Subthalamic deep brain stimulation and dopaminergic medication in Parkinson’s disease: Impact on inter-limb coupling

• STN DBS improves bimanual movement performance in Parkinson’s disease (PD).
• Dopaminergic medication improves bimanual performance in PD.
• PD patients exhibit normal temporal inter-limb coupling but lack spatial inter-limb coupling.
• Neither dopaminergic medication nor STN DBS alters temporal inter-limb coupling in PD patients.
• Dopaminergic medication and STN DBS do not restore spatial inter-limb coupling in PD patients.

Patients with Parkinson’s disease (PD) often present with bimanual coordination deficits whose exact origins remain unclear. One aspect of bimanual coordination is inter-limb coupling. This is characterized by the harmonization of movement parameters between limbs. We assessed different aspects of bimanual coordination in patients with PD, including inter-limb coupling, and determined whether they are altered by subthalamic (STN) deep brain stimulation (DBS) or dopaminergic medication. Twenty PD patients were tested before STN DBS surgery; with and without medication. Post- surgery, patients were tested with their stimulators on and off as well as with and without medication. Patients were asked to perform a unimanual and bimanual rapid repetitive diadochokinesis task. The difference in mean amplitude and mean duration of cycles between hands was computed in order to assess inter-limb coupling. Also, mean angular velocity of both hands and structural coupling were computed for the bimanual task. There was a positive effect of medication and stimulation on mean angular velocity, which relates to clinical improvement. PD patients exhibited temporal inter-limb coupling that was not altered by either medication or STN stimulation. However, PD patients did not exhibit spatial inter-limb coupling. Again, this was not altered by medication or stimulation. Collectively, the results suggest that structures independent of the dopaminergic system and basal ganglia may mediate temporal and spatial inter-limb coupling.