Neuro pathways enhancing motor performance through intense exercise in Parkinson’s: proposed explanation through EEG P300 enhancement through burst multi muscle electric stimulation sustained in Parkinson’s patients
DOI: Pending DOI
Synopsis
Intense exercise can be simulated by repetitive burst neuromuscular stimulation applied to multiple muscles simultaneously in the upper and lower extremities and the trunk is demonstrated to have a dramatic neurological enhancement effect into the pre-motor and supplementary motor regions as well as the primary sensory -motor cortex as demonstrated by EEG auditory evoked potentials.
These locations include the frontal, central and also the prefrontal electrode locations.
Background
It is demonstrated that proprioceptive input into the basal ganglia BG is facilitated by dopamine. Without this, it is difficult for the basal ganglia to process afferent input from the peripheral stretch receptor 1a afferents, as profoundly demonstrated in Parkinson’s motor impairment.
Position sense is transmitted from the BG to the pre-motor cortex for planning and then on to the motor cortex for execution.
Without sufficient pre-motor position calculation movement becomes slow and uncoordinated as in bradykinesia, freezing of gait and related motor dyskinesia.
Researchers at Carnegie Mellon have shown that very brief bursts of afferent input of less than 200 msec. are able to pass into the BG. Longer duration stimuli do not.
Therefore, repeated brief peripheral afferent bursts of about 100 msec with rest periods of 200 msec to multiple weight bearing and trunk muscles could activate the premotor cortical targets required for coordinated movement.
Methods
Case study of cortical response changes in a79 yo normal male.
EEG auditory cortical evoked potentials were generated to produce a physiological baseline. The evoked responses were repeated after stimulation intervention and P300 amplitude and delay were compared pre and post stimulation intervention.
Burst neuromuscular stimulation was applied to 20 large muscle groups of the upper and lower extremities as well as the trunk.
Stimulation was performed using the Neuro20 Inc system with continuous stimulation at 40 Hz biphasic square waves of 175 microseconds run continuously for 5 seconds to establish muscle contraction thresholds followed by paired pulse 25 msec stimulation with the same pulse shape and amplitude as established during the continuous phase.
Intensity of stimulation was well tolerated for 20 minutes.
Pre and post EEG analysis was performed using the WAVi Inc EEG system.
Results
EEG cortical P300 amplitudes increased significantly in the frontal and central electrode regions. The range was between 70 and 120%. Specifically the electrodes were at F3, F4 and FZ as well as C3, C4 and CZ. It was noted that the amplitudes did not increase in the parietal or occipital regions. These findings were consistent in the initial three daily trials. The data were reviewed for artifacts and inaccuracies of which none were found. Same protocol was repeated after a one day pause for two more sessions. The percentage increase averaged 40 to 60% in sessions four and five because the baseline amplitudes had increased from the initial sessions.
Follow up EEG P300 amplitudes remained elevated at an average of 45% at 6 weeks.
Level of significance requires 20% change in P300 amplitude.
Single foot balance was noticeably improved over 6 weeks.
Discussion
These results helped shed light on the pathways of both burst stimulation as well as intense exercise as techniques to improve function in Parkinson’s patients.
It has been noted that this treatment protocol for Parkinson’s patients has been rather effective in improving gait performance and reducing freezing. The underlying mechanism of pulse electric stimulation producing these beneficial effects has been questioned. This application of burst electric stimulation to multiple muscle groups has demonstrated a very significant increase in pre-motor as well as primary motor sensory cortical regions through the pre-and post application of P300 cortical of a potentials.
Disclosures
None
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