Impaired presynaptic inhibition in the motor cortex in Parkinson disease

Objective: Intracortical inhibition in the motor cortex may be measured with short interval intracortical inhibition (SICI), likely mediated by GABA(A) receptors, and long interval intracortical inhibition (LICI), likely mediated by GABA(B) receptors. Separate neuronal populations mediate SICI and LICI, and LICI inhibits SICI, likely through GABA(B) mediated presynaptic inhibition. The purpose of this study was to test the hypothesis that cortical presynaptic inhibition in Parkinson disease (PD) is impaired. Methods: Eleven patients with PD were studied at rest both OFF and ON dopaminergic medications and the results were compared to nine healthy, age-matched controls. Motor evoked potentials were recorded from the first dorsal interosseous muscle and a triple-stimulus transcranial magnetic stimulation paradigm was used to evaluate SICI in the presence of LICI. The interstimulus interval (ISI) for SICI was 2 msec and LICI was studied at 100 (LICI100) and 150 msec (LICI150) ISIs. Results: There was no difference in SICI between the controls and PD ON and PD OFF groups. LICI100 was stronger than LICI150 and both were reduced in the PD ON and OFF groups. LICI100 led to a much greater reduction in SICI in the control group compared to both the PD OFF and ON groups. LICI150 caused no significant change in SICI with no significant difference between the controls and PD OFF and PD ON groups. Conclusions: The inhibitory effect of long interval intracortical inhibition on short interval intracortical inhibition, likely representing presynpatic inhibition in the motor cortex, is decreased in Parkinson disease and may be a nondopaminergic feature of the disease. Neurology (R) 2009; 72: 842-849