Gleichgewichtsstörungen und Stürze gehören zu den wichtigsten Symptomen der Parkinson Krankheit (PD). Bei jungen PD-Patienten werden diese Probleme durch Nebenwirkungen der Medikation zusätzlich verstärkt. Aufgrund des noch sehr limitierten Verständnisses der zugrunde liegenden Mechanismen, die zum erhöhten Sturzrisiko bei jungen PD-Patienten beitragen, mangelt es derzeit an alternativen und effektiven bewegungsbasierten Therapien, um diese Sturzgefahr zu verringern. Diese Arbeit zielt darauf ab, solche Mechanismen zu identifizieren und eine effektive Methode zur Früherkennung des Sturzrisikos bei jungen PD-Patienten zu entwickeln. Es wurde der Beitrag der zentralen und peripheren neuromuskulären sowie sensomotorischen Fähigkeiten, dynamischen Stabilitätskontrolle und Anpassungsfähigkeit der Fortbewegung auf die Sturzrate junger PD-Patienten mittels eines Vergleichs zwischen gesunden Probanden und jungen PD-Patienten mit und ohne Sturzerfahrung (Fallers vs. Non-Fallers) untersucht. Der Vergleich zeigte, dass die PD-Fallers zentral begründete Defizite in der Muskelkraft ihrer Beinstrecker aufwiesen sowie eine verringerte Abfangleistung nach simulierten Vorwärtsstürzen. Die Parameter „Muskelkraft“ und „Annäherung an die vordere Stabilitätsgrenze“ identifizieren gemeinsam 90% der Fälle junger PD-Faller. PD-Patienten zeigten auch eine uneingeschränkte prädiktive Anpassungsfähigkeit auf Gangstörungen, aber ein weniger stabiles Gangmuster und weniger effektive reaktive Antworten auf wiederholte Gangstörungen im Vergleich zu Kontrollpersonen. Diese Arbeit stellt relevante Informationen dar, die für die Entwicklung von alternativen nicht-medikamentösen Therapien zur Reduzierung des Sturzrisikos bei jungen PD-Patienten nützlich sind. Darüber hinaus wurde eine akkurate Methode zur Früherkennung von jungen PD-Patienten mit einem erhöhen Sturzrisiko erarbeitet. Diese Patienten könnten von Training der Beinstrecker und der dynamischen Stabilität profitieren. / Postural instability and falls are some of the main symptoms associated with the Parkinson`s disease (PD). In early-onset patients (diagnosed before the age of 51) these problems are worsened by medication-related side-effects. There is a lack of effective exercise-based training interventions to reduce the risk of falling due to our limited understanding of the underlying mechanisms contributing to falls in early-onset PD. The present thesis aims to identify those mechanisms responsible for falls and to develop a sensitive method of assessment for the early discrimination of patients at risk of falling in early-onset PD. We investigated the contribution of central and peripheral neuromuscular and sensory-motor capacities, dynamic stability control and locomotor adaptability to the increased risk of falling in young PD patients by means of comparing healthy controls and early-onset PD fallers and non-fallers. The comparison revealed that PD fallers have central originated deficits in leg extensors` muscle strength - evidenced by increased antagonistic moments and activation deficit of the agonists - and a reduced increase of the base of support in response to simulated forward falls, both resulting in decreased recovery performance. The factors “muscle strength” and “approach to the anterior limit of stability” together could correctly classify 90% of the PD fallers. In addition, while young PD patients showed unaltered predictive adaptability to gait perturbations, they exhibited less stable gait patterns and less effective reactive responses to repeated gait perturbations compared to controls. This thesis provides relevant information for the development of alternative non-medication based therapies aiming to reduce falls in early-onset PD and an accurate assessment tool for the early identification of young patients at a high risk of falling. These patients may benefit from leg-extensors'' strengthening and dynamic stability training.

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Conselho Nacional de Desenvolvimento Científico e Tecnológico / Considering the hypothesis that GABA and oxidative stress are involved in the development of oral movements associated with important neuropathologies, the present study investigated the possible ability of V. officinalis in the prevention of vacuous chewing movements (VCMs) induced by reserpine in rats. Adult male rats were treated with reserpine (1 mg/kg, s.c.) and/or with V. officinalis (in the drinking water). VCMs, locomotor activity and oxidative stress measurements were evaluated. The neuroprotective effect of V. officinalis against iron-induced cell toxicity was investigated in brain cortical slices. Furthermore, we carried out the identification of valeric acid and gallic acid by HPLC in the V. officinalis tincture. Our findings demonstrate that reserpine caused a marked increase on VCMs and the co-treatment with V. officinalis was able to reduce the intensity of VCM. Reserpine did not induce oxidative stress in cerebral structures (cortex, hippocampus, striatum and substantia nigra). However, a significant positive correlation between DCF-oxidation (an estimation of oxidative stress) in the cortex and VCMs (p<0.05) was observed. Moreover, a tendency for a negative correlation between Na+K+- ATPase activity in substantia nigra and the number of VCMs was observed (p= 0.06). In vitro, V. officinalis protected brain cortical slices viability against Fe(II)-induced neurotoxicity. In conclusion, V. officinalis had in vitro and in vivo neuroprotective effects in rats, i.e., reduced Fe(II) neurotoxicity and reserpine-induced VCMs, probably via modulation of oxidative stress in specific brain nucleus and its GABA-mimetic action. However, the mechanisms involved in this protective activity needs to further investigated to better understand the action of V. officinalis. / Considerando as hipóteses do papel da neurotransmissão gabaérgica e do estresse oxidativo no desenvolvimento de movimentos orais associados a neuropatologias importantes, o presente estudo investigou a possível habilidade da tintura de V. officinalis na prevenção dos movimentos de mascar no vazio (MMV) induzidos por reserpina em ratos. Os animais foram tratados com reserpina (1 mg/Kg, s.c.) e/ou com V. officinalis (na água de beber). MMV, atividade locomotora e medidas de estresse oxidativo foram avaliadas. O efeito neuroprotetor da V. officinalis contra a toxicidade celular induzida por ferro foi investigada em fatias de córtex cerebral. Além disso, fez-se a identificação do ácido valérico e do ácido gálico por HPLC na tintura de V. officinalis. Os resultados demonstram que a reserpina causou um aumento nos MMV quando comparado com o seu veículo e o co-tratamento com V. officinalis foi capaz de reduzir a intensidade dos MMV. A reserpina não alterou de forma significativa alguns parâmetros de estresse oxidativo analisados nas estruturas do cérebro (córtex, hipocampo, estriado e substantia nigra). Porém, uma correlação positiva entre os níveis de oxidação da DCF (uma estimativa do estresse oxidativo) no cortex e o número de MMV (p<0.05) foi observada. Além disso, foi observada uma tendência a haver uma correlação negativa entre a atividade da Na+/K+- ATPase na substantia nigra e o número de MMV (p= 0.055). In vitro, V. officinalis protegeu as fatias de córtex cerebral contra a neurotoxicidade induzida por ferro. Desta forma, pode-se concluir que a V. officinalis apresentou efeitos neuroprotetores em ratos tanto in vitro quanto in vivo, ou seja, reduziu a neurotoxicidade induzida por ferro e os MMV induzidos por reserpina, provavelmente via modulação do estresse oxidativo em núcleos específicos do cérebro e sua ação gabamimética. Porém, os mecanismos envolvidos nesta atividade protetora necessitam de mais investigações para melhor entender a ação da V. officinalis.