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Supplementing Best Care with Specialized Rehabilitation Treatment in Parkinson's Disease: A Retrospective Study by Different Expert Centers

Ghilardi, Maria Felice; Quartarone, Angelo; Di Rocco, Alessandro; Calabrò, Rocco Salvatore; Luo, Sheng; Liu, Hongliang; Norcini, Monica; Canesi, Margherita; Cian, Veronica; Zarucchi, Marianna; Ortelli, Paola; Volpe, Daniele; Bakdounes, Leila; Castelli, Davide; Di Fonzo, Alessio; Franco, Giulia; Frattini, Emanuele; Avanzino, Laura; Pelosin, Elisa; Ogliastro, Carla; Ceravolo, Roberto; Palermo, Giovanni; Tommasini, Luca; Frosini, Daniela; Parnetti, Lucilla; Tambasco, Nicola; Nigro, Pasquale; Simoni, Simone; Schmidt, Peter
PMID: 38792540
ISSN: 2077-0383
CID: 5655242

Beta power and movement-related beta modulation as hallmarks of energy for plasticity induction: Implications for Parkinson's disease

Ghilardi, Maria Felice; Tatti, Elisa; Quartarone, Angelo
Extensive work on movement-related beta oscillations (~13-30 Hz) over the sensorimotor areas in both humans and animals has demonstrated that sensorimotor beta power decreases during movement and transiently increases after movement. This beta power modulation has been interpreted as reflecting interactions between sensory and motor cortical areas with attenuation of sensory afferents during movement and their subsequent re-activation for internal models updating. More recent studies in neurologically normal subjects have demonstrated that this movement-related modulation as well as mean beta power at rest increase with practice and that previous motor learning enhances such increases. Conversely, patients with Parkinson's disease (PD) do not show such practice-related increases. Interestingly, a 2-h inactivity period without sleep can restore beta power values to baseline in normal subjects. Based on these results and on those of biochemical and electrophysiological studies in animals, we expand the current interpretation of beta activity and propose that the practice-related increases of beta power over sensorimotor areas are local indices of energy used for engaging plasticity-related activity. This paper provides some preliminary evidence in this respect linking findings of biochemical and electrophysiological studies in both humans and animals. This novel interpretation may explain the high level of beta power at rest, the deficient modulation during movement as well as the decreased skill formation in PD as resulting from deficiency in energy consumption, availability and regulation that are altered in this disease.
PMID: 34144879
ISSN: 1873-5126
CID: 4917882

Art therapy for Parkinson's disease

Cucca, Alberto; Di Rocco, Alessandro; Acosta, Ikuko; Beheshti, Mahya; Berberian, Marygrace; Bertisch, Hilary C; Droby, Amgad; Ettinger, Tom; Hudson, Todd E; Inglese, Matilde; Jung, Yoon J; Mania, Daniella F; Quartarone, Angelo; Rizzo, John-Ross; Sharma, Kush; Feigin, Andrew; Biagioni, Milton C; Ghilardi, M Felice
OBJECTIVE:To explore the potential rehabilitative effect of art therapy and its underlying mechanisms in Parkinson's disease (PD). METHODS:Observational study of eighteen patients with PD, followed in a prospective, open-label, exploratory trial. Before and after twenty sessions of art therapy, PD patients were assessed with the UPDRS, Pegboard Test, Timed Up and Go Test (TUG), Beck Depression Inventory (BDI), Modified Fatigue Impact Scale and PROMIS-Self-Efficacy, Montreal Cognitive Assessment, Rey-Osterrieth Complex Figure Test (RCFT), Benton Visual Recognition Test (BVRT), Navon Test, Visual Search, and Stop Signal Task. Eye movements were recorded during the BVRT. Resting-state functional MRI (rs-fMRI) was also performed to assess functional connectivity (FC) changes within the dorsal attention (DAN), executive control (ECN), fronto-occipital (FOC), salience (SAL), primary and secondary visual (V1, V2) brain networks. We also tested fourteen age-matched healthy controls at baseline. RESULTS:At baseline, PD patients showed abnormal visual-cognitive functions and eye movements. Analyses of rs-fMRI showed increased functional connectivity within DAN and ECN in patients compared to controls. Following art therapy, performance improved on Navon test, eye tracking, and UPDRS scores. Rs-fMRI analysis revealed significantly increased FC levels in brain regions within V1 and V2 networks. INTERPRETATION/CONCLUSIONS:Art therapy improves overall visual-cognitive skills and visual exploration strategies as well as general motor function in patients with PD. The changes in brain connectivity highlight a functional reorganization of visual networks.
PMID: 33526323
ISSN: 1873-5126
CID: 4776032

