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Piepjohn P, Bald C, Kuhlenbäumer G, Becktepe JS, Deuschl G, Schmidt G. Real-time classification of movement patterns of tremor patients. BIOMED ENG-BIOMED TE 2022; 67:119-130. [PMID: 35218686 DOI: 10.1515/bmt-2021-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 01/27/2022] [Indexed: 11/15/2022]
Abstract
The process of diagnosing tremor patients often leads to misdiagnoses. Therefore, existing technical methods for analysing tremor are needed to more effectively distinguish between different diseases. For this purpose, a system has been developed that classifies measured tremor signals in real time. To achieve this, the hand tremor of 561 subjects has been measured in different hand positions. Acceleration and surface electromyography are recorded during the examination. For this study, data from subjects with Parkinson's Disease, Essential Tremor, and physiological tremor are considered. In a first signal analysis feature extraction is performed, and the resulting features are examined for their discriminative value. In a second step, three classification models based on different pattern recognition techniques are developed to classify the subjects with respect to their tremor type. With a trained decision tree, the three tremor types can be classified with a relative diagnostic accuracy of 83.14%. A neural network achieves 84.24% and the combination of both classifiers yields a relative diagnostic accuracy of 85.76%. The approach is promising and involving more features of the recorded time series will improve the discriminative value.
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Affiliation(s)
- Patricia Piepjohn
- Faculty of Engineering, Institute of Electrical and Information Engineering, Digital Signal Processing and System Theory, Kiel University, Kiel, Germany
| | - Christin Bald
- Faculty of Engineering, Institute of Electrical and Information Engineering, Digital Signal Processing and System Theory, Kiel University, Kiel, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Gerhard Schmidt
- Faculty of Engineering, Institute of Electrical and Information Engineering, Digital Signal Processing and System Theory, Kiel University, Kiel, Germany
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Fan Y, Shen S, Yang J, Yao D, Li M, Mao C, Wang Y, Hao X, Ma D, Li J, Shi J, Guo M, Li S, Yuan Y, Liu F, Yang Z, Zhang S, Hu Z, Fan L, Liu H, Zhang C, Wang Y, Wang Q, Zheng H, He Y, Song B, Xu Y, Shi C. GIPC1
CGG
repeat expansion is associated with movement disorders. Ann Neurol 2022; 91:704-715. [PMID: 35152460 DOI: 10.1002/ana.26325] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Yu Fan
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Academy of Medical Sciences of Zhengzhou University Zhengzhou 450000 Henan China
| | - Si Shen
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
| | - Jing Yang
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Henan Key Laboratory of Cerebrovascular Diseases The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450,000 Henan China
- The Henan Medical Key Laboratory of Hereditary Neurodegenerative Diseases The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
| | - Dabao Yao
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
| | - Mengjie Li
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
| | - Chengyuan Mao
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Henan Key Laboratory of Cerebrovascular Diseases The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450,000 Henan China
| | - Yunchao Wang
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Henan Key Laboratory of Cerebrovascular Diseases The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450,000 Henan China
| | - Xiaoyan Hao
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
| | - Dongrui Ma
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
| | - Jiadi Li
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Academy of Medical Sciences of Zhengzhou University Zhengzhou 450000 Henan China
| | - Jingjing Shi
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
| | - Mengnan Guo
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
| | - Shuangjie Li
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
| | - Yanpeng Yuan
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Henan Key Laboratory of Cerebrovascular Diseases The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450,000 Henan China
| | - Fen Liu
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Academy of Medical Sciences of Zhengzhou University Zhengzhou 450000 Henan China
| | - Zhihua Yang
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Academy of Medical Sciences of Zhengzhou University Zhengzhou 450000 Henan China
| | - Shuo Zhang
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Academy of Medical Sciences of Zhengzhou University Zhengzhou 450000 Henan China
| | - Zhengwei Hu
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Academy of Medical Sciences of Zhengzhou University Zhengzhou 450000 Henan China
| | - Liyuan Fan
