Brain, Vol. 123, No. 2, 394-403,
February 2000
© 2000 Oxford University Press
Cortical motor reorganization in akinetic patients with Parkinson's disease
A functional MRI study
1 INSERM U455 and 2 Departments of Neurology, 3 Neuroradiology, 4 Clinical Pharmacology and Clinical Investigation Center, University Hospital of Toulouse, France and 5 Neuroradiology Department, Istituto Mediterraneo di Neuroscienze, Pozzilli, Italy
Correspondence to:
Professor O. Rascol, Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine, 37 Allées Jules Guesde, 31073 Toulouse Cedex, France E-mail: rascol{at}cict.fr
Using functional MRI (fMRI), we have studied the changes induced by the performance of a complex sequential motor task in the cortical areas of six akinetic patients with Parkinson's disease and six normal subjects. Compared with the normal subjects, the patients with Parkinson's disease exhibited a relatively decreased fMRI signal in the rostral part of the supplementary motor area (SMA) and in the right dorsolateral prefrontal cortex, as previously shown in PET studies. Concomitantly, the same patients exhibited a significant bilateral relative increase in fMRI signal in the primary sensorimotor cortex, lateral premotor cortex, inferior parietal cortex, caudal part of the SMA and anterior cingulate cortex. These fMRI data confirm that the frontal hypoactivation observed in patients with Parkinson's disease is restricted to the rostral part of the SMA and to the dorsolateral prefrontal cortex. These results also show that, apart from the lateral premotor and parietal cortices, increased fMRI signals can be found in other cortical motor areas of these patients, including the posterior SMA, the anterior cingulate cortex and the primary sensorimotor cortices, which are then likely to participate in the same putative attempt by the dopamine-denervated brain to recruit parallel motor circuits in order to overcome the functional deficit of the striatocortical motor loops.
Parkinson's disease; fMRI; supplementary motor area; cingulate cortex; akinesia; motor reorganization
DLPF = dorsolateral prefrontal; fMRI = functional MRI; SMA = supplementary motor area; SPECT = single photon emission computed tomography
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