Objective: The aim of this study is to reveal the differences in the effect of brainstem reflexes between the motor subtypes of PD, akinetic rigid(AR) and tremor dominant(TD) groups.

Background: PD is a progressive neurodegenerative disease with motor and non-motor symptoms.Studies have shown that brainstem involvement occurs especially in the early stages of the disease, before substantia nigra degeneration and is mostly associated with non-motor findings.PD has been accepted as a heterogeneous disease in recent years and it is discussed that different pathogenetic mechanisms may be in question in different subtypes.Especially recently, it has been stated that central nervous system(CNS) onset and peripheral nervous system(PNS) onset PD models may cause different motor symptoms and nonmotor symptoms.Vestibular evoked myogenic reflexes(VEMP) is one of the non-invasive, easy-to-apply electrophysiological tests that evaluates all pathways from the cervicobulbar junction to the upper brainstem.In our study, it was aimed to reveal the pathophysiological differences between motor subtypes by examining these VEMP responses in Parkinson’s disease.

Method: Thirty idiopathic Parkinson’s patients(15AR,15TD) and 11 healthy individuals determined according to MDS diagnostic criteria were included in the study.Parkinson’s patients were evaluated with UPDRS in their ten periods under optimal medical treatment, and their UPDRSIII motor scores were determined.A mean global tremor score and a mean score for the complex of postural instability and walking difficulties were calculated when determining motor subtypes.Responses to cVEMP, oVEMp and mVEMP were compared among the groups.

Results: In the AR group; NMS(Nonmotor syptoms scale)scores, vemp abnormal responses and oVEMP abnormal responses were statistically different.When the parametric values such as peak latency, amplitude and amplitude asymmetry ratio between the TD, AR and control groups were examined, no significant difference was found.

Conclusion: As a result of our hypothesis, the significant oVEMP abnormality in the AR group might suggest that the AR lower motor type supports a central-onset(upper brainstem) pathophysiology.Despite this promising emerging evidence for VEMPs in neurodegenerative disorders, there are no specific studies conducted among motor subtypes of PD in the literature.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparison-of-cervical-ocular-and-masseter-vestibular-evoked-myogenic-potentials-in-parkinson-patients-according-to-clinical-subgroups/