Cortical motor reorganization in akinetic patients with Parkinson's disease

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Abstract

Using functional MRI (fMRI), we have studied the changes induced by the\nperformance of a complex sequential motor task in the cortical areas of six\nakinetic patients with Parkinson's disease and six normal subjects. Compared with\nthe normal subjects, the patients with Parkinson's disease exhibited a relatively\ndecreased fMRI signal in the rostral part of the supplementary motor area (SMA)\nand in the right dorsolateral prefrontal cortex, as previously shown in PET\nstudies. Concomitantly, the same patients exhibited a significant bilateral\nrelative increase in fMRI signal in the primary sensorimotor cortex, lateral\npremotor cortex, inferior parietal cortex, caudal part of the SMA and anterior\ncingulate cortex. These fMRI data confirm that the frontal hypoactivation\nobserved in patients with Parkinson's disease is restricted to the rostral part\nof the SMA and to the dorsolateral prefrontal cortex. These results also show\nthat, apart from the lateral premotor and parietal cortices, increased fMRI\nsignals can be found in other cortical motor areas of these patients, including\nthe posterior SMA, the anterior cingulate cortex and the primary sensorimotor\ncortices, which are then likely to participate in the same putative attempt by\nthe dopamine-denervated brain to recruit parallel motor circuits in order to\novercome the functional deficit of the striatocortical motor loops.

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