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Academy of Medical Sciences of Zhengzhou University Zhengzhou 450000 Henan China
| | - Han Liu
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Henan Key Laboratory of Cerebrovascular Diseases The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450,000 Henan China
| | - Chan Zhang
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Henan Key Laboratory of Cerebrovascular Diseases The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450,000 Henan China
| | - Yanlin Wang
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Henan Key Laboratory of Cerebrovascular Diseases The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450,000 Henan China
| | - Qingzhi Wang
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Henan Key Laboratory of Cerebrovascular Diseases The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450,000 Henan China
| | - Hong Zheng
- Department of Cell Biology and Medical Genetics Basic Medical College of Zhengzhou University Zhengzhou 450052 Henan China
| | - Ying He
- Department of Cell Biology and Medical Genetics Basic Medical College of Zhengzhou University Zhengzhou 450052 Henan China
| | - Bo Song
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Henan Key Laboratory of Cerebrovascular Diseases The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450,000 Henan China
- Institute of Neuroscience Zhengzhou University Zhengzhou 450000 Henan China
- The Key Laboratory of Cerebrovascular Diseases Prevention and Treatment The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
| | - Yuming Xu
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Henan Key Laboratory of Cerebrovascular Diseases The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450,000 Henan China
- Institute of Neuroscience Zhengzhou University Zhengzhou 450000 Henan China
- The Henan Medical Key Laboratory of Hereditary Neurodegenerative Diseases The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- The Key Laboratory of Cerebrovascular Diseases Prevention and Treatment The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
| | - Changhe Shi
- Department of Neurology The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- Henan Key Laboratory of Cerebrovascular Diseases The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450,000 Henan China
- Institute of Neuroscience Zhengzhou University Zhengzhou 450000 Henan China
- The Henan Medical Key Laboratory of Hereditary Neurodegenerative Diseases The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
- The Key Laboratory of Cerebrovascular Diseases Prevention and Treatment The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou 450000 Henan China
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Chang SJ, Mitchell R, Hukin J, Singhal A. Treatment-responsive Holmes tremor in a child with low-pressure hydrocephalus: video case report and systematic review of the literature. J Neurosurg Pediatr 2022; 29:520-527. [PMID: 35148507 DOI: 10.3171/2021.12.peds21539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Holmes tremor (HT) is a rare and debilitating movement disorder comprising both rest and action tremor, and it is known for its resistance to treatment. Its most common causes include ischemic or hemorrhagic insults and trauma. Mechanistically, the combined rest and action tremor is thought to require a double lesion of both the dopaminergic nigrostriatal system and the dentatorubrothalamic pathways, often near the midbrain where both pathways converge. The aim of this study was to characterize HT as a presenting sign in cases of hydrocephalus and to discuss potential pathomechanisms, clinical presentations, and treatment options. METHODS MEDLINE and Web of Science were searched for cases of HT with hydrocephalus from database inception to August 2021, and these were compiled along with the authors' own unique case of treatment-responsive HT in a child with low-pressure obstructive hydrocephalus secondary to a tectal tumor. Patient characteristics, presenting signs/symptoms, potential precipitating factors, interventions, and patient outcomes were recorded. RESULTS Nine patients were identified including the authors' video case report. All patients had a triventriculomegaly pattern with at least a component of obstructive hydrocephalus, and 4 patients were identified as having low-pressure hydrocephalus. Parinaud's syndrome and bradykinesia were the most commonly associated signs. Levodopa and CSF diversion were the most commonly used and effective treatments for HT in this population. This review was not registered and did not receive any funding. CONCLUSIONS HT is a poorly understood and probably underrecognized presentation of hydrocephalus that is difficult to treat, limiting the strength of the evidence in this review. Treatment options include CSF diversion, antiparkinsonian agents, antiepileptic agents, deep brain stimulation, and MR-guided focused ultrasound, and aim toward the nigrostriatal and dentatorubrothalamic pathways hypothesized to be involved in its pathophysiology.
