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Synergic control of action in levodopa-naïve Parkinson’s disease patients: II. Multi-muscle synergies stabilizing vertical posture

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Abstract

Postural instability is a major disabling feature in Parkinson’s disease (PD). We quantified the organization of leg and trunk muscles into synergies stabilizing the center of pressure (COP) coordinate within the uncontrolled manifold hypothesis in levodopa-naïve patients with PD and age-matched control subjects. The main hypothesis was that changes in the synergic control of posture are present early in the PD process even before levodopa exposure. Eleven levodopa-naïve patients with PD and 11 healthy controls performed whole-body cyclical voluntary sway tasks and a self-initiated load-release task during standing on a force plate. Surface electromyographic activity in 13 muscles on the right side of the body was analyzed to identify muscle groups with parallel scaling of activation levels (M-modes). Data were collected both before (“off-drug”) and approximately 60 min after the first dose of 25/100 carbidopa/levodopa (“on-drug”). COP-stabilizing synergies were quantified for the load-release task. Levodopa-naïve patients with PD showed no COP-stabilizing synergy “off-drug”, whereas controls showed posture-stabilizing multi-M-mode synergy. “On-drug”, patients with PD demonstrated a significant increase in the synergy index. There were no significant drug effects on the M-mode composition, anticipatory postural adjustments, indices of motor equivalence, or indices of COP variability. The results suggest that levodopa-naïve patients with PD already show impaired posture-stabilizing multi-muscle synergies that may be used as promising behavioral biomarkers for emerging postural disorders in PD. Moreover, levodopa modified synergy metrics differently in these levodopa-naïve patients compared to a previous study of patients on chronic antiparkinsonian medications (Falaki et al. in J Electromyogr Kinesiol 33:20–26, 2017a), suggesting different neurocircuitry involvement.

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Acknowledgments

We would like to thank all the participants in the study. XH and MML were supported by NIH grants NS060722, ES019672, NS082151, and NS112008. MLL, XH, and MML were supported by NIH grant NS095873.

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Authors and Affiliations

  1. Graduate Program in Physical Therapy, City University of São Paulo, São Paulo, SP, Brazil

    Sandra M. S. F. Freitas

  2. Department of Kinesiology, The Pennsylvania State University, Rec.Hall-267, University Park, PA, 16802, USA

    Sandra M. S. F. Freitas, Paulo B. de Freitas, Xuemei Huang & Mark L. Latash

  3. Department of Neurology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA

    Sandra M. S. F. Freitas, Paulo B. de Freitas, Tyler Corson, Mechelle M. Lewis & Xuemei Huang

  4. Interdisciplinary Graduate Program in Health Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil

    Paulo B. de Freitas

  5. Department of Pharmacology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA

    Mechelle M. Lewis & Xuemei Huang

  6. Department of Radiology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA

    Xuemei Huang

  7. Department of Neurosurgery, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA

    Xuemei Huang

  8. Department of Physiology, University of Montreal, Montreal, QC, Canada

    Ali Falaki

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  1. Sandra M. S. F. Freitas
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Correspondence to Mark L. Latash.

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Communicated by Francesco Lacquaniti.

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Freitas, S.M.S.F., de Freitas, P.B., Falaki, A. et al. Synergic control of action in levodopa-naïve Parkinson’s disease patients: II. Multi-muscle synergies stabilizing vertical posture. Exp Brain Res 238, 2931–2945 (2020). https://doi.org/10.1007/s00221-020-05947-z

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