Neck Vibration Proprioceptive Postural Response Intact in Progressive Supranuclear Palsy unlike Idiopathic Parkinson's Disease.

Stefan Kammermeier,Annika Plate,Lucia Dietrich,Kai Bötzel,Arun Singh,Stefan Lorenzl,Kathrin Maierbeck

doi:10.3389/fneur.2017.00689

Abstract

Progressive supranuclear palsy (PSP) and late-stage idiopathic Parkinson’s disease (IPD) are neurodegenerative movement disorders resulting in different postural instability and falling symptoms. IPD falls occur usually forward in late stage, whereas PSP falls happen in early stages, mostly backward, unprovoked, and with high morbidity. Postural responses to sensory anteroposterior tilt illusion by bilateral dorsal neck vibration were probed in both groups versus healthy controls on a static recording posture platform. Three distinct anteroposterior body mass excursion peaks (P1–P3) were observed. 18 IPD subjects exhibited well-known excessive response amplitudes, whereas 21 PSP subjects’ responses remained unaltered to 22 control subjects. Neither IPD nor PSP showed response latency deficits, despite brainstem degeneration especially in PSP. The observed response patterns suggest that PSP brainstem pathology might spare the involved proprioceptive pathways and implies viability of neck vibration for possible biofeedback and augmentation therapy in PSP postural instability.

Highlights

Idiopathic Parkinson’s disease (IPD) and the most frequent atypical Parkinsonism syndrome progressive supranuclear palsy (PSP) are neurodegenerative diseases with different postural instability features and frequent falling along the disease course.In the alpha-synucleinopathy idiopathic Parkinson’s disease (IPD) [1,2,3], hypokinetic rigid motor symptoms can be well treated within the first years with dopaminergic medication
Neither amplitude nor latency of peaks P1 through P3 correlated with demographic parameters, independent of group affiliation, between-groups, or within a given group; neither applied for the eyes open (EO) versus eyes closed (EC) condition
It should be noted that the differences in response behavior were statistically not significantly related to clinical neck rigidity, which is statutorily higher in PSP than in IPD

Summary

Introduction

Idiopathic Parkinson’s disease (IPD) and the most frequent atypical Parkinsonism syndrome progressive supranuclear palsy (PSP) are neurodegenerative diseases with different postural instability features and frequent falling along the disease course.In the alpha-synucleinopathy IPD [1,2,3], hypokinetic rigid motor symptoms can be well treated within the first years with dopaminergic medication. In advanced stage after typically or more years, postural control is affected with motor freezing and falling [4], likely due to the degeneration of non-dopaminergic structures [3]. Falls in this context are defined as involuntary collisions with or sliding down to a lower surface as reported by either patient or caretakers. Advanced-stage IPD patients typically fall forward, mostly while walking: by failure to initiate a walking motion, freezing, or out of a forward motion by failure to stop; body posture is in general physiological flexion with a forward shift of body mass, whereas in early stages, backward and omnidirectional falling is observed [3, 5]. Orthostatic dysfunction [6] and frontal executive disorders [3, 7] may contribute to falls

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