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Affiliation(s)
- Stephano J Chang
- 1Division of Neurosurgery, Department of Surgery, University of British Columbia
| | - Ruth Mitchell
- 2Faculty of Medicine and the Division of Neurosurgery, University of British Columbia and British Columbia Children's Hospital; and
| | - Juliette Hukin
- 3Divisions of Neurology and Hematology/Oncology/Bone Marrow Transplant, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Ash Singhal
- 2Faculty of Medicine and the Division of Neurosurgery, University of British Columbia and British Columbia Children's Hospital; and
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54
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Kvernmo N, Konglund AE, Reich MM, Roothans J, Pripp AH, Dietrichs E, Volkmann J, Skogseid IM. Deep brain stimulation for arm tremor: A randomized trial comparing two targets. Ann Neurol 2022; 91:585-601. [PMID: 35148020 PMCID: PMC9311445 DOI: 10.1002/ana.26317] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/14/2022] [Accepted: 02/07/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (VIM) effectively suppresses arm tremor. Uncontrolled studies suggest the posterior subthalamic area (PSA) may be superior. We compared the intra-individual efficacy of VIM- versus PSA-DBS on tremor suppression and arm function. METHODS We performed a randomized, double-blind, crossover trial at Oslo University Hospital in patients (18-80 years) with isolated or combined action tremor affecting at least one arm. Four-contact DBS leads were implanted (bi- or unilaterally) with a trajectory to cover the VIM (upper two contacts) and PSA (lower two contacts). Patients were randomized (1:1 ratio) post-surgery to: Group 1, VIM-stimulation months 0-3 (period 1), then PSA-stimulation months 4-6 (period 2); Group 2, PSA-stimulation first, then VIM-stimulation. Primary endpoint was the difference in improvement from baseline to the end of the VIM- versus PSA-period in the sum of the dominant arm tremor scores of the Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS), items 5/6 + 10-14. RESULTS Forty-five patients were randomized to Group 1 (n = 23) or 2 (n = 22). In the primary endpoint per-protocol analysis (mixed model, n = 40), mean difference in the sum FTMTRS score improvement for the dominant arm was -2.65 points (95% CI -4.33 to -0.97; p = 0.002). The difference in favour of PSA stimulation was highly significant in period 2, but not period 1. INTERPRETATION Our randomized trial demonstrated that PSA stimulation provided superior tremor suppression compared with VIM stimulation. A period effect reducing tremor for up to three months in both groups was most likely attributed to a post-surgery stun effect. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Nadja Kvernmo
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Norway
| | - Ane E Konglund
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Martin M Reich
- Department of Neurology, University Hospital of Wuerzburg, Wuerzburg, Germany.,Visual DBS lab, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Jonas Roothans
- Visual DBS lab, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Are H Pripp
- Department of Biostatistics, Oslo University Hospital, Oslo, Norway
| | - Espen Dietrichs
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Norway
| | - Jens Volkmann
- Department of Neurology, University Hospital of Wuerzburg, Wuerzburg, Germany.,Institute of Clinical Medicine, University of Wuerzburg, Germany
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55
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Meng L, Jin M, Zhu X, Ming D. Peripherical Electrical Stimulation for Parkinsonian Tremor: A Systematic Review. Front Aging Neurosci 2022; 14:795454. [PMID: 35197841 PMCID: PMC8859162 DOI: 10.3389/fnagi.2022.795454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
Parkinsonian tremor is one of the most common motor disorders in patients with Parkinson's disease (PD). Compared to oral medications and brain surgery, electrical stimulation approaches have emerged as effective and non-invasive methods for tremor reduction. The pathophysiology, detection and interventions of tremors have been introduced, however, a systematic review of peripherical electrical stimulation approaches, methodologies, experimental design and clinical outcomes for PD tremor suppression is still missing. Therefore, in this paper, we summarized recent studies on electrical stimulation for tremor suppression in PD patients and discussed stimulation protocols and effectiveness of different types of electrical stimulation approaches in detail. Twenty out of 528 papers published from 2010 to 2021 July were reviewed. The results show that electrical stimulation is an efficient intervention for tremor suppression. The methods fall into three main categories according to the mechanisms: namely functional electrical stimulation (FES), sensory electrical stimulation (SES) and transcutaneous electrical nerve stimulation (TENS). The outcomes of tremor suppression were varied due to various stimulation approaches, electrode locations and stimulation parameters. The FES method performed the best in tremor attenuation where the efficiency depends mainly by the control strategy and accuracy of tremor detection. However, the mechanism underlying tremor suppression with SES and TENS, is not well-known. Current electrical stimulation approaches may only work for a number of patients. The potential mechanism of tremor suppression still needs to be further explored.
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Affiliation(s)
- Lin Meng
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Mengyue Jin
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Xiaodong Zhu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Xiaodong Zhu
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- Department of Biomedical Engineering, Tianjin University, Tianjin, China
- *Correspondence: Dong Ming
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Everlo CS, Elting JWJ, Tijssen MA, van der Stouwe AM. Electrophysiological testing aids the diagnosis of tremor and myoclonus in clinically challenging patients. Clin Neurophysiol Pract 2022; 7:51-58. [PMID: 35243186 PMCID: PMC8867002 DOI: 10.1016/j.cnp.2021.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/07/2021] [Accepted: 12/17/2021] [Indexed: 01/01/2023] Open
Abstract
Objective We investigated how clinical neurophysiological testing can help distinguish tremor and myoclonus and their subtypes. Methods We retrospectively analysed clinical and neurophysiological data from patients who had undergone polymyography (EMG + accelerometry) to diagnose suspected tremor or myoclonus. We show a systematic approach, which includes contraction pattern, rhythm regularity, burst duration and evidence of cortical drive. Results We detected 773 patients in our database, of which 556 patients were ultimately diagnosed with tremor (enhanced physiological tremor n = 169, functional tremor n = 140, essential tremor n = 90, parkinsonism associated tremor n = 64, cerebellar tremor n = 19, Holmes tremor n = 12, dystonic tremor n = 8, tremor not further specified n = 9), 140 with myoclonus and 23 with a combination of tremor and myoclonus. Polymyography confirmed the presumptive diagnosis in the majority of the patients and led to a change of diagnosis in 287 patients (37%). Conversions between diagnoses of tremor and myoclonus occurred most frequently between enhanced physiological tremor, essential tremor, functional tremor and cortical myoclonus. Conclusions Neurophysiology is a valuable additional tool in clinical practice to differentiate between tremor and myoclonus, and can guide towards a specific subtype. Significance We show how the stepwise neurophysiological approach used at our medical center aids the diagnosis of tremor versus myoclonus.
