Management Of Parkinson's Disease Research Articles

Cajanus cajan (L) Millsp seeds extract prevents rotenone-induced motor- and non-motor features of Parkinson disease in mice: Insight into mechanisms of neuroprotection

Ethnopharmacological relevanceCajanus cajan (L) Millsp (Fabaceae) seed decoction is used by traditional healers in Nigeria as nerve tonic, hence, could be beneficial in the treatment of Parkinson's disease (PD), a progressive and debilitating neurodegenerative disease that imposes great burden on the healthcare system globally. Aim of the studyThis study aimed at investigating the neuroprotective effect of ethanol seed extract of Cajanus cajan (CC) in the treatment of rotenone-induced motor symptoms and non-motor symptoms associated with PD. Materials and methodsTo assess the protective action of CC on rotenone-induced motor- and non-motor symptoms of PD, mice were first pretreated with CC (50, 100 or 200 mg/kg, p.o.) an hour before oral administration of rotenone (1 mg/kg, p.o, 0.5% in carboxyl-methylcellulose) for 28 consecutive days and weekly behavioural tests including motor assessment (open field test (OFT), rotarod, pole and cylinder tests) and non-motor assessment (novel object recognition (NOR), Y-maze test (YM), forced swim and tail suspension, gastric emptying and intestinal fluid accumulation tests) were carried out. The animals were euthanized on day 28 followed by the collection of brain for assessment of oxidative stress, inflammatory markers and immunohistochemical analysis of the striatum (STR) and substantia nigra (SN). Phytochemicals earlier isolated from CC were docked with protein targets linked with PD pathology such as; catechol-O-methyltransferase (COMT), tyrosine hydroxylase (TH) and Leucine rich receptor kinase (LRRK).Results: this study showed that CC significantly reduced rotenone-induced spontaneous motor impairment in OFT, pole, cylinder and rotarod tests in mice as well as significant improvement in non-motor features (significant reversal of rotenone-induced deficits discrimination index and spontaneous alternation behaviour in NORT and YM test, respectively, reduction in immobility time in forced swim/tail suspension test, gastrointestinal disturbance in intestinal transit time in mice. Moreso, rotenone-induced neurodegeneration, oxidative stress and neuroinflammation were significantly attenuated by CC administration. In addition, docking analysis showed significant binding affinity of CC phytochemicals with COMT, TH and LRRK2 receptors. ConclusionCajanus cajan seeds extract prevented both motor and non-motor features of Parkinson disease in mice through its antioxidant and anti-inflammatory effects. Hence, could be a potential phytotherapeutic adjunct in the management of Parkinson disease.

Holter STAT-ON™ against other tools for detecting MF in advanced Parkinson's disease: an observational study.

Different screening tools to identify advanced Parkinson's disease (APD) have emerged in recent years. Among them, wearable medical devices, such as STAT-ON™, have been proposed to help to objectively detect APD. To analyze the correlation between STAT-ON™ reports and other assessment tools to identify APD and to assess the accuracy of screening tools in APD patients, using the STAT-ON™ as the gold standard. In this retrospective, observational study, data from the University Hospital Complex of Pontevedra database on 44 patients with potential APD who wore STAT-ON™ were extracted. Data were collected according to different sources of tools for identifying APD: (1) STAT-ON™, (2) information provided by the patient, (3) questionnaire for advanced Parkinson's disease (CDEPA), (4) 5-2-1 Criteria, and (5) Making Informed Decisions to Aid Timely Management of Parkinson's Disease (MANAGE-PD). Considering STAT-ON™ recordings as a reference, the sensitivity, specificity, and positive and negative predictive values for each tool were calculated. The kappa index assessed the degree of agreement between the gold standard and the other instruments. Although no statistically significant association was found between STAT-ON™ recordings and any screening methods evaluated, the CDEPA questionnaire demonstrated the highest sensitivity and VPN values to detect patients with APD candidates for second-line therapy (SLT). According to the correlation analyses, MANAGE-PD demonstrated the highest degree of concordance with STAT-ON™ recordings to identify the SLT indication and to predict the SLT decision. STAT-ON™ device may be a helpful tool to detect APD and to guide treatment decisions.

