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|Title: ||Clinical and Neurophysiological correlates of cortical excitability changes studied using the cortical threshold tracking TMS in hyperkinetic and hypokinetic movement disorders|
|Authors: ||Kim, Samuel Doohwan|
|Issue Date: ||6-Jan-2015|
|Publisher: ||University of Sydney|
The University of Sydney Medical School
|Abstract: ||This thesis attempts to answer the question, “what is the significance of abnormal cortical excitability studies in movement disorders?” Remarkably similar cortical excitability findings have been reported in Parkinson's disease (PD) and Stiff-man syndrome (SMS) despite these disorders manifesting with hypokinetic and hyperkinetic movement disorders, respectively.
In SMS patients, there was a significant reduction in short intracortical inhibition (SICI) with dissociation between the measures of cortical and spinal excitability and clinical measures of disease severity and plasma levels of anti-GAD antibodies. The results suggest that spinal hyperexcitability and muscle stiffness and spasms are unlikely to be simply due to cortical disinhibition of spinal circuits.
In PD patients, there was a significant reduction in SICI and intracortical inhibition (ICF) which appeared to be dependent on disease severity and plasma levodopa levels. Most significant findings were detected in those who had been on long term levodopa carbidopa intestinal gel (LCIG) treatment. Specifically, there was a lack of decrement in hand tapping speed, an objective measure of bradykinesia, despite a significant reduction in matching plasma levodopa levels and SICI. These results raise the possibility of restoration of the long duration effect of levodopa as a result of sustained continuous dopaminergic therapy.
This thesis confirms there is much value in further careful research of cortical excitability changes in Parkinson’s disease and other related movement disorders.|
|Type of Work: ||PhD Doctorate|
|Type of Publication: ||Doctor of Philosophy Ph.D.|
|Appears in Collections:||Sydney Digital Theses (Open Access)|
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|KIM Samuel - Final Thesis.pdf||Thesis||5.65 MB||Adobe PDF|
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