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Affiliation(s)
- Cheryl S.J. Everlo
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Jan Willem J. Elting
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Marina A.J. Tijssen
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - A.M. Madelein van der Stouwe
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
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Peters J, Motin MA, Perju-Dumbrava L, Ali SM, Ding C, Eller M, Raghav S, Kumar DK, Kempster P. Computerised analysis of writing and drawing by essential tremor phenotype. BMJ Neurol Open 2022; 3:e000212. [PMID: 34988457 PMCID: PMC8679070 DOI: 10.1136/bmjno-2021-000212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/16/2021] [Indexed: 11/04/2022] Open
Abstract
We investigated whether computerised analysis of writing and drawing could discriminate essential tremor (ET) phenotypes according to the 2018 Consensus Statement on the Classification of Tremors. The Consensus scheme emphasises soft additional findings, mainly motor, that do not suffice to diagnose another tremor syndrome. Ten men and nine women were classified by blinded assessors according to Consensus Axis 1 definitions of ET and ET plus. Blinded scoring of tremor severity and alternating limb movement was also conducted. Twenty healthy participants acted as controls. Four writing and three drawing tasks were performed on a Wacom Intuos Pro Large digital tablet with a pressure-sensor mounted ink pen. Sixty-seven computerised measurements were obtained, comprising static (dimensional and temporal), kinematic and pen pressure features. The mean age of ET participants was 67.2±13.0 years and mean tremor duration was 21.7±19.0 years. Six were classified as ET, five had one plus feature and eight had two plus features. The computerised analysis could predict the presence and number of ET plus features. Measures of acceleration and variation of pen pressure performed strongly to separate ET phenotypes (p<0.05). Plus features were associated with higher scores on the Fahn-Tolosa-Marin Tremor Rating Scale (p=0.001) and it appeared that ET groups were mainly being separated according to severity of tremor and by compensatory manoeuvres used by participants with more severe tremor. There were, in addition, a small number of negative kinematic correlations suggesting some slowness with ET plus. Abnormal repetitive limb movement was also correlated with tremor severity (R=0.57) by clinical grading. Critics of the Consensus Statement have drawn attention to weaknesses of the ET plus concept in relation to duration and severity of ET. This classification of ET may be too biased towards tremor severity to assist in distinguishing underlying biological differences by clinical measurement.
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Affiliation(s)
- James Peters
- Neurosciences Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Mohammod Abdul Motin
- Department of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, Australia.,Department of Electrical and Electronic Engineering, Rajshahi University of Engineering and Technology, Kazla, Bangladesh
| | | | - Sheik Mohammed Ali
- Department of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, Australia
| | - Catherine Ding
- Neurosciences Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Michael Eller
- Neurosciences Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Sanjay Raghav
- Neurosciences Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Dinesh Kant Kumar
- Department of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, Australia
| | - Peter Kempster
- Neurosciences Department, Monash Medical Centre, Clayton, Victoria, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
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Mahendran S, Bichsel O, Gassert R, Baumann CR, Imbach LL, Waldvogel D. Differentiation of Parkinson’s disease tremor and essential tremor based on a novel hand posture. Clin Park Relat Disord 2022; 7:100146. [PMID: 35647517 PMCID: PMC9136132 DOI: 10.1016/j.prdoa.2022.100146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Tremor is one of the most common movement disorders but the correct diagnosis of tremor disorders, especially the differentiation between Parkinson’s disease tremor (PT) and essential tremor (ET) remains a challenge for clinicians. Method We examined a novel hand position to distinguish PT from ET. We prospectively collected accelerometric tremor data in 14 ET patients and 14 PT patients with arms and hands fully stretched against arms stretched and hands relaxed, i. e. hanging down. The total acceleration from the three pairwise-perpendicular accelerometric axes during the 1-minute blocks of the two hand positions were computed and high-passed filtered at 2 Hz. The power spectral density during each hand position was calculated and summed up over the frequency domain. Results Our results showed a significantly higher occurrence of tremor in the hands hanging down position in PT patients compared to ET patients (p = 0.0262). Moreover, in PT patients the tremor intensity significantly increased when transitioning from the stretched hand position to the hanging-down position (83 % of cohort) and vice versa in ET patients (75 % of cohort). Conclusion In conclusion, the new hand posture can differentiate between PT and ET with high accuracy (sensitivity 83 %, specificity 75 % for PT) and may be a helpful tool in the clinical assessment of tremor.
