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000022043 1001_ $$0P:(DE-HGF)0$$aFlorin, E.$$b0
000022043 245__ $$aSubtype-specific statistical causalities in parkinsonian tremor
000022043 260__ $$aAmsterdam [u.a.]$$bElsevier Science$$c2012
000022043 300__ $$a353 - 362
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000022043 500__ $$aLars Timmermann is supported by the Deutsche Forschungsgemeinschaft (KFO 219; TI 319/2-1), the German Ministry of Research and Education (BMBF), the medical faculty of the University of Cologne "Fortune-Program", the "Manfred and Ursula Muller Foundation" (Ti 159/2006), the "Kluh-Foundation", and "Hoffnungsbaum e.V." Gereon R. Fink gratefully acknowledges additional support from the Deutsche Forschungsgemeinschaft (KFO 219; SCHU, 1439/3-1). Esther Florin thanks Johannes Pfeifer for his critical review of the manuscript and his support with the statistical analysis. Alfons Schnitzler acknowledges support from the Volkswagen Stiftung (I/80191).
000022043 520__ $$aTremor is one of the cardinal symptoms of Parkinson's disease. Up to now, however, its pathophysiology remains poorly understood. Previously, oscillatory coupling at tremor frequency between the subthalamic nucleus und affected muscles was shown. In these studies, however, causality of coupling could not be demonstrated. Thus, we analyzed the statistical causality between intraoperatively recorded local field potentials in the subthalamic area and affected arm muscles during tremor episodes, using squared partial directed coherence, a recently developed causality measure. The analysis identified differential statistical causality patterns for Parkinson's disease patients of the akinetic-rigid subtype during tremor episodes (n=6) versus patients of the tremor-dominant subtype (n=8): for the akinetic-rigid Parkinson's disease patients significantly more cases of the subthalamic region were found to be statistically causal for electromyographic-tremor activity, a result in accordance with the standard basal ganglia model. In contrast, for the tremor-dominant patients, significantly more instances of electromyographic tremor activity turned out to be causal for activity of the subthalamic region. Furthermore, the clinical effective stimulation site coincided with the location of most input causalities from the periphery in seven out of eight tremor-dominant patients. The data suggest that, although tremor activity in tremor-dominant and akinetic-rigid Parkinson's disease patients was clinically similar, statistical causality between tremor electromyogram (EMG) and the subthalamic nucleus was fundamentally different. Therefore, we hypothesize different pathophysiological mechanisms to underlie the generation of tremor in the two subtypes of Parkinson's disease.
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000022043 65320 $$2Author$$adeep brain stimulation
000022043 65320 $$2Author$$aconnectivity
000022043 65320 $$2Author$$adirectionality
000022043 65320 $$2Author$$ahuman
000022043 65320 $$2Author$$asubthalamic nucleus
000022043 650_2 $$2MeSH$$aAged
000022043 650_2 $$2MeSH$$aDeep Brain Stimulation
000022043 650_2 $$2MeSH$$aElectromyography
000022043 650_2 $$2MeSH$$aFemale
000022043 650_2 $$2MeSH$$aHumans
000022043 650_2 $$2MeSH$$aMale
000022043 650_2 $$2MeSH$$aMiddle Aged
000022043 650_2 $$2MeSH$$aMuscle, Skeletal: physiopathology
000022043 650_2 $$2MeSH$$aParkinsonian Disorders: complications
000022043 650_2 $$2MeSH$$aParkinsonian Disorders: physiopathology
000022043 650_2 $$2MeSH$$aSubthalamic Nucleus: physiopathology
000022043 650_2 $$2MeSH$$aTremor: etiology
000022043 650_2 $$2MeSH$$aTremor: physiopathology
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000022043 7001_ $$0P:(DE-HGF)0$$aHimmel, M.$$b1
000022043 7001_ $$0P:(DE-HGF)0$$aReck, C.$$b2
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