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Review Article
The Supplementary Motor Complex in Parkinson’s Disease
Shervin Rahimpour, Shashank Rajkumar, Mark Hallett
J Mov Disord. 2022;15(1):21-32.   Published online November 25, 2021
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  • 379 Download
  • 6 Web of Science
  • 8 Crossref
AbstractAbstract PDF
Parkinson’s disease (PD) is a neurodegenerative disorder characterized by both motor and nonmotor symptoms. Although the basal ganglia is traditionally the primary brain region implicated in this disease process, this limited view ignores the roles of the cortex and cerebellum that are networked with the basal ganglia to support motor and cognitive functions. In particular, recent research has highlighted dysfunction in the supplementary motor complex (SMC) in patients with PD. Using the PubMed and Google Scholar search engines, we identified research articles using keywords pertaining to the involvement of the SMC in action sequencing impairments, temporal processing disturbances, and gait impairment in patients with PD. A review of abstracts and full-text articles was used to identify relevant articles. In this review of 63 articles, we focus on the role of the SMC in PD, highlighting anatomical and functional data to create new perspectives in understanding clinical symptoms and, potentially, new therapeutic targets. The SMC has a nuanced role in the pathophysiology of PD, with both hypo- and hyperactivation associated with various symptoms. Further studies using more standardized patient populations and functional tasks are needed to more clearly elucidate the role of this region in the pathophysiology and treatment of PD.


Citations to this article as recorded by  
  • Libet’s legacy: A primer to the neuroscience of volition
    Tomáš Dominik, Alfred Mele, Aaron Schurger, Uri Maoz
    Neuroscience & Biobehavioral Reviews.2024; 157: 105503.     CrossRef
  • Neural correlates of fine motor grasping skills: Longitudinal insights into motor cortex activation using fNIRS
    Xiaoli Li, Minxia Jin, Nan Zhang, Wei Hongman, LianHui Fu, Qi Qi
    Brain and Behavior.2024;[Epub]     CrossRef
  • Affection of Motor Network Regions by Tau Pathology Across the Alzheimer's Disease Spectrum
    Gérard N. Bischof, Elena Jaeger, Kathrin Giehl, Merle C. Hönig, Peter H. Weiss, Alexander Drzezga
    eneuro.2024; 11(1): ENEURO.0242-23.2023.     CrossRef
  • Parkinson’s Disease Risk Variant rs9638616 is Non-Specifically Associated with Altered Brain Structure and Function
    Thomas Welton, Thomas Wei Jun Teo, Ling Ling Chan, Eng-King Tan, Louis Chew Seng Tan
    Journal of Parkinson's Disease.2024; : 1.     CrossRef
  • Sensorimotor network connectivity correlates with motor improvement after repetitive transcranial magnetic stimulation in patients with Parkinson's disease
    Shumei Chi, Xinrui Wen, Yang Yu, Guanjun Wang, Jie Zhang, Chuang Xue, Xiaoying Zhang, Zheng Wang, Meiduo Gesang, Jiefang Chen, Sha Wu, Man Jin, Jian Liu, Benyan Luo
    Parkinsonism & Related Disorders.2023; 106: 105218.     CrossRef
  • Impaired topological properties of cortical morphological brain networks correlate with motor symptoms in Parkinson's disease
    Su Yan, Jun Lu, Yuanhao Li, Tian Tian, Yiran Zhou, Hongquan Zhu, Yuanyuan Qin, Wenzhen Zhu
    Journal of Neuroradiology.2023;[Epub]     CrossRef
  • A new model for freedom of movement using connectomic analysis
    Diego Alonzo Rodríguez-Méndez, Daniel San-Juan, Mark Hallett, Chris G. Antonopoulos, Erick López-Reynoso, Ricardo Lara-Ramírez
    PeerJ.2022; 10: e13602.     CrossRef
  • Cortical and subcortical morphological alterations in motor subtypes of Parkinson’s disease
    Jianyu Li, Yuanchao Zhang, Zitong Huang, Yihan Jiang, Zhanbing Ren, Daihong Liu, Jiuquan Zhang, Roberta La Piana, Yifan Chen
    npj Parkinson's Disease.2022;[Epub]     CrossRef
Brief communication
Effectiveness of Exercise on the Sequence Effect in Parkinson’s Disease
Suk Yun Kang, Young Ho Sohn
J Mov Disord. 2020;13(3):213-217.   Published online August 31, 2020
  • 5,044 View
  • 143 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
To determine the benefits of motor training on the sequence effect (SE), an essential component of bradykinesia in Parkinson’s disease (PD).
Seven patients with de novo PD participated in this study. The patients performed regular pentagon drawing tests and exercises during four visits. The first two visits occurred before the start of medication, and the last two visits occurred at least six months after the start of medication. We assessed the severity of bradykinesia and SE at each visit and compared the results before and after exercise in both the de novo and treatment conditions.
In the de novo condition, the severity of bradykinesia significantly improved after motor training (p = 0.018), but it did not resolve and only showed a trend of improvement after treatment (p = 0.068). The severity of the SE decreased significantly in the drug-naïve condition (p = 0.028) but not after medication (p = 0.273).
Our study suggests that regular motor training may be beneficial for the SE in PD.


