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Tapping and Peg Insertion after Levodopa Intake in Treated and de novo Parkinsonian Patients

Published online by Cambridge University Press:  02 December 2014

Thomas Müller ,
Sabiene Benz  and
Horst Przuntek
Thomas Müller
Affiliation:
Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
Sabiene Benz
Affiliation:
Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
Horst Przuntek
Affiliation:
Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
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Abstract

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Background:

Investigators use instrumental tasks for objective assessment of parkinsonian motor disability and its drug response. To date, such studies on treated parkinsonian patients have not addressed acute and long-term effects of dopaminergic drugs.

Objectives:

To determine the impact of long-term dopaminergic therapy within a standardized levodopa challenge test design in combination with two repeatedly performed instrumental tasks, peg insertion and tapping, in previously treated and untreated parkinsonian patients.

Results:

Tapping significantly deteriorated in previously untreated, but not in treated parkinsonian patients after levodopa intake. In contrast, motor symptoms and peg insertion significantly improved in both groups of parkinsonian patients. Results of both tests differed between parkinsonian patients and matched controls.

Conclusion:

Worsening of cognitively less demanding tapping may result from upregulated presynaptic inhibitory feedback regulation, sedative effects of levodopa or dopamine overflow in untreated parkinsonian patients, who are sensitive to these effects in contrast to treated parkinsonian patients. Tapping is a task with autonomic repetitive performance and programming of standardised movements with a low need for cognitive effort. This autonomic functioning of attentional control and selective processing is intact in Parkinson's disease. Peg insertion depends on more complex movements and thus hypothetically on dopamine-associated cognitive processes. Therefore, impairment of peg insertion responded to dopaminergic stimulation in both groups of parkinsonian patients. Future studies on the efficacy of antiparkinsonian drugs, using instrumental tasks for objective assessment, should consider long-term impact of antiparkinsonian drug therapy and associated cognitive efforts.

Résumé:

RÉSUMÉ:Introduction:

Les investigateurs utilisent des appareils comme outils d'évaluation objective de l'invalidité motrice et de la réponse thérapeutique chez les parkinsoniens. Jusqu'à maintenant, de telles études chez des parkinsoniens traités n'ont pas évalué les effets aigus et à long terme des médicaments dopaminergiques.

Objectives:

L'étude vise à déterminer l'impact de la thérapie dopaminergique à long terme dans le cadre d'un test standardisé de provocation à la lévodopa effectué en combinaison avec deux tâches, l'insertion de chevilles sur une planchette et le tapping, chez des parkinsoniens traités et non traités antérieurement.

Résultats:

Le tapping se détériore significativement après l'administration de lévodopa chez les parkinsoniens non traités contrairement aux parkinsoniens traités. Par contre, les symptômes moteurs et l'insertion de chevilles sur une planchette s'amélioraient significativement dans les deux groupes de parkinsoniens. Les résultats des deux tests étaient différents chez les parkinsoniens et les contrôles appariés.

Conclusion:

Une détérioration du tapping, qui est moins exigeant au point de vue cognitif, peut résulter d'une régulation à la hausse de la rétroinhibition présynaptique, des effets sédatifs de la lévodopa ou à un excédent .de dopamine chez les parkinsoniens non traités. Par contre, l'altération de l'insertion de l'insertion de chevilles sur une planchette, une tache plus exigeante au point de vue cognitif, a répondu à la stimulation dopaminergique chez les parkinsoniens. D'autres études sur l'efficacité des antiparkinsoniens au moyen d'outils pour l'évaluation objective devraient considérer l'impact à long terme des agents antiparkinsoniens et des efforts cognitifs associés.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 1 , February 2002 , pp. 73 - 77
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

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