Brain, Vol. 124, No. 11, 2131-2146,
November 2001
© 2001 Oxford University Press
Review article |
Pathophysiology of bradykinesia in Parkinson's disease
.
1 Dipartimento di Scienze Neurologiche, Istituto Neurologico Neuromed IRCCS, Università di Roma `La Sapienza', Rome, Italy, 2 MRC Human Movement and Balance Unit, The Institute of Neurology, London, UK, 3 The Royal Adelaide Hospital, The University Department of Medicine, Adelaide, Australia and 4 Human Motor Control Section, NINDS, NIH, Bethesda, Maryland, USA
Correspondence to:
Professor Alfredo Berardelli, Dipartimento di Scienze Neurologiche, Viale Università 30, 00185 Roma, Italy
Bradykinesia means slowness of movement and is one of the cardinal manifestations of Parkinson's disease. Weakness, tremor and rigidity may contribute to but do not fully explain bradykinesia. We argue that bradykinesia results from a failure of basal ganglia output to reinforce the cortical mechanisms that prepare and execute the commands to move. The cortical deficit is most apparent in midline motor areas. This leads to particular difficulty with self-paced movements, prolonged reaction times and abnormal pre-movement EEG activity. Movements are often performed with normally timed EMG bursts but the amount of EMG activity is underscaled relative to the desired movement parameters. There are also abnormalities in sensory scaling and sensorimotor integration. The brain appears to be able to compensate to some degree for the basal ganglia deficit. There is overactivity in the lateral premotor areas during task performance and movements can be speeded by giving sensory cues. Attention to movement is also beneficial. However, we propose that the engagement of compensatory processes may also lead to reduced performance in other tasks. For example, patients' problems in performing more than one task at the same time could result from lack of sufficient resources both to compensate for their basal ganglia deficit and to run two tasks simultaneously. Surgical therapies are unlikely to work solely by normalizing basal ganglia output to that seen in healthy individuals. It seems more plausible that surgery removes an interfering signal that allows more efficient compensation by other structures.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Karimi, N. Golchin, S. D. Tabbal, T. Hershey, T. O. Videen, J. Wu, J. W. M. Usche, F. J. Revilla, J. M. Hartlein, A. R. Wernle, et al. Subthalamic nucleus stimulation-induced regional blood flow responses correlate with improvement of motor signs in Parkinson disease Brain, August 12, 2008; (2008) awn179v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J Jankovic Parkinson's disease: clinical features and diagnosis J. Neurol. Neurosurg. Psychiatry, April 1, 2008; 79(4): 368 - 376. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Desmurget and R. S. Turner Testing Basal Ganglia Motor Functions Through Reversible Inactivations in the Posterior Internal Globus Pallidus J Neurophysiol, March 1, 2008; 99(3): 1057 - 1076. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R Agostino, L Dinapoli, N Modugno, E Iezzi, P Romanelli, and A Berardelli Effects of unilateral subthalamic deep brain stimulation on contralateral arm sequential movements in Parkinson's disease J. Neurol. Neurosurg. Psychiatry, January 1, 2008; 79(1): 76 - 78. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Mazzoni, A. Hristova, and J. W. Krakauer Why Don't We Move Faster? Parkinson's Disease, Movement Vigor, and Implicit Motivation J. Neurosci., July 4, 2007; 27(27): 7105 - 7116. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. M. Aly, J. R. Playfer, S. L. Smith, and D. M. Halliday A novel computer-based technique for the assessment of tremor in Parkinson's disease Age Ageing, July 1, 2007; 36(4): 395 - 399. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Purzner, G. O. Paradiso, D. Cunic, J. A. Saint-Cyr, T. Hoque, A. M. Lozano, A. E. Lang, E. Moro, M. Hodaie, F. Mazzella, et al. Involvement of the Basal Ganglia and Cerebellar Motor Pathways in the Preparation of Self-Initiated and Externally Triggered Movements in Humans J. Neurosci., May 30, 2007; 27(22): 6029 - 6036. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Spielman, L. O. Ramig, L. Mahler, A. Halpern, and W. J. Gavin Effects of an Extended Version of the Lee Silverman Voice Treatment on Voice and Speech in Parkinson's Disease Am J Speech Lang Pathol, May 1, 2007; 16(2): 95 - 107. