PD observed during the early stage of the disease without medication.
authors.affiliation: Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA ; Department of Neurology, Medical Center, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Suk Yun
authors.initials: SY
authors.lastname: Kang
authors.affiliation: Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Wasaka
authors.affiliation: Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA ; Kaiser Permanente Midatlantic Permanente Medical Group, Suitland, MD, USA.
authors.forename: Ejaz A
authors.initials: EA
authors.lastname: Shamim
authors.affiliation: Clinical Neurosciences Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Sungyoung
authors.initials: S
authors.lastname: Auh
authors.affiliation: Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Yoshino
authors.initials: Y
authors.lastname: Ueki
authors.affiliation: Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Nguyet
authors.initials: N
authors.lastname: Dang
authors.affiliation: Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Hallett
keywords: Bradykinesia; De novo; Parkinson’s disease; Pegboard test; Progressive slowness; Sequence effect