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Neural mechanism of voluntary movement and development of therapeutic approach

開催日 2014/9/11
時間 14:00 - 16:00
会場 Room B(501)
Chairperson(s) 山下 俊英 / Toshihide Yamashita (大阪大学大学院 医学系研究科 分子神経科学 / Department of Molecular Neuroscience, Graduate School of Medicine, Osaka University, Japan)
星 英司 / Eiji Hoshi (東京都医学総合研究所 前頭葉機能プロジェクト / Frontal Lobe Function Project, Tokyo Metropolitan Institute of Medical Science, Japan)

rTMS treatment for Parkinson’s disease

  • S1-B-2-4
  • 宇川 義一 / Yoshikazu Ugawa:1 
  • 1:福島県立医科大学 / Dept.of Neurol., School of Medicine, Fukushima Medical University, Japan 

rTMS treatment for Parkinson's disease
Yoshikazu Ugawa, MD
Department of Neurology, Fukushima Medical University

In this talk, I will show some neuro-plastic issues in Parkinson's disease. How abnormal in plasticity in PD, and to treat the patients using plasticity induction in PD.
What's QPS (quadripulse stimulation)?
There are several stimulation methods to induce the plastic changes in human brain. QPS must be most powerful and reliable one for human plasticity induction. One stimulation burst consisting of four monophasic pulses is given every five seconds for 30 minutes. It eventually gives 360 bursts (1440 pulses) in one session. After QPS the stimulated cortical area excitability is bidirectionally modulated depending on the interval of magnetic pulses in one burst. Short interval QPS potentiates the excitability and longer interval QPS depresses the target area. Their physiological characteristics, bidirectional modulation, effect dependence on the interval of pulses, spatial specificity are all compatible with the synaptic plasticity reported previously.
Dopamine/Dopamine agonists and plasticity
It is well known that dopamine enhances both LTP and LTD, and the former is one of D1 effects and the latter is a kind of D2 effects. To study the relation between dopamine and QPS, we compared LTP/LTD effect between baseline condition and the condition after L-Dopa intake in normal volunteers. Dopamine enhanced both LTP of QPS5 and LTD of QPS50. It is again compatible with plasticity induction in animals.
Neuroplasticity in Parkinson's disease (PD)
In PD patients, even at early stage, QPS induced neither LTP nor LTD like effects in the motor cortex. This lack of plasticity was normalized by L-DOPA intake in parallel with motor symptoms improvements.
Treatment using the plasticity induction
We have already performed two nation-wide studies of rTMS treatment for PD patients. The LTP induction in supplementary motor area had beneficial effects on some motor symptoms, rigidity and akinesia, in PD. One nation-wide clinical trial of rTMS treatment of PD is now on-going to get the Ministry of Health, Labour and Welfare approval as a treatment for PD.

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