Proprioception in Parkinson's disease is acutely depressed by dopaminergic medications

Abstract

Objectives-Impaired proprioception has been previously reported in patients with Parkinson's disease. It was hypothesised that dopaminergic medications transiently depress proprioception, with amplification of adventitious movements as a result. This study tested for eVects on proprioception of dopaminergic drugs, and for associations between such eVects and drug induced dyskinesias. Methods-In 17 patients with Parkinson's disease, arm proprioception was tested in the practically defined "oV" state, and retested 1 hour after taking levodopa or dopamine agonist. Testing consisted of side to side comparison of elbow angle, matching the contralateral elbow angle, and spatial recall of an unrestrained arm. Results-Proprioception deteriorated as hypothesised, reaching significance by one tailed t test for each of the three tasks. The relative deterioration (and the 95% lower confidence bound for estimated deterioration) was 31% (4%) for side to side elbow comparison, was 27% (11%) for accuracy in matching the contralateral elbow angle, and was 11% (0%) for spatial recall. Dyskinetic (n=6) and nondyskinetic (n=11) patients did not diVer significantly in these eVects on proprioception. Control subjects (n=6) and untreated parkinsonian subjects (n=5) did not significantly diVer from the parkinsonian patients in the oV state. Conclusions-Administration of levodopa and dopamine agonists were associated with a modest acute suppression in central responsiveness to joint position. It is speculated that compensatory exaggerated movement could account in part for the phenomenon of drug induced dyskinesias. (J Neurol Neurosurg Psychiatry 2001;71:607-610)

Dopaminergic contributions to distance estimation in Parkinson's disease: A sensory-perceptual deficit?

“…Instead, researchers suggest that the supplementary motor area may be involved which degrades in PD, but only responds to dopamine replacement in those with severe impairment in those regions which involve proprioceptive processing and motor execution (Jacobs & Horak, 2006;Mongeon et al, 2009). Alternatively previous studies have also suggested that dopaminergic medication worsens proprioceptive deficits in PD (Mongeon et al, 2009;O'Suilleabhain et al, 2001). The current study does not provide support for this hypothesis either, since performance 'ON' medication did not get worse during walking conditions but instead slightly improved.…”

“…Abnormal vibration-induced movement errors have been observed in PD during joint flexion-extension tasks (Rickards & Cody, 1997;Schrader et al, 2008), and PET imaging studies of passive finger vibration have demonstrated a reduction in sensory evoked brain activations in the cortical (parietal and frontal) and subcortical (BG) areas of the brain (Boecker et al, 1999a). During limb position tasks, individuals with PD make more errors then healthy control participants when required to identify the occurrence and/or direction of passive movements (Schneider et al, 1987) as well as demonstrating greater errors in matching static limb position, detecting limb displacements, or using the lower limbs to estimate the size of an object (Martens & Almeida, 2011;O'Suilleabhain, Bullard, & Dewey, 2001;Zia et al, 2000). Similarly, tasks involving reaching and pointing to remembered targets have found that PD patients exhibit significantly large errors when locating the original target (Keijsers, Admiraal, Cools, Bloem, & Gielen, 2005;Klockgether et al, 1995), especially when patients are unable to see their hand (Mongeon, Blanchet, & Messier, 2009) or in the complete absence of visual information (Keijsers et al, 2005).…”

“…There has been some evidence that dopaminergic medication makes proprioceptive processing worse in PD (O'Suilleabhain et al, 2001), however conflicting evidence has shown no difference between 'ON' and 'OFF' states (Almeida et al, 2005). In an effort to clarify the role of dopaminergic medication in sensory cue processing, the current study tested all PD participants both 'ON' and 'OFF' dopaminergic medication across sensory cue conditions.…”

A Prospective Study of Alterations in Balance among Patients with Parkinson’s Disease

“…Seeing as somatosensory input was not correlated with Hoehn-Yahr stage, it seems possible that these other correlations may have been due to the therapeutic drugs being taken. O’Suilleabhain et al [27] found that levodopa worsens the proprioception of PD patients, and suggested that it may cause dyskinesia. In the present study, however, PD patients did not show the poor SOT condition 1 performance that would result from dyskinetic swaying.…”

Impact of Parkinson’s disease on proprioceptively based on-line movement control

“…Several studies have indicated that non-medicated and medicated PD patients show proprioceptive deficits (Klockgether et al 1995;Demirci et al 1997;Zia et al 2000;O'Suilleabhain et al 2001;Maschke et al 2003;Mongeon et al 2009). However, no study has investigated whether proprioceptively based on-line movement guidance is selectively altered in PD patients.…”