Background: The integrity of frontal systems responsible for voluntary control and their interaction with subcortical regions involved in reflexive responses were studied in patients with Parkinson's disease (PD). Previous studies have shown that patients with PD have impaired executive function, including deficits in attention, motor planning and decision making. Methods: Executive function was measured through eye movements: reflexive (stimulus driven) prosaccades and voluntary (internally guided) antisaccades. Patients with advanced idiopathic PD, off and on their optimal levodopa therapy, were tested on a prosaccade and an antisaccade task and compared with matched controls. Results: Levodopa significantly increased response time for reflexive prosaccades and reduced error rate for voluntary antisaccades. Conclusions: Consistent with our proposed model, patients with PD in the medicated state are better able to plan and execute voluntary eye movements. These findings suggest levodopa improves function of the voluntary frontostriatal system, which is deficient in PD.

When a monkey attends to, remembers, and looks toward targets, the activity of some neurons in the lateral intraparietal area (LIP) changes. We recorded from isolated neurons during both a spatial and a shape match-to-sample task to examine and characterize voluntary active processes in LIP. Many LIP neurons show spatially selective activity during the delay period that depends on the location of the sample, but for most cells, this activity does not differ between the two tasks. Although much past work in posterior parietal cortex has explained responses in this region in terms of active processes such as decision-making and motor planning, our findings suggest that much of that activity represents more passive processing. Nevertheless, we do see a significant minority of units that demonstrate instruction-dependent activity during the delay period, suggesting that these units could represent the neural correlates of voluntary or active processes. Separately, we found that during the presentation of the sample stimulus and test array, some units show stronger responses to the stimulus in the shape-matching task when the animal must attend to the shape of a stimulus. This elevated response to the sample during the shape task provides evidence for feature-based attention in LIP. Attention to shape is a property that has not previously been described in primate cortex.

The superior colliculus (SC) plays a central role in the control of saccadic eye movements and has also been implicated in control of covert spatial attention. While there is a growing body of evidence from studies of awake behaving primates that supports these proposals, direct evidence from humans has been sparse. In the present study we tested a patient with thiamine deficiency and a lesion of the SC, who performed both eye movement tasks (prosaccades and antisaccades, with or without a gap) and a covert spatial attention task assessing inhibition of return (IOR). For eye movements, the gap effect was disrupted, and abnormal saccade metrics occurred, with reflexive eye movements being disrupted moreso than voluntary eye movements. Each of these effects resolved coincident with thiamine treatment. The covert attention task revealed a complete absence of IOR. The unequal disruption of voluntary and reflexive eye movements supports the idea that oculomotor responses can be generated in an independent fashion by frontal cortical and lower level neural systems. The role of the SC and other structures in these orienting processes is discussed.

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