Systemic effects of deep brain stimulation on synergic control in Parkinson's disease

Abstract Objective We explored effects of deep brain stimulation (DBS) in patients with Parkinson’s disease (PD) on the synergic control of fingers in a multi-finger force production task and of muscles in a task involving vertical posture. Methods The finger task involved the four fingers of a hand producing accurate total force followed by a targeted quick force pulse. The postural task involved releasing a load from extended arms. The analysis of synergies was performed within the framework of the uncontrolled manifold hypothesis. Results DBS led to no significant changes in indices of stability during steady-state phases. In contrast, DBS improved indices of agility, quantified as anticipatory synergy adjustments that reduced stability of salient performance variables in preparation to their quick change. There were moderate-to-strong correlations between indices of both stability and agility measured in the multi-finger force production and multi-muscle whole-body action. Conclusions Our results point at systemic changes in synergic control in PD. They show that DBS is effective in improving only one components of synergic control related to agility in performance being relatively ineffective for the stability component. Significance The results show systemic brain mechanisms of synergies and suggest differential effects of DBS on indices of stability and agility.