Increased pre-SMA activation in early PD patients during simple self-initiated hand movements

The slowness of movement, termed bradykinesia, is one of the main symptoms of Parkinson's disease (PD). This symptom may be due to the inability of PD patients to maximise the speed of internally driven movements. The mesial premotor areas and in particular the pre-supplementary motor area (pre-SMA) seem to play a crucial role in the temporal initiation of movements in humans and animals. However, this activation seems to be debatable in imaging studies of PD patients. We performed a motor paradigm with temporally self-initiated movements in nine de novo PD patients before and after initiation of dopaminergic medication. The main finding was an increased activation of the pre-SMA in de novo PD patients compared with healthy age-matched control subjects. This result indicates the contribution of the pre-SMA in the temporal initiation of self-generated movements and in the disease pathology of PD. Increased bilateral activation of the superior cerebellum, mainly on the ipsilateral side, and a decreased activation of the ipsilateral inferior cerebellum in PD patients were also present. These findings provide new insights into the activation pattern of the cerebellum in PD patients.