Motor Skill Learning in People With Parkinson's Disease
Condition: Parkinson's Disease
MeSH terms: Parkinson Disease
Study type: Observational

Summary: 
      This study will compare brain changes in people with Parkinson's disease with those of normal
      control subjects while they learn motor skills. People with Parkinson's disease sometimes
      have trouble learning new skills, but it is not known why. This study will use repetitive
      transcranial magnetic stimulation (rTMS), nerve conduction studies, and
      electroencephaolography (EEG) to look for differences in the way the brain changes with
      learning in people with Parkinson's disease.

      Healthy normal volunteers and people with Parkinson's disease who are between 21 and 80 years
      of age may be eligible for this study. Participants undergo the following procedures in five
      visits to the NIH Clinical Center:

      Visit 1

      Medical and neurological examination.

      Visit 2

      Motor training. Participants perform a pinching movement once every other second, timed to a
      metronome, during rTMS. For TMS, a wire coil is held on the subject's scalp. A brief
      electrical current is passed through the coil, creating a magnetic pulse that stimulates the
      brain. The subject hears a click and may feel a pulling sensation on the skin under the coil.
      There may be a twitch in the muscles of the face, arm or leg. rTMS involves repeated magnetic
      pulses delivered in short bursts of impulses.

      Visits 3 and 4

      Brain physiology studies using rTMS, nerve conduction studies (electrical nerve stimulation)
      and EEG. A nerve at the subject's wrist is stimulated with electrical impulses to measure the
      speed with which nerves conduct electrical impulses and the strength of the connection
      between the nerve and the muscle. rTMS is performed for 20 minutes. The EEG measures the
      electrical activity of the brain (brain waves). For this test, electrodes (metal discs) are
      placed on the scalp with a conductive gel and the brain waves are recorded while the subject
      moves his or her thumb briskly for 20 minutes.

      Visit 5

      Subjects undergo rTMS for 20 minutes and have an EEG.

      ...
    

Detailed description: 
      Objective

      The aims of the present study are to:

        1. Clarify that the altered plasticity of the primary motor cortex (M1) in patients with
           Parkinson's disease (PD) is associated with impaired motor learning by using the paired
           associative stimulation (PAS) technique, which can enhance or inhibit the M1
           excitability with paired stimulation to the contralateral peripheral nerve and cerebral
           cortex.

        2. Elucidate that the altered plasticity of the M1 in patients with PD goes together with
           impaired sensorimotor integration via the basal ganglia-thalamocortical loop.

      Study population

      12 right-handed patients with PD

      12 right-handed age-matched healthy volunteers

      Design

      Patients and age-matched healthy volunteers will complete five different sessions: Visit 1:
      clinical screening; Visit 2: motor learning session; Visit 3 and 4: the paired associative
      stimulation (PAS) sessions; Visit 5: the control session.

      During the motor learning session, subjects will be asked to perform metronome-paced pinch of
      their index finger and thumb.

      During the PAS sessions, they will receive 20 minutes of paired stimulation to the
      contralateral peripheral nerve stimulation and transcranial magnetic stimulation (TMS) at the
      appropriate timing for producing changes of the M1 excitability.

      During the control session, they will receive 20 minutes of repetitive TMS without the
      peripheral nerve stimulation.

      Outcome measures

      For the motor learning session:

        -  peak acceleration (MPA) of thumb movement

        -  maximal peak force (MPF) between the index finger and thumb

      For the PAS and control sessions:

        -  peak-to-peak motor evoked potential (MEP) amplitude

        -  resting motor threshold

        -  afferent inhibition

        -  event related desynchronization (ERD) and event related synchronization (ERS)
    

Keywords: Electroencephalogram (EEG); Nerve Conduction Study; Transcranial Magnetic Stimulation (TMS); Motor Evoked Potential; Parkinson Disease; PD; Healthy Volunteer; HV