Modulation of Cutaneous Reflexes From the Foot During Gait in Parkinson's Disease

Abstract

Normal gait is characterized by a phase-dependent modulation of cutaneous reflexes. The role of the basal ganglia in regulating these reflexes is largely unknown. Therefore cutaneous reflex responses from the skin of the foot were studied during walking of patients with mild to moderate Parkinson's disease (PD). The reflex responses were elicited by stimulation of the sural nerve of the most affected leg. The responses were studied in the biceps femoris (BF) and tibialis anterior (TA) of both legs. The latencies, durations, and phase-dependent modulation patterns of the responses were mostly comparable with those observed in healthy subjects. However, on average the amplitude of the responses in the ipsilateral and contralateral BF was respectively 1.4- and 5-fold larger for the PD patients than that for the healthy subjects. This increase was mostly seen throughout the whole step cycle. However, in some PD patients the crossed BF responses were very large during the contralateral swing phase. In such cases the increase in crossed reflexes sometimes reflected premotoneuronal gating since it was not always due to increased background activation in that period. Fast activation of contralateral BF reflexes is known to occur in conjunction with ipsilateral perturbations when there is a threat to stability. It is concluded that cutaneous reflexes are facilitated in PD but that some of the increase in reflexes in BF may be indirectly related to unsteady gait and to perceived instability.