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Hanajima, Y. Nomura, M. Segawa, and Y. Ugawa Intracortical inhibition of the motor cortex in Segawa disease (DYT5) Neurology, March 27, 2007; 68(13): 1039 - 1044. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Sawamoto, M. Honda, T. Hanakawa, T. Aso, M. Inoue, H. Toyoda, K. Ishizu, H. Fukuyama, and H. Shibasaki Cognitive slowing in Parkinson disease is accompanied by hypofunctioning of the striatum Neurology, March 27, 2007; 68(13): 1062 - 1068. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. J. Hass, M. A. Collins, and J. L. Juncos Resistance Training With Creatine Monohydrate Improves Upper-Body Strength in Patients With Parkinson Disease: A Randomized Trial Neurorehabil Neural Repair, March 1, 2007; 21(2): 107 - 115. [Abstract] [PDF]
|
|
|
|
 |
|
 M. E Morris Locomotor Training in People With Parkinson Disease Physical Therapy, October 1, 2006; 86(10): 1426 - 1435. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. C. Parr-Brownlie and B. I. Hyland Bradykinesia Induced by Dopamine D2 Receptor Blockade Is Associated with Reduced Motor Cortex Activity in the Rat J. Neurosci., June 15, 2005; 25(24): 5700 - 5709. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Mir, K. Matsunaga, F. Gilio, N. P. Quinn, H. R. Siebner, and J. C. Rothwell Dopaminergic drugs restore facilitatory premotor-motor interactions in Parkinson disease Neurology, June 14, 2005; 64(11): 1906 - 1912. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. J. Metter, M. Schrager, L. Ferrucci, and L. A. Talbot Evaluation of Movement Speed and Reaction Time as Predictors of All-Cause Mortality in Men J. Gerontol. A Biol. Sci. Med. Sci., June 1, 2005; 60(7): 840 - 846. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Kuoppamaki, J C Rothwell, R G Brown, N Quinn, K P Bhatia, and M Jahanshahi Parkinsonism following bilateral lesions of the globus pallidus: performance on a variety of motor tasks shows similarities with Parkinson's disease J. Neurol. Neurosurg. Psychiatry, April 1, 2005; 76(4): 482 - 490. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Payoux, P. Remy, P. Damier, M. Miloudi, I. Loubinoux, B. Pidoux, V. Gaura, O. Rascol, Y. Samson, and Y. Agid Subthalamic Nucleus Stimulation Reduces Abnormal Motor Cortical Overactivity in Parkinson Disease Arch Neurol, August 1, 2004; 61(8): 1307 - 1313. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Desmurget, V. Gaveau, P. Vindras, R. S. Turner, E. Broussolle, and S. Thobois On-line motor control in patients with Parkinson's disease Brain, August 1, 2004; 127(8): 1755 - 1773. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Nieuwboer, R. Dom, W. De Weerdt, K. Desloovere, L. Janssens, and V. Stijn Electromyographic profiles of gait prior to onset of freezing episodes in patients with Parkinson's disease Brain, July 1, 2004; 127(7): 1650 - 1660. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Turner, M. Desmurget, J. Grethe, M. D. Crutcher, and S. T. Grafton Motor Subcircuits Mediating the Control of Movement Extent and Speed J Neurophysiol, December 1, 2003; 90(6): 3958 - 3966. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A W A Van Gemmert, C H Adler, and G E Stelmach Parkinson's disease patients undershoot target size in handwriting and similar tasks J. Neurol. Neurosurg. Psychiatry, November 1, 2003; 74(11): 1502 - 1508. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Maurer, T. Mergner, J. Xie, M. Faist, P. Pollak, and C. H. Lucking Effect of chronic bilateral subthalamic nucleus (STN) stimulation on postural control in Parkinson's disease Brain, May 1, 2003; 126(5): 1146 - 1163. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M G Longstaff, P R Mahant, M A Stacy, A W A Van Gemmert, B C Leis, and G E Stelmach Discrete and dynamic scaling of the size of continuous graphic movements of parkinsonian patients and elderly controls J. Neurol. Neurosurg. Psychiatry, March 1, 2003; 74(3): 299 - 304. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Escola, Th. Michelet, F. Macia, D. Guehl, B. Bioulac, and P. Burbaud Disruption of information processing in the supplementary motor area of the MPTP-treated monkey: A clue to the pathophysiology of akinesia? Brain, January 1, 2003; 126(1): 95 - 114. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. D. Sanger Pathophysiology of Pediatric Movement Disorders J Child Neurol, January 1, 2003; 18(1_suppl): S9 - S24. [Abstract] [PDF]
|
|