Wearable electrochemical microneedle sensing platform for real-time continuous interstitial fluid monitoring of apomorphine: Toward Parkinson management

Parkinson’s disease (PD) is a progressive neurodegenerative disorder, impacting millions of people across the globe. For its management, pro-neurotransmitters or agonists are commonly being prescribed, which help to mitigate the symptoms. However, the progressiveness of PD and narrowing down of the drug therapeutic window eventually led to its ineffective management. Therefore, the requirement of continuous monitoring of administered drugs is of utmost need. In view of this, here, we demonstrate a microneedle-based wearable electrochemical sensor platform for the continuous monitoring of apomorphine (APO), a widely used therapeutic drug for Parkinson’s management. The APO sensor relies on a metallized carbon-paste packed hollow microneedle, operated using the square wave voltammetry (SWV) and chronoamperometry (CA) based transduction modes. Under the optimal conditions, the microneedle sensor offers sensitive detection of micromolar APO concentrations in artificial interstitial fluid (ISF) through the monitoring of the two oxidation peaks of the APO catechol and tertiary amine moieties (at 0.1 V and 0.7 V, respectively). The microneedle sensor exhibited a detection limit of 0.6 and 0.75 μM with the transduction techniques SWV and CA, respectively, and good operational stability as well as anti-biofouling protection in artificial-ISF medium. The specificity has been tested for the developed sensor in the presence of potential interfering molecules, where the developed sensor showed the selectivity towards APO. The attractive analytical performance demonstrated in the skin mimic environment makes the new wearable APO microneedle sensor a powerful candidate for continuous APO detection in PD management.

Validation and clinical value of the MANAGE-PD tool: A clinician-reported tool to identify Parkinson's disease patients inadequately controlled on oral medications

IntroductionMaking Informed Decisions to Aid Timely Management of Parkinson's Disease (MANAGE-PD) is a clinician-reported tool designed to facilitate timely identification and management of patients with advancing Parkinson's disease (PD) with suboptimal symptom control while on standard therapy. The objective of this study was to evaluate the validity and clinical value of the tool. MethodsDriven by structured inputs from a steering committee and panel of PD experts, the tool was developed to classify patients into 3 categories. Validity and clinical value were elucidated using a two-pronged approach: (i) hypothetical patient vignettes (n = 10) developed based on the MANAGE-PD tool and rated by 17 PD specialists and 400 general neurologists (GN) and (ii) patients with PD (n = 2546) managed in real-world clinical settings. Vignette validity was based on concordance between PD experts’ clinical judgement and MANAGE-PD vignette categorization. Patient-level data was used for known-group comparisons (validity) and discordant pair analysis (clinical value). ResultsThe tool demonstrated strong validity and clinical value among PD specialists (intraclass coefficient [ICC] 0.843; Fleiss weighted kappa [ƙweighted] 0.79) and GN (ICC 0.690; ƙweighted 0.65) using patient vignettes. MANAGE-PD also demonstrated real-world validity and clinical value based on ability to identify patients with incrementally higher clinical, economic, and humanistic PD burden across categories of the tool (p < 0.01). ConclusionsMANAGE-PD demonstrated robust validity and clinical value in identifying patients with suboptimal PD symptom control. Clinical use of MANAGE-PD may complement treatment decision-making and facilitate timely and comprehensive management of patients with advancing PD.

Constipation Management in Parkinson Disease.

BACKGROUND: Constipation is the most frequently reported nonmotor gastrointestinal symptom of Parkinson disease and can precede motor symptoms by up to 20 years. The causes of constipation can be multifactorial, but the implications can lead to life-threatening complications. Early recognition of constipation can lead to better health outcomes and quality of life. MANAGEMENT CONSIDERATIONS: The combination of nonpharmacological management through screening tools, nursing assessment, and patient education as well as pharmacological management is considered best practice. IMPLICATIONS FOR PRACTICE: Nurses who are knowledgeable on the current treatment options for constipation in Parkinson disease will be better equipped as active multidisciplinary team players to provide optimal care to their patients and achieve the best health outcomes.

Nanotechnology Driven Approaches for the Management of Parkinson's Disease: Current Status and Future Perspectives.