Citations to this article as recorded by  
  • Exploring the Complex Phenotypes of Impaired Finger Dexterity in Mild-to-moderate Stage Parkinson’s Disease: A Time-Series Analysis
    Pattamon Panyakaew, Kotchakorn Duangjino, Apiwoot Kerddonfag, Teerit Ploensin, Krerk Piromsopa, Chanon Kongkamol, Roongroj Bhidayasiri
    Journal of Parkinson's Disease.2023; 13(6): 975.     CrossRef
  • The Effects of Intensive Neurorehabilitation on Sequence Effect in Parkinson's Disease Patients With and Without Freezing of Gait
    Alessia Putortì, Michele Corrado, Micol Avenali, Daniele Martinelli, Marta Allena, Silvano Cristina, Valentina Grillo, Luca Martinis, Stefano Tamburin, Mariano Serrao, Antonio Pisani, Cristina Tassorelli, Roberto De Icco
    Frontiers in Neurology.2021;[Epub]     CrossRef
Original Article
The Sequence Effect in De Novo Parkinson’s Disease
Suk Yun Kang, Toshiaki Wasaka, Ejaz A. Shamim, Sungyoung Auh, Yoshino Ueki, Nguyet Dang, Mark Hallett
J Mov Disord. 2011;4(1):38-40.
  • 12,993 View
  • 57 Download
  • 12 Crossref
AbstractAbstract PDF
Background and Purpose

The sequence effect (SE) in Parkinson’s disease (PD) denotes progressive slowness in speed or progressive decrease in amplitude of repetitive movements. It is a well-known feature of bradykinesia and is considered unique in PD. Until now, it was well-documented in advanced PD, but not in drug-naïve PD. The aim of this study is to know whether the SE can also be measured in drug-naïve PD.


We measured the SE with a computer-based, modified Purdue pegboard in 4 drug-naïve PD patients, which matched our previous study with advanced PD patients.


We observed progressive slowness during movement, that is, SE. Statistical analysis showed a strong statistical trend toward the SE with the right hand, but no significance with the left hand. There was no statistical significance of SE with either the more or less affected hands.


These results indicate that the SE can be identified in drug-naïve PD, as well as in advanced PD, with objective measurements and support the idea that the SE is a feature in PD observed during the early stage of the disease without medication.


