Abstract
Background: Mirror movements are often reported in the early stages of Parkinson's disease (PD) and have been attributed to bilateral activation of the primary motor cortex; however, the precise cortical mechanisms are still unclear. Subclinical mirror activation (MA) that accompanies mirror movement has also been reported in healthy aging adults. Objective: To characterize mirror activation and determine the cortical mechanisms of MA in individuals with PD who demonstrate mirror movements. Hypothesis: 5 Hz rTMS to the supplementary motor area (SMA) will reduce MA by increasing interhemispheric inhibition (IHI) of the ipsilateral motor cortex. Methods: MA was assessed using surface electromyography during maximal and submaximal unimanual contractions of the first dorsal interosseous in 7 individuals with PD with mirror movements (PD-MM: 70.9 ± 13.9 years; UPDRS III: 28.0 ± 8.2), 7 individuals with PD without mirror movements (PD-NM: 71 ± 10.1 years; UPDRS III: 27.8 ± 6.7) and 7 healthy controls (74.4 ± 6.0 years). IHI of the ipsilateral motor cortex was assessed using paired-pulse transcranial magnetic stimulation. Results: MA was enhanced in both PD groups during submaximal contractions, with the latest onset of activation in PD-NM. Ipsilateral motor cortex excitability was the highest in PDMM; however, IHI did not differ between PD and controls. 5 Hz rTMS to the SMA reduced IHI in PD-NM; however, did not affect MA. Conclusions: IHI may not be the sole contributor to the expression of overt mirror movements in PD. Expression of overt mirror movement may be due to the combination of enhanced ipsilateral motor cortex excitability and an earlier onset of electromyographic activation in the mirror hand (mirror activation) in PDMM.