Parkinson's disease (PD) is believed to be one of the commonly found adult-onset movement disorder occurring due to neurodegeneration and striatal dopamine deficiency. Although clinical diagnosis depends on the occurrence of bradykinesia and other cardinal motor features, PD is linked with many non-motor symptoms that are responsible for overall disability. Among several factors, genetic and environment-related factors are thought to be the major ones accountable for PD. Comprehensive research has shown that a number of drugs are effective in providing symptomatic relief to the patients suffering from PD. But some drug molecules suffer from significant drawbacks such as poor bioavailability and instability, therefore, they sometimes fail to deliver the expected results. Hence, to resolve these issues, new promising novel drug delivery systems have been developed. Liposomes, solid lipid nanoparticles, nanoemulsion, self-emulsifying drug delivery system (SEDDS), niosomes are some of the novel drug delivery system (NDDS) carriers that have been explored for enhancing the CNS concentration of levodopa, apomorphine, resveratrol, and other numerous drugs. This paper elucidates various drugs that have been studied for their potential contribution to the treatment and management of PD and also reviews and acknowledges the efforts of several scientists who successfully established various NDDS approaches for these drugs for the management of PD.

Depression and Anxiety Management in Parkinson Disease.

BACKGROUND: Depression and anxiety are common but underrecognized and undertreated nonmotor symptoms of Parkinson disease (PD) due to their diagnostic criteria overlapping with other PD symptoms, limited randomized controlled studies in this specific population, and the need for multidisciplinary expertise. The purpose of this article is to offer evidence-based solutions for managing comorbid depression and anxiety in patients with PD through a case study analysis. CASE STUDY: A case study is used to illustrate the somatic manifestations of anxiety in PD that leads to diagnostic challenge and multidisciplinary management. MANAGEMENT CONSIDERATIONS: The appropriate use of screening tools, pharmacological and nonpharmacological management, and education are important interventions to consider when treating depression and anxiety in PD. CONCLUSION: Effective management requires accurate assessments, individualized treatment modalities, and patient education. Nurses who are knowledgeable about the effects and management of mood disorders in PD can play an integral role in the multidisciplinary team approach for assessment, patient and caregiver education, and treatment plan implementation.

Bacoside-A exerts protective effect against Parkinson’s disease-induced functional damage in mice via inhibition of apoptosis and oxidative response

Purpose: To determine the effect of bacoside-A on Parkinson's disease (PD) in a rat model, and elucidate its mechanism of action.Methods: A rat model of PD was established by administration of 5 µL of 6-hydroxydopamine in ascorbic acid (0.1 %). Measurement of serum levels of inflammatory factors was carried out using enzyme-linked immunosorbent assay (ELISA) kits. Western blotting was used to assay Bax, cytochrome c and Bcl-2 in rat hippocampus.Results: Bacoside-A treatment significantly reduced PD-induced high turning values in rats (p &lt; 0.05). Treatment with bacoside-A reversed PD-mediated suppression of serum activities of CAT and glutathione peroxidase (GPx). In bacoside-A-treated PD rats, dose-dependent suppression of acetylcholinesterase (AChE) and inducible nitric oxide synthase (iNOS) activities were observed (p &lt; 0.05). Bacoside-A-treated PD rats significantly (p &lt; 0.018) reduced interleukin (IL)-1β and IL-6 levels. Treatment of PD rats with bacoside-A effectively reduced levels of tumor necrosis factor (TNF)-α, NF-κB p65, (COX)-2 and p53 protein, and also reversed up-regulations of Bax, cytochrome C, caspase-3 and caspase-9.Conclusion: Bacoside-A exhibits a protective effect against Parkinson disease-induced oxidative damage and neuronal degeneration in rats through downregulation of iNOS, AChE, inflammatory cytokines and pro-apoptotic proteins. Therefore, bacoside-A has potentials for use in the management of Parkinson disease.&#x0D; Keywords: Parkinson disease, Neuroprotective, Pro-apoptotic, Cytokines, Neurotoxicity

Vigorous Aerobic Exercise in the Management of Parkinson Disease: A Systematic Review.

To summarize the findings from studies examining the effects of vigorous-intensity aerobic exercise in the management of Parkinson disease. TYPE: Systematic review. PubMed/MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, SPORTDiscus, and ScienceDirect databases were searched up to May 2020. Reference lists of the included articles were also searched for additional studies. Searches were restricted to English language. Seven papers, including six studies, five randomized controlled trials and one controlled trial, were identified. The studies examined the effects of vigorous-intensity aerobic exercise in participants with Parkinson disease. Studies in which the minimal intensity required was ≥77% of maximum heart rate, 60% of heart rate reserve or 64% of maximal oxygen uptake met the inclusion criteria. Method appraisal showed a mean score of 5.3 in the Physiotherapy Evidence Database (PEDro) scale. No statistically significant differences were found between vigorous-intensity aerobic exercise and moderate/low-intensity aerobic exercise for the main outcomes (disease severity and motor function). Only one study concluded a significant higher aerobic fitness in favor of the group that exercised at vigorous intensity compared to the moderate intensity group. Vigorous-intensity aerobic exercise has not shown statistically significant improvements in motor and nonmotor impairments in individuals with Parkinson disease as compared to moderate/low-intensity aerobic exercise. Hence, the current evidence is too limited to allow recommendations for clinical practice.