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Liatis T, Gutierrez‐Quintana R, Mari L, Czopowicz M, Polidoro D, Bhatti SFM, Cozzi F, Tirrito F, Brocal J, José‐López R, Kaczmarska A, Cappello R, Harris G, Alves L, Rusbridge C, Rossmeisl JH. Primary orthostatic tremor and orthostatic tremor-plus in dogs: 60 cases (2003-2020). J Vet Intern Med 2022; 36:179-189. [PMID: 34897811 PMCID: PMC8783359 DOI: 10.1111/jvim.16328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Orthostatic tremor (OT) is a rare movement disorder characterized by high-frequency (>12 Hz) involuntary, rhythmic, sinusoidal movements affecting predominantly the limbs while standing. OBJECTIVE To describe the signalment, presenting complaints, phenotype, diagnostic findings, treatment, and outcome of a large sample of dogs with OT. ANIMALS Sixty dogs diagnosed with OT based on conscious electromyography. METHODS Multicenter retrospective case series study. Dogs were included if they had a conscious electromyography consistent with muscle discharge frequency >12 Hz while standing. RESULTS Fifty-three cases were diagnosed with primary OT (POT). Giant breed dogs represented most cases (83%; 44/53). Most dogs (79%; 42/53) were younger than 2 years of age at onset of signs, except for Retrievers which were all older than 3.5 years of age. The most common presenting complaints were pelvic limb tremors while standing (85%; 45/53) and difficulty when rising or sitting down (45%; 24/53). Improvement of clinical signs occurred in most dogs (85%; 45/53) treated medically with phenobarbital, primidone, gabapentin, pregabalin or clonazepam, but it was mostly partial rather than complete. Orthostatic tremor-plus was seen in 7 dogs that had concurrent neurological diseases. CONCLUSIONS AND CLINICAL IMPORTANCE Primary OT is a progressive disease of young, purebred, giant/large-breed dogs, which appears to begin later in life in Retrievers. Primary OT apparently responds partially to medications. Orthostatic tremor-plus exists in dogs and can be concomitant or associated with other neurological diseases.
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Affiliation(s)
- Theofanis Liatis
- Small Animal Hospital, School of Veterinary MedicineUniversity of GlasgowGlasgowUnited Kingdom
| | | | - Lorenzo Mari
- Small Animal Referral CentreAnimal Health TrustNewmarketUnited Kingdom
- Wear ReferralsStockton‐on‐TeesUnited Kingdom
| | - Michał Czopowicz
- Division of Veterinary Epidemiology and EconomicsInstitute of Veterinary Medicine, Warsaw University of Life Sciences—SGGWWarsawPoland
| | - Dakir Polidoro
- Small Animal Teaching Hospital, Small Animal Department, Faculty of Veterinary MedicineGhent UniversityGhentBelgium
| | - Sofie F. M. Bhatti
- Small Animal Teaching Hospital, Small Animal Department, Faculty of Veterinary MedicineGhent UniversityGhentBelgium
| | | | | | - Josep Brocal
- Small Animal Hospital, School of Veterinary MedicineUniversity of GlasgowGlasgowUnited Kingdom
- Wear ReferralsStockton‐on‐TeesUnited Kingdom
| | - Roberto José‐López
- Small Animal Hospital, School of Veterinary MedicineUniversity of GlasgowGlasgowUnited Kingdom
| | - Adriana Kaczmarska
- Small Animal Hospital, School of Veterinary MedicineUniversity of GlasgowGlasgowUnited Kingdom
| | | | - Georgina Harris
- The Queen's Veterinary School Hospital, Department of Veterinary MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Lisa Alves
- The Queen's Veterinary School Hospital, Department of Veterinary MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Clare Rusbridge
- Fitzpatrick Referrals Orthopaedics and NeurologyGodalmingUnited Kingdom
- School of Veterinary MedicineUniversity of SurreyGuilfordUnited Kingdom
| | - John H. Rossmeisl
- Department of Small Animal Clinical Sciences, Virginia‐Maryland College of Veterinary MedicineVirginia Polytechnic Institute and State UniversityBlacksburgVirginiaUSA
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Shi M, Wang A, Fang Y, Guo J, Li Z, Jin S, Zhao H. Study on the pathogenesis of Holmes tremor by multimodal 3D medical imaging: case reports of three patients. BMC Neurol 2021; 21:473. [PMID: 34872506 PMCID: PMC8647471 DOI: 10.1186/s12883-021-02503-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background We examined for the first time the imaging characteristics of Holmes tremor (HT) through multimodal 3D medical imaging. Case presentation Three patients with Holmes tremor who visited the Affiliated Hospital of Chengdu University of TCM from August 2018 to April 2021 were retrospectively investigated to summarize their clinical and