Art Therapy for Parkinson's disease: preliminary findings from the ExplorARTPD Study [Meeting Abstract]

Cucca, A.; Di Rocco, A.; Acosta, I.; Berberian, M.; Bertish, H.; Inglese, M.; Mania, D.; Quartarone, A.; Rizzo, J.; Ghilardi, M.; Feigin, A.; Biagioni, M.
ISSN: 1351-5101
CID: 4989352

New insights into cortico-basal-cerebellar connectome: clinical and physiological considerations

Quartarone, Angelo; Cacciola, Alberto; Milardi, Demetrio; Ghilardi, Maria Felice; Calamuneri, Alessandro; Chillemi, Gaetana; Anastasi, Giuseppe; Rothwell, John
The current model of the basal ganglia system based on the 'direct', 'indirect' and 'hyperdirect' pathways provides striking predictions about basal ganglia function that have been used to develop deep brain stimulation approaches for Parkinson's disease and dystonia. The aim of this review is to challenge this scheme in light of new tract tracing information that has recently become available from the human brain using MRI-based tractography, thus providing a novel perspective on the basal ganglia system. We also explore the implications of additional direct pathways running from cortex to basal ganglia and between basal ganglia and cerebellum in the pathophysiology of movement disorders.
PMID: 31628799
ISSN: 1460-2156
CID: 4146632

Visual-Spatial Dysfunction in Parkinson's Disease: an Exploratory Multimodal Biomarker Study [Meeting Abstract]

Cucca, Alberto; Droby, Amgad; Beheshti, Mahya; Acosta, Ikuko; Mania, Daniella; Sharma, Kush; Berberian, Marygrace; Bertish, Hilary C.; Hudson, Todd; Di Rocco, Alessandro; Ghilardi, Maria Felice; Inglese, Matilde; Rizzo, John-Ross; Biagioni, Milton; Feigin, Andrew
ISSN: 0028-3878
CID: 4561632

Prior Practice Affects Movement-Related Beta Modulation and Quiet Wake Restores It to Baseline

Tatti, Elisa; Ricci, Serena; Nelson, Aaron B; Mathew, Dave; Chen, Henry; Quartarone, Angelo; Cirelli, Chiara; Tononi, Giulio; Ghilardi, Maria Felice
Beta oscillations (13.5-25 Hz) over the sensorimotor areas are characterized by a power decrease during movement execution (event-related desynchronization, ERD) and a sharp rebound after the movement end (event-related synchronization, ERS). In previous studies, we demonstrated that movement-related beta modulation depth (peak ERS-ERD) during reaching increases within 1-h practice. This increase may represent plasticity processes within the sensorimotor network. If so, beta modulation during a reaching test should be affected by previous learning activity that engages the sensorimotor system but not by learning involving other systems. We thus recorded high-density EEG activity in a group of healthy subjects performing three 45-min blocks of motor adaptation task to a visually rotated display (ROT) and in another performing three blocks of visual sequence-learning (VSEQ). Each block of either ROT or VSEQ was followed by a simple reaching test (mov) without rotation. We found that beta modulation depth increased with practice across mov tests. However, such an increase was greater in the group performing ROT over both the left and frontal areas previously involved in ROT. Importantly, beta modulation values returned to baseline values after a 90-min of either nap or quiet wake. These results show that previous practice leaves a trace in movement-related beta modulation and therefore such increases are cumulative. Furthermore, as sleep is not necessary to bring beta modulation values to baseline, they could reflect local increases of neuronal activity and decrease of energy and supplies.
PMID: 33013332
ISSN: 1662-5137
CID: 4626592