Effect of exercise therapy in multi disiciplainary approach of parkinson disorder: A short review

Parkinson being an progressive disorder has drew many challenges in physical therapy management, and having wide variety of signs and symptoms it has always proven as challenging to the therapists, however in last five years there was extremely good progress in management of Parkinson disease. But due to its heterogeneity signs from individual to individual, hardly literature has been proven useful for practice. In multidisciplinary team approach exercise therapy has drastically proven to support and maintain quality of life in daily activities. This review provides the importance of exercise therapy in Parkinson in multi disciplinary approach. Keywords: Excercise therapy, Parkinson, Multidisciplinary.

Synergistic action of propolis with levodopa in the management of Parkinsonism in Drosophila melanogaster.

Background The Phosphatase and tensin-induced putative kinase 1 (PINK1B9) mutant for Drosophila melanogaster is a key tool that has been used in assessing the pathology of Parkinsonism and its possible remedy. This research was targeted toward determining the effects of ethanolic extract of propolis, with levodopa therapy in the management of Parkinsonism. Method The PINK1B9 flies were divided into groups and fed with the different treatment doses of ethanoic extract of propolis. The treatment groups were subjected to 21 days of administration of propolis and the levodopa at different doses after which percentage climbing index, antioxidant activity and lifespan studies were done. Results Propolis alone improved motor activity, antioxidant and lifespan in Drosophila melanogaster than in PINK1 flies. Propolis in combination with levodopa significantly (P<0.05) improved physiological parameters at higher than lower concentrations in Parkinsonism Drosophila melanogaster demonstrating its importance in managing side effects associated with levodopa. Conclusion Propolis is a novel candidate as an alternative and integrative medicinal option to use in the management of Parkinsonism in both animals and humans at higher concentrations.

Investigation of anti-Parkinson activity of dicyclomine

Background Parkinson’s disease (PD) is a progressive neurodegenerative disorder. The major causative factors that progress the PD are age, genetic abnormalities, environmental factors and degeneration of dopamine neurons in substantia nigra. PD normally exerts a tonic inhibitory effect on striatal cholinergic interneurons. Anticholinergics act by normalizing the disequilibrium between striatal dopamine and acetylcholine-resulted reduction in tremors. Objective This study sought to evaluate the anti-Parkinson potential of dicyclomine in haloperidol (HAL)- and paraquat (PQT)-induced Parkinsonism models in mice. Materials and methods Sixty albino mice were divided into six groups (n = 10) for each model. Group I: received distilled water 1 mL/kg, Group II: diseased group received HAL (1 mg/kg) for consecutive 21 days and PQT (2 mg/kg) every three days for three weeks, Group III: treated with sinemet (20 mg/kg), Group IV–VI: received 40, 80 and 160 mg/kg dose of dicyclomine, respectively, for consecutive 21 days. The effect of treatments on spontaneous locomotor activity and motor co-ordination was evaluated by using open field, rotarod, actophotometer and light and dark box tests. Cataleptic behavior was estimated by the block method and triple horizontal bar apparatus. Biochemical markers of oxidative stress and levels of neurotransmitters were estimated. Results Findings from this study showed that dicyclomine at highest dose level of 160 mg/kg prevented HAL- and PQT-induced PD through enhancement of antioxidant defense system. Conclusion The study concluded that dicyclomine could be the potential drug in the management of Parkinsonism.

New rational in Treatment of Parkinsonism

Abstract Parkinsonism disease is the second most common aging neurodegenerative disorders characterized by degeneration of dopaminergic neurons settled in the substantia nigra, leading to the appearance of both motor and non-motor symptoms. This work aims to show the effect of stem cell therapy on treatment of Parkinsonism and also to show the mechanism of the action. In this work, Parkinsonism was induced by subcutanous injection of rotenone. Rats were divided randomly in to 3 groups; control, Parkinsonism, stem cell. Brain specimens were obtained for histological study. In Parkinsonism group, marked pathological changes were noticed in the form of; shrunken dopaminergic cells with pyknotic nuclei. Interestingly, improvement of some of the pathological changes was observed in the stem cell group. It could be concluded that, stem cell has a beneficial effect in management of Parkinsonism and this need further investigations in the future.

