title: Subthalamic stimulation and levodopa modulate cortical reactivity in Parkinson's patients.
abstract: The effects of deep brain stimulation of the subthalamic nucleus (DBS-STN) and L-dopa (LD) on cortical activity in Parkinson's disease (PD) are poorly understood.
  
  
  
  By combining transcranial magnetic stimulation (TMS) and electroencephalography (EEG) we explored the effects of STN-DBS, either alone or in combination with L-Dopa (LD), on TMS-evoked cortical activity in a sample of implanted PD patients.
  
  
  
  PD patients were tested in three clinical conditions: i) LD therapy with STN-DBS turned on (ON/ON condition); ii) without LD therapy with STN-DBS turned on (OFF/ON condition); iii) without LD therapy with STN-DBS turned off (OFF/OFF condition). TMS pulses were delivered over left M1 while simultaneously acquiring EEG. Eight age-matched healthy volunteers (HC) were tested as a control group.
  
  
  
  STN-DBS enhanced early global TMS-evoked activity (∼45-80ms) and high-alpha TMS-evoked oscillations (11-13 Hz) as compared to OFF/OFF condition, independently from concomitant LD therapy. LD intake (ON/ON condition) produced a further increase of late TMS-evoked activity (∼80-130ms) and beta TMS-evoked oscillations (13-30 Hz), as compared to OFF/OFF and OFF/ON conditions, that normalized reactivity as compared to HC range of values.
  
  
  
  Our data reveal that bilateral STN-DBS and LD therapy induce a modulation of specific cortical components and specific ranges of frequency. These findings demonstrate that STN-DBS and LD therapy may have synergistic effects on motor cortical activity.
authors: Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy.
authors: Elias Paolo
authors: EP
authors: Casula
authors: Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy; Department of System Medicine, Policlinico di Tor Vergata, Rome, Italy.
authors: Mario
authors: M
authors: Stampanoni Bassi
authors: Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy; Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
authors: Maria Concetta
authors: MC
authors: Pellicciari
authors: Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy.
authors: Viviana
authors: V
authors: Ponzo
authors: Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy.
authors: Domenica
authors: D
authors: Veniero
authors: Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy.
authors: Antonella
authors: A
authors: Peppe
authors: Department of Neurology, Sant'Eugenio Hospital, Rome, Italy.
authors: Livia
authors: L
authors: Brusa
authors: Department of Neurology, Sant'Eugenio Hospital, Rome, Italy; Stroke Unit, Policlinico Tor Vergata, Rome, Italy.
authors: Paolo
authors: P
authors: Stanzione
authors: Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy; Department of System Medicine, Policlinico di Tor Vergata, Rome, Italy; Department of Neurology, Sant'Eugenio Hospital, Rome, Italy.
authors: Carlo
authors: C
authors: Caltagirone
authors: Department of Neurology, Sant'Eugenio Hospital, Rome, Italy.
authors: Alessandro
authors: A
authors: Stefani
authors: Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy; Department of System Medicine, Policlinico di Tor Vergata, Rome, Italy; Stroke Unit, Policlinico Tor Vergata, Rome, Italy. Electronic address: g.koch@hsantalucia.it.
authors: Giacomo
authors: G
authors: Koch
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000494:pharmacology / Q000627:therapeutic use; D001931:Brain Mapping; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000187:drug effects* / Q000503:physiopathology; D046690:Deep Brain Stimulation; D004569:Electroencephalography; D005071:Evoked Potentials / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D007980:Levodopa / Q000494:pharmacology* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D012720:Severity of Illness Index; D013057:Spectrum Analysis; D020531:Subthalamic Nucleus / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
keywords: DBS; EEG; L-dopa; Parkinson; TMS