imaging data. Results Holmes tremor in two of the three patients was caused by hypertensive cerebral hemorrhage and in the third patient induced by hemorrhage due to ruptured brain arteriovenous malformations. HT occurred 1 to 24 months after the primary disease onset and manifested as a tremor in the contralateral limb, mostly in the upper portion. Cranial MRI showed that the lesions involved the thalamus in all three patients. The damaged thalamic nuclei included the ventral anterior nucleus, ventral lateral nucleus and ventromedial lateral nucleus, and the damaged nerve fibers included left thalamocortical tracts in one patient. In the other two patients, the damaged thalamic nuclei included the centromedian and dorsomedial nucleus, and the damaged nerve fibers included left cerebellothalamic and thalamocortical tracts. One patient showed significant improvement after treatment with pramipexole while the other two patients exhibited a poor response, one of whom had no response to the treatment with pramipexole and was only significantly relieved by clonazepam. Conclusion We used multimodal 3D medical imaging for the first time to analyze the pathogenesis of HT and found that multiple thalamic nuclei were damaged. The damaged nuclei and nerve fiber tracts of two patients were different from those of the third patient, with different clinical manifestations and therapeutic effects. Therefore, it is speculated that there may be multiple pathogeneses for HT.
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Affiliation(s)
- Min Shi
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Sichuan Province, 610072, Chengdu, P R China
| | - Anrong Wang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Sichuan Province, 610072, Chengdu, P R China
| | - Yu Fang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Sichuan Province, 610072, Chengdu, P R China
| | - Jun Guo
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Sichuan Province, 610072, Chengdu, P R China
| | - Zhaoying Li
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Sichuan Province, 610072, Chengdu, P R China
| | - Suoguo Jin
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Sichuan Province, 610072, Chengdu, P R China
| | - Huan Zhao
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Sichuan Province, 610072, Chengdu, P R China.
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Bai Y, Yin Z, Diao Y, Hu T, Yang A, Meng F, Zhang J. Loss of long-term benefit from VIM-DBS in essential tremor: A secondary analysis of repeated measurements. CNS Neurosci Ther 2021; 28:279-288. [PMID: 34866345 PMCID: PMC8739044 DOI: 10.1111/cns.13770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/18/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022] Open
Abstract
AIMS Deep brain stimulation (DBS) in the ventral intermediate nucleus (Vim-DBS) is the preferred surgical therapy for essential tremor (ET). Tolerance and disease progression are considered to be the two main reasons underlying the loss of long-term efficacy of Vim-DBS. This study aimed to explore whether Vim-DBS shows long-term loss of efficacy and to evaluate the reasons for this diminished efficacy from different aspects. METHODS In a repeated-measures meta-analysis of 533 patients from 18 studies, Vim-DBS efficacy was evaluated at ≤6 months, 7-12 months, 1-3 years, and ≥4 years. The primary outcomes were the score changes in different components of the Fahn-Tolosa-Marin Tremor Rating Scale (TRS; total score, motor score, hand-function score, and activities of daily living [ADL] score). Secondary outcomes were the long-term predictive factors. RESULTS The TRS total, motor, and ADL scores showed significant deterioration with disease progression (p = 0.002, p = 0.047, and p < 0.001, respectively), while the TRS total (p < 0.001), hand-function (p = 0.036), and ADL (p = 0.004) scores indicated a significant long-term reduction in DBS efficacy, although the motor subscore indicated no loss of efficacy. Hand-function (p < 0.001) and ADL (p = 0.028) scores indicated DBS tolerance, while the TRS total and motor scores did not. Stimulation frequency and preoperative score were predictive factors for long-term results. CONCLUSION This study provides level 3a evidence that long-term Vim-DBS is effective in controlling motor symptoms without waning benefits. The efficacy reduction for hand function was caused by DBS tolerance, while that for ADL was caused by DBS tolerance and disease progression. More attention should be given to actual functional recovery rather than changes in motor scores in patients with ET.