Diet and lifestyle management in Parkinson disease: A population based study in India

Diet and lifestyle management in Parkinson disease: A population based study in India

Pathophysiology and management of parkinson disease: a review

Parkinson’s disease is a neurological disorder that is characterized by the typical motor symptoms of Parkinsonism associated with Lewy bodies and loss of dopaminergic neurons within the substantia nigra. It is associated with fluctuations of motor and non-motor symptoms, dyskinesia and psychosis. Parkinson’s disease affects almost 1% of individuals older than 60 years. The incidence is higher in Europe, North and South America compared to Africa. Male to female ratio is 3:2. The aim of this review is to describe the pathophysiology and management of Parkinson’s disease. Aetiological risk factors of Parkinson’s disease were theorised to be due to genetic and environmental factors. Some of the environmental risk factors include chronic pesticide exposure, prior head injury etc. while some of the genetic risk factors include beta-glucocerobrosidase gene (GBA), leucine- rich repeat kinase-2 (LRRK2) and synuclein alpha (SNCA) genes. Parkinson disease is mainly a disorder of the basal ganglia, a group of nuclei located at the base of the forebrain. There are two main neuropathological discoveries related to the disease: the damage of pigmented dopaminergic neurons in the substantia nigra pars compacta (SNpc), and the appearance of Lewy bodies that leads to the formation of Lewy neurites, which are typical pathologic outcomes in Parkinson disease. The management comprises of diagnosis and treatment. The diagnosis is mainly clinical while the treatment is essentially medical which include. Levodopa/carbidopa administration in combination for control of motor symptoms.Keywords; Parkinson’s disease, Substantia nigra, Lewy bodies, levodopa, dopaminergicneurons.

Antiapoptotic role of Agaricus blazei extract in rodent model of Parkinson's disease.

Rotenoneis a pesticide that has been shown to induce the pathological symptoms ofParkinson'sdisease(PD) in both cellular and animal models. In this study, we investigated the protective effect of Agaricus blazei extract onrotenone-induceddopaminergic degeneration and apoptosisin mice model. A. blazei extract blocked therotenone-mediated diminution of dopamine transporter (DAT) and vesicular monoamine transporter 2 (VMAT 2) expression and the downregulation of Bcl-2 and the upregulation of Bax, caspases-3, -6, -8 and caspase-9. Present data suggest that A. blazei extract plays a crucial role in regulation of proteins expression such as DAT and VMAT2 and pro-apoptotic and anti-apoptotic in Parkinsonism. In conclusion, the present study shows that A. blazei extract act as potential neuroprotective agent in the management of Parkinsonism.

Telmisartan Ameliorates Astroglial and Dopaminergic Functions in a Mouse Model of Chronic Parkinsonism.

Many studies reported the neuroprotective effects of angiotensin II type 1 receptor (AT1R) antagonists in Parkinson's disease (PD). However, the role of AT1R blockade on astroglial, in turn, dopaminergic functions in chronic PD is still to be studied. In the present study, telmisartan (TEL; 3 and 10mg/kg/day; p.o), was used to study the effects AT1R blockade on astrocytic and dopaminergic functions in a chronic 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mouse model of Parkinsonism (250mg/kg, i.p, in 10 equally divided doses at 3.5days interval) in C57BL/6J mice. TEL significantly downregulated glial fibrillary acidic protein (GFAP), inducible nitric oxide synthase (iNOS), TNFα and IL1β expressions and nitric oxide (NO) content. Significant upregulation glial cell derived neurotrophic factor (GDNF) expression and increased glutathione (GSH) content reveal the ameliorating effects of TEL on astroglial functions. On the other hand, TEL upregulated tyrosine hydroxylase (TH), dopamine transporter (DAT), and vesicular monoamine transporter 2 (VMAT2) expressions. Finally, TEL improved dopamine and its turnover and restored locomotor performance. Present experiment reveals that TEL has the potential to alleviate astroglial functions, apart from restoring dopaminergic functions, at least in part. To conclude, TEL may be a better disease-modifying therapeutic regimen in the management of Parkinsonism, acting primarily via astroglial-dopaminergic functions.

