Subthalamic stimulation breaks the balance between distal and axial signs in Parkinson\u2019s disease

Cyril Atkinson-Clement,Frédérique Fluchère,Christelle Baunez,Serge Pinto,Alexandre Eusebio,Alexandre Zénon,Thierry Legou,Émilie Cavazzini,Jean-Philippe Azulay,Tatiana Witjas

doi:10.1038/s41598-021-01386-0

Abstract

In Parkinson’s disease (PD), the effects of both Ldopa and subthalamic deep brain stimulation (STN-DBS) are known to change cost-valuation. However, this was mostly studied through reward-effort task involving distal movements, while axial effort, less responsive to treatments, have been barely studied. Thus, our objective was to compare the influence of both Ldopa and STN-DBS on cost-valuation between two efforts modalities: vowel production (as an example of axial movement) and hand squeezing (as an example of distal movement). Twelve PD patients were recruited to participate in this study. The task consisted in deciding whether to accept or reject trials based on a reward-effort trade-off. Participants performed two blocks with hand squeezing, and two with vowel production, in the four treatment conditions (LdopaOn/Off; STN-DBS On/Off). We found that STN-DBS changed the ratio difference between hand and phonation efforts. Vowel production effort was estimated easier to perform with STN-DBS alone, and harder when associated with Ldopa. The difference between hand and phonation efforts was correlated with quality of life in Off/Off and On Ldopa alone conditions, and with impulsive assessment On STN-DBS alone. We highlighted that STN-DBS could introduce an imbalance between the actual motor impairments and their subjective costs. With this finding, we also suggest paying particular attention to the different treatment effects that should be expected for axial and distal movement dysfunctions.

Highlights

To cite this version: Cyril Atkinson-Clement, Émilie Cavazzini, Alexandre Zénon, Thierry Legou, Tatiana Witjas, et al
To compare axial and lateralized cost-valuations, we focused on the two following modalities: vowel production—a sub-component of phonation—as an example of axial function, and hand squeezing as an example of distal movement
Hand squeezing maximal effort was significantly higher in the Off Dopa/On DBS condition in comparison to the Off/Off condition (main effect: F(3;96) = 2.91; p = 0.039; d = 0.66; post-hoc: p = 0.035), which was not observed for vowel production maximal effort (F(3;96) = 1.73; p = 0.17; d = 0.5)

Summary

Introduction

To cite this version: Cyril Atkinson-Clement, Émilie Cavazzini, Alexandre Zénon, Thierry Legou, Tatiana Witjas, et al. In Parkinson’s disease (PD), the effects of both Ldopa and subthalamic deep brain stimulation (STNDBS) are known to change cost-valuation This was mostly studied through reward-effort task involving distal movements, while axial effort, less responsive to treatments, have been barely studied. We highlighted that STN-DBS could introduce an imbalance between the actual motor impairments and their subjective costs With this finding, we suggest paying particular attention to the different treatment effects that should be expected for axial and distal movement dysfunctions. Recent studies explored motivation deficits and treatment effects in PD by using motor effort-based decision-making tasks[1] These studies reported that PD patients show over-valuation of handgrip effort compared to healthy controls (HC), which can be normalized[2] or not[3] under medication. Among PD symptoms, altered distal hand movements are the most responsive to pharmacological and neurosurgical treatments

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