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Affiliation(s)
- Yutong Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Yu Diao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Tianqi Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Fangang Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
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Gadot R, Shofty B, Najera RA, Anand A, Banks G, Khan AB, LoPresti MA, Vanegas Arroyave N, Sheth SA. Case Report: Dual Target Deep Brain Stimulation With Externalized Programming for Post-traumatic Complex Movement Disorder. Front Neurosci 2021; 15:774073. [PMID: 34819837 PMCID: PMC8606815 DOI: 10.3389/fnins.2021.774073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Movement disorders can be common, persistent, and debilitating sequelae of severe traumatic brain injury. Post-traumatic movement disorders are usually complex in nature, involving multiple phenomenological manifestations, and can be difficult to control with medical management alone. Deep brain stimulation (DBS) has been used to treat these challenging cases, but distorted brain anatomy secondary to trauma can complicate effective targeting. In such cases, use of diffusion tractography imaging and inpatient testing with externalized DBS leads can be beneficial in optimizing outcomes. Case Description: We present the case of a 42-year-old man with severe, disabling post-traumatic tremor who underwent bilateral, dual target DBS to the globus pallidus internus (GPi) and a combined ventral intermediate nucleus of the thalamus (Vim)/dentato-rubro-thalamic tracts (DRTT) target. DRTT fiber tracts were reconstructed preoperatively to assist in surgical targeting given the patient’s distorted anatomy. Externalization and survey of the four leads extra-operatively with inpatient testing allowed for internalization of the leads that demonstrated benefit. Six months after surgery, the patient’s tremor and dystonic burden had decreased by 67% in the performance sub-score of The Essential Tremor Rating Scale (TETRAS). Conclusion: A patient-tailored approach including target selection guided by individualized anatomy and tractography as well as extra-operative externalized lead interrogation was shown to be effective in optimizing clinical outcome in a patient with refractory post-traumatic tremor.
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Affiliation(s)
- Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ricardo A Najera
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Adrish Anand
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Garrett Banks
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, United States
| | - Abdul Basit Khan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Melissa A LoPresti
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | | | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
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Abstract
Essential tremor (ET) is one of the most common movement disorders, with a reported >60 million affected individuals worldwide. The definition and underlying pathophysiology of ET are contentious. Patients present primarily with motor features such as postural and action tremors, but may also have other non-motor features, including cognitive impairment and neuropsychiatric symptoms. Genetics account for most of the ET risk but environmental factors may also be involved. However, the variable penetrance and challenges in validating data make gene-environment analysis difficult. Structural changes in cerebellar Purkinje cells and neighbouring neuronal populations have been observed in post-mortem studies, and other studies have found GABAergic dysfunction and dysregulation of the cerebellar-thalamic-cortical circuitry. Commonly prescribed medications include propranolol and primidone. Deep brain stimulation and ultrasound thalamotomy are surgical options in patients with medically intractable ET. Further research in post-mortem studies, and animal and cell-based models may help identify new pathophysiological clues and therapeutic targets and, together with advances in omics and machine learning, may facilitate the development of precision medicine for patients with ET.
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Li Y, Tao L, Chen H, Wang H, Zhang X, Zhang X, Duan X, Fang Z, Li Q, He W, Lv F, Luo J, Xiao Z, Cao J, Fang W. Identifying Depressed Essential Tremor Using Resting-State Voxel-Wise Global Brain Connectivity: A Multivariate Pattern Analysis. Front Hum Neurosci 2021; 15:736155. [PMID: 34712127 PMCID: PMC8545862 DOI: 10.3389/fnhum.2021.736155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/07/2021] [Indexed: 12/30/2022] Open
Abstract
Background and Objective: Although depression is one of the most common non-motor symptoms in essential tremor (ET), its pathogenesis and diagnosis biomarker are still unknown. Recently, machine learning multivariate pattern analysis (MVPA) combined with connectivity mapping of resting-state fMRI has provided a promising way to identify patients with depressed ET at the individual level and help to reveal the brain network pathogenesis of depression in patients with ET. Methods: Based on global brain connectivity (GBC) mapping from 41 depressed ET, 49 non-depressed ET, 45 primary depression, and 43 healthy controls (HCs), multiclass Gaussian process classification (GPC) and binary support vector machine (SVM) algorithms were used to identify patients with depressed ET from non-depressed ET, primary depression, and HCs, and the accuracy and permutation tests were used to assess the classification performance. Results: While the total accuracy (40.45%) of four-class GPC was poor, the four-class GPC could discriminate depressed ET from non-depressed ET, primary depression, and HCs with a sensitivity of 70.73% (P < 0.001). At the same time, the sensitivity of using binary SVM to discriminate depressed ET from non-depressed ET, primary depression, and HCs was 73.17, 80.49, and 75.61%, respectively (P < 0.001). The significant discriminative features were mainly located in cerebellar-motor-prefrontal cortex circuits (P < 0.001), and a further correlation analysis showed that the GBC values of significant discriminative features in the right middle prefrontal gyrus, bilateral cerebellum VI, and Crus 1 were correlated with clinical depression severity in patients with depressed ET. Conclusion: Our findings demonstrated that GBC mapping combined with machine learning MVPA could be used to identify patients with depressed ET, and the GBC changes in cerebellar-prefrontal cortex circuits not only posed as the significant discriminative features but also helped to understand the network pathogenesis underlying depression in patients with ET.