Cucca, A.; Mania, D.; Sharma, K.; Acosta, I.; Berberian, M.; Beheshti, M.; Biagioni, M.; Droby, A.; Di Rocco, A.; Ghilardi, M. F.; Inglese, M.; Rizzo, J. R.; Feigin, A.
ISSN: 1353-8020
CID: 4790882

Effects of rTMS and intensive rehabilitation in Parkinson's Disease on learning and retention

Marchesi, Giorgia; Albanese, Giulia Aurora; Ferrazzoli, Davide; George, Shaina; Ricci, Serena; Tatti, Elisa; Di Rocco, Alessandro; Quartarone, Angelo; Frazzitta, Giuseppe; Ghilardi, M Felice
Movement is accompanied by modulation of oscillatory activity in different ranges over the sensorimotor areas. This increase is more evident in normal subjects and less in patients with Parkinson's Disease (PD), a disorder associated with deficits in the formation of new motor skills. Here, we investigated whether such EEG changes improved in a group of PD patients, after two different treatments and whether this relates to performance. Subjects underwent either a session of 5 Hz repetitive Transcranial Magnetic Stimulation (rTMS) over the right posterior parietal cortex or a 4-week Multidisciplinary Intensive Rehabilitation Treatment (MIRT). We used a reaching task with visuo-motor adaptation to a rotated display in incremental 10° steps up to 60°. Retention of the learned rotation was tested before and after either intervention over two consecutive days. High-density EEG was recorded throughout the testing. We found that patients adapted their movements to the rotated display similarly to controls, although retention was poorer. Both rTMS and MIRT lead to improvement in retention of the learned rotation. Mean beta modulation levels changed significantly after MIRT and not after rTMS. These results suggest that rTMS produced local improvement reflected in enhanced short-term skill retention; on the other hand, MIRT determined changes across the contralateral sensorimotor area, reflected in beta EEG changes.
PMID: 31374802
ISSN: 1945-7901
CID: 4032392

Cognitive performance in mid-stage Parkinson's disease: functional connectivity under chronic antiparkinson treatment

Vancea, Roxana; Simonyan, Kristina; Petracca, Maria; Brys, Miroslaw; Di Rocco, Alessandro; Ghilardi, Maria Felice; Inglese, Matilde
Cognitive impairment in Parkinson's disease (PD) is related to the reorganization of brain topology. Although drug challenge studies have proven how levodopa treatment can modulate functional connectivity in brain circuits, the role of chronic dopaminergic therapy on cognitive status and functional connectivity has never been investigated. We sought to characterize brain functional topology in mid-stage PD patients under chronic antiparkinson treatment and explore the presence of correlation between reorganization of brain architecture and specific cognitive deficits. We explored networks topology and functional connectivity in 16 patients with PD and 16 matched controls through a graph theoretical analysis of resting state-functional MRI data, and evaluated the relationships between network metrics and cognitive performance. PD patients showed a preserved small-world network topology but a lower clustering coefficient in comparison with healthy controls. Locally, PD patients showed lower degree of connectivity and local efficiency in many hubs corresponding to functionally relevant areas. Four disconnected subnetworks were also identified in regions responsible for executive control, sensory-motor control and planning, motor coordination and visual elaboration. Executive functions and information processing speed were directly correlated with degree of connectivity and local efficiency in frontal, parietal and occipital areas. While functional reorganization appears in both motor and cognitive areas, the clinical expression of network imbalance seems to be partially compensated by the chronic levodopa treatment with regards to the motor but not to the cognitive performance. In a context of reduced network segregation, the presence of higher local efficiency in hubs regions correlates with a better cognitive performance.
PMID: 28942477
ISSN: 1931-7565
CID: 2717832