Novel action of vinpocetine in the prevention of paraquat-induced parkinsonism in mice: involvement of oxidative stress and neuroinflammation.

Parkinson's disease (PD) is a multifactorial chronic progressive neurodegenerative disease caused by age, genetic and environmental factors such as paraquat (PQT). PQT (a quartenary nitrogen herbicide) is implicated in some form of idiopathic PD. This study sought to investigate the protective effect of vinpocetine on paraquat-induced Parkinsonism in mice. Forty-eight male albino mice were randomly divided into 6 groups and treated orally as follows for 21days; Group 1: vehicle normal (10ml/kg), group 2: vehicle control (10ml/kg); groups 3-5: vinpocetine (5, 10 or 20mg/kg); group 6: vinpocetine (20mg/kg). Animals in groups 2-5 were given PQT (10mg/kg, i.p.) every 3days for 3weeks. The effect of treatments on spontaneous motor activity (open field test), muscle coordination (rotarod tests), cataleptic behaviour (bar test), and working memory (Y-maze test) were assayed. After the behavioural assay on day 21, the midbrain was isolated for estimation of oxidative stress and TNF-α. Intraperitoneal injection of paraquat significantly induced motor deficits, muscle incoordination, catalepsy and working memory impairment which was ameliorated by the pretreatment of mice with vinpocetine. In addition, paraquat injection caused marked increase in nitroso-oxidative stress markers with concomitant deficits in antioxidant enzymes activities (GSH and SOD) as well as induction of tumour necrotic factor-α (TNF-α) in the mid-brain which were attenuated by the pretreatment of mice with vinpocetine. Findings from this study showed that vinpocetine prevented paraquat-induced motor deficits, memory impairment, oxidative stress and neuroinflammation through enhancement of antioxidant defense system and inhibition of neuroinflammatory cytokine. Thus, could be a potential drug in the management of Parkinsonism.

A decision support system for Parkinson disease management: expert models for suggesting medication change

Parkinson’s disease (PD) is a degenerative disorder of the central nervous system, which requires a long-term, interdisciplinary disease management. The EU Horizon 2020 project PD_manager (http://www.parkinson-manager.eu/) is aimed at developing a decision support system for PD management. As part of this task, we have developed decision-support models that identify situations in which the disease has progressed to the point which requires a change of medical therapy. The input data includes motor symptoms, non-motor symptoms and epidemiologic data. The models were developed in collaboration with medical experts, using a qualitative multi-criteria method DEX. In this paper, we describe the process and results of model development, and assess the quality of models in terms of classification accuracy, transparency, correctness and completeness.

Pallidal deep brain stimulation modulates excessive cortical high β phase amplitude coupling in Parkinson disease

ObjectiveDeep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) are equally efficacious in the management of Parkinson disease (PD). Studies of STN-DBS have revealed a therapeutic reduction in excessive cortical β-γ phase-amplitude coupling (PAC). It is unclear whether this is specific to STN-DBS and potentially mediated by modulation of the hyperdirect pathway or if it is a generalizable mechanism seen with DBS of other targets. Moreover, it remains unclear how cortical signals are differentially modulated by movement versus therapy. To clarify, the effects of GPi-DBS and movement on cortical β power and β-γ PAC were examined. MethodsRight sensorimotor electrocorticographic signals were recorded in 10 PD patients undergoing GPi-DBS implantation surgery. We evaluated cortical β power and β-γ PAC during blocks of rest and contralateral hand movement (finger tapping) with GPi-DBS off and on. ResultsMovement suppressed cortical low β power (P = 0.008) and high β-γ PAC (P = 0.028). Linear mixed effect modeling (LMEM) showed that power in low and high β bands are differentially modulated by movement (P = 0.022). GPi-DBS also results in a significant suppression of high β-γ PAC but without power modulation in either β sub-band (P = 0.008). Cortical high β-γ PAC is significantly correlated with severity of bradykinesia (Rho = 0.59, P = 0.045) and changes proportionally with therapeutic improvement (Rho = 0.61, P = 0.04). ConclusionsSimilar to STN-DBS, GPi-DBS reduces motor cortical β-γ PAC, like that also reported with dopaminergic mediations, suggesting it is a generalizable symptom biomarker in PD, independent of therapeutic target or proximity to the hyperdirect pathway.