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Affiliation(s)
- Yufen Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Tao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huiyue Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hansheng Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoyu Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xueyan Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiyue Duan
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhou Fang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wanlin He
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jin Luo
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng Xiao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Cao
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weidong Fang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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65
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Pandey S, Benito-León J, Kuo SH. Editorial: Tremor Syndromes: Current Concepts and Future Perspectives. Front Neurol 2021; 12:752463. [PMID: 34646231 PMCID: PMC8502893 DOI: 10.3389/fneur.2021.752463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Julián Benito-León
- Department of Neurology, University Hospital, Madrid, Spain.,Center for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, United States.,Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, United States
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Phokaewvarangkul O, Vateekul P, Wichakam I, Anan C, Bhidayasiri R. Using Machine Learning for Predicting the Best Outcomes With Electrical Muscle Stimulation for Tremors in Parkinson's Disease. Front Aging Neurosci 2021; 13:727654. [PMID: 34566628 PMCID: PMC8461308 DOI: 10.3389/fnagi.2021.727654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/16/2021] [Indexed: 11/21/2022] Open
Abstract
Recent studies have identified that peripheral stimulation in Parkinson’s disease (PD) is effective in tremor reduction, indicating that a peripheral feedback loop plays an important role in the tremor reset mechanism. This was an open-label, quasi-experimental, pre- and post-test design, single-blind, single-group study involving 20 tremor-dominant PD patients. The objective of this study is to explore the effect of electrical muscle stimulation (EMS) as an adjunctive treatment for resting tremor during “on” period and to identify the best machine learning model to predict the suitable stimulation level that will yield the longest period of tremor reduction or tremor reset time. In this study, we used a Parkinson’s glove to evaluate, stimulate, and quantify the tremors of PD patients. This adjustable glove incorporates a 3-axis gyroscope to measure tremor signals and an EMS to provide an on-demand muscle stimulation to suppress tremors. Machine learning models were applied to identify the suitable pulse amplitude (stimulation level) in five classes that led to the longest tremor reset time. The study was registered at the www.clinicaltrials.gov under the name “The Study of Rest Tremor Suppression by Using Electrical Muscle Stimulation” (NCT02370108). Twenty tremor-dominant PD patients were recruited. After applying an average pulse amplitude of 6.25 (SD 2.84) mA and stimulation period of 440.7 (SD 560.82) seconds, the total time of tremor reduction, or tremor reset time, was 329.90 (SD 340.91) seconds. A significant reduction in tremor parameters during stimulation was demonstrated by a reduction of Unified Parkinson’s Disease Rating Scale (UPDRS) scores, and objectively, with a reduction of gyroscopic data (p < 0.05, each). None of the subjects reported any serious adverse events. We also compared gyroscopic data with five machine learning techniques: Logistic Regression, Random Forest, Support Vector Machine (SVM), Neural Network (NN), and Long-Short-Term-Memory (LSTM). The machine learning model that gave the highest accuracy was LSTM, which obtained: accuracy = 0.865 and macro-F1 = 0.736. This study confirms the efficacy of EMS in the reduction of resting tremors in PD. LSTM was identified as the most effective model for predicting pulse amplitude that would elicit the longest tremor reset time. Our study provides further insight on the tremor reset mechanism in PD.
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Affiliation(s)
- Onanong Phokaewvarangkul
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Peerapon Vateekul
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Itsara Wichakam
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chanawat Anan
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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67
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Essential tremor amplitude modulation by median nerve stimulation. Sci Rep 2021; 11:17720. [PMID: 34489503 PMCID: PMC8421420 DOI: 10.1038/s41598-021-96660-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 08/05/2021] [Indexed: 11/08/2022] Open
Abstract
Essential tremor is a common neurological disorder, