Dopamine Agonist Modifies Cortical Activity in Parkinson Disease

OBJECTIVES: To investigate, using functional magnetic resonance imaging, the influence of a long-term dopaminergic therapy on brain activation during a simple motor task in early, previously untreated patients with Parkinson disease. METHODS: Thirteen patients with Parkinson disease in Hoehn-Yahr stage 1 or 2, with a right predominance of the disease, underwent functional magnetic resonance imaging during self-paced continuous right-hand tapping before and after 6 months of therapy with ropinirole 15 mg/d. The task was monitored online with a dedicated device, which measures the strength and frequency of the tapping. RESULTS: All patients with Parkinson disease on ropinirole treatment showed a clinically significant improvement, and their functional magnetic resonance imaging pattern after treatment showed a reduced activation in the right postcentral (primary sensory-motor area), supramarginal and inferior parietal gyri compared with the activation pattern before treatment. No area of increased activation was observed after therapy. CONCLUSIONS: In line with the classical functional deafferentation hypothesis, dopaminergic stimulation should increase motor cortex activity as a result of restoration of the striatocortical loops. On the contrary, our results challenge this hypothesis as we found decreased cerebral activity after a short-term chronic dopaminergic treatment. We suggest that the recruitment of cortical motor circuits aimed to overcome the functional deficit of the striatocortical loops lessens after dopaminergic treatment.