title: Effect of subthalamic stimulation on distal and proximal upper limb movements in Parkinson's disease.
abstract: A different innervation pattern of proximal and distal muscles from the contra- and ipsilateral motor circuits raises the question as to whether bilateral, contra- and ipsilateral subthalamic stimulation may have different effects on the distal and proximal movements of the upper limb. To answer this question, we performed kinematic analyzes in patients with Parkinson's disease.
  
  
  
  Twenty-eight Parkinsonian patients treated by bilateral subthalamic stimulation were examined with an age-matched control group of 28 healthy subjects. They performed 14s of finger tapping, hand grasping and pronation-supination. The patient group performed these sessions in four conditions (BOTH ON, BOTH OFF, CONTRA ON, IPSI ON) after withdrawal of dopaminergic medication for 12h and a fifth condition after taking medication (BOTH ON-MED ON). A motion sensor with a three-dimensional gyroscope was worn on the index finger. Speed, amplitude, rhythm and decrement of movements were calculated and compared across these conditions.
  
  
  
  Speed and amplitude of the more distal movements were improved similarly by contra- and bilateral stimulation. Bilateral stimulation was more effective than contralateral stimulation for the more proximal movements. Contra- and bilateral stimulation ameliorated the rhythm similarly in each movement task. Decrement of distal and proximal movements was not affected by the stimulation conditions.
  
  
  
  This is the first study to show that the outcome of bi- and unilateral subthalamic stimulation on proximal and distal upper limb movements should be evaluated separately postulating the different somatotopic organization of subloops in the cortico-basal ganglia motor circuits.
authors.affiliation: Department of Neurology, Semmelweis University, Balassa utca 6, 1083 Budapest, Hungary. Electronic address: tamas.gertrud@med.semmelweis-univ.hu.
authors.forename: Gertrúd
authors.initials: G
authors.lastname: Tamás
authors.affiliation: Department of Neurology, Semmelweis University, Balassa utca 6, 1083 Budapest, Hungary.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kelemen
authors.affiliation: Department of Neurology, Semmelweis University, Balassa utca 6, 1083 Budapest, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Radics
authors.affiliation: Department of Neurosurgery, University of Debrecen, Móricz Zsigmond körút 22, 4032 Debrecen, Hungary.
authors.forename: István
authors.initials: I
authors.lastname: Valálik
authors.affiliation: Great Lakes NeuroTechnologies Inc., 10055 Sweet Valley Dr, Cleveland, OH, USA.
authors.forename: Dustin
authors.initials: D
authors.lastname: Heldman
authors.affiliation: Department of Neurology, University of Szeged, Semmelweis u. 6, 6725 Szeged, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Klivényi
authors.affiliation: Department of Neurology, University of Szeged, Semmelweis u. 6, 6725 Szeged, Hungary; MTA-SZTE Neuroscience Research Group, Semmelweis u. 6, 6725 Szeged, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Vécsei
authors.affiliation: Department of Neurology, University of Debrecen, Móricz Zsigmond körút 22, 4032 Debrecen, Hungary.
authors.forename: Eszter
authors.initials: E
authors.lastname: Hidasi
authors.affiliation: National Institute of Clinical Neurosciences, Amerikai út 57, 1145 Budapest, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Halász
authors.affiliation: Department of Neurosurgery, University of Szeged, Semmelweis u. 6, 6725 Szeged, Hungary.
authors.forename: Dávid
authors.initials: D
authors.lastname: Kis
authors.affiliation: MR Research Centre, Semmelweis University, Balassa utca 6, 1083 Budapest, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Barsi
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Kútvölgyi u. 4, 1125 Budapest, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Golopencza
authors.affiliation: National Institute of Clinical Neurosciences, Amerikai út 57, 1145 Budapest, Hungary.
authors.forename: Loránd
authors.initials: L
authors.lastname: Erőss
mesh_terms: D001696:Biomechanical Phenomena; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D005385:Fingers / Q000503:physiopathology; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010300:Parkinson Disease / Q000503:physiopathology*; D020127:Recovery of Function; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D034941:Upper Extremity / Q000503:physiopathology*
keywords: Bilateral stimulation; Deep brain stimulation; Distal movement; Parkinson's disease; Proximal movement; Unilateral stimulation