Citations to this article as recorded by  
  • Bradykinesia in Neurodegenerative Disorders: A Blinded Video Analysis of Pathology‐Proven Cases
    Luca Marsili, Kevin R. Duque, Nathan Gregor, Elhusseini Abdelghany, Jesus Abanto, Andrew P. Duker, Matthew C. Hagen, Alberto J. Espay, Matteo Bologna
    Movement Disorders.2023; 38(3): 496.     CrossRef
  • The Sequence Effect Worsens Over Time in Parkinson’s Disease and Responds to Open and Closed-Loop Subthalamic Nucleus Deep Brain Stimulation
    Yasmine M. Kehnemouyi, Matthew N. Petrucci, Kevin B. Wilkins, Jillian A. Melbourne, Helen M. Bronte-Stewart
    Journal of Parkinson's Disease.2023; 13(4): 537.     CrossRef
  • Neurofeedback-guided kinesthetic motor imagery training in Parkinson’s disease: Randomized trial
    Sule Tinaz, Serageldin Kamel, Sai S. Aravala, Mohamed Elfil, Ahmed Bayoumi, Amar Patel, Dustin Scheinost, Rajita Sinha, Michelle Hampson
    NeuroImage: Clinical.2022; 34: 102980.     CrossRef
  • The Pathophysiological Correlates of Parkinson's Disease Clinical Subtypes
    Daniele Belvisi, Andrea Fabbrini, Maria Ilenia De Bartolo, Matteo Costanzo, Nicoletta Manzo, Giovanni Fabbrini, Giovanni Defazio, Antonella Conte, Alfredo Berardelli
    Movement Disorders.2021; 36(2): 370.     CrossRef
  • The Effects of Intensive Neurorehabilitation on Sequence Effect in Parkinson's Disease Patients With and Without Freezing of Gait
    Alessia Putortì, Michele Corrado, Micol Avenali, Daniele Martinelli, Marta Allena, Silvano Cristina, Valentina Grillo, Luca Martinis, Stefano Tamburin, Mariano Serrao, Antonio Pisani, Cristina Tassorelli, Roberto De Icco
    Frontiers in Neurology.2021;[Epub]     CrossRef
  • Evolving concepts on bradykinesia
    Matteo Bologna, Giulia Paparella, Alfonso Fasano, Mark Hallett, Alfredo Berardelli
    Brain.2020; 143(3): 727.     CrossRef
  • Effectiveness of Exercise on the Sequence Effect in Parkinson’s Disease
    Suk Yun Kang, Young Ho Sohn
    Journal of Movement Disorders.2020; 13(3): 213.     CrossRef
  • Neurophysiological correlates of bradykinesia in Parkinson’s disease
    Matteo Bologna, Andrea Guerra, Giulia Paparella, Laura Giordo, Danilo Alunni Fegatelli, Anna Rita Vestri, John C Rothwell, Alfredo Berardelli
    Brain.2018; 141(8): 2432.     CrossRef
  • Insula as the Interface Between Body Awareness and Movement: A Neurofeedback-Guided Kinesthetic Motor Imagery Study in Parkinson’s Disease
    Sule Tinaz, Kiran Para, Ana Vives-Rodriguez, Valeria Martinez-Kaigi, Keerthana Nalamada, Mine Sezgin, Dustin Scheinost, Michelle Hampson, Elan D. Louis, R. Todd Constable
    Frontiers in Human Neuroscience.2018;[Epub]     CrossRef
  • Sequence Effect in Parkinson’s Disease Is Related to Motor Energetic Cost
    Sule Tinaz, Ajay S. Pillai, Mark Hallett
    Frontiers in Neurology.2016;[Epub]     CrossRef
  • Bradykinesia in early and advanced Parkinson's disease
    Matteo Bologna, Giorgio Leodori, Paola Stirpe, Giulia Paparella, Donato Colella, Daniele Belvisi, Alfonso Fasano, Giovanni Fabbrini, Alfredo Berardelli
    Journal of the Neurological Sciences.2016; 369: 286.     CrossRef
  • Neural correlates of progressive reduction of bradykinesia in de novo Parkinson's disease
    Eeksung Lee, Ji Eun Lee, Kwangsun Yoo, Jin Yong Hong, Jungsu Oh, Mun Kyung Sunwoo, Jae Seung Kim, Yong Jeong, Phil Hyu Lee, Young Ho Sohn, Suk Yun Kang
    Parkinsonism & Related Disorders.2014;[Epub]     CrossRef

JMD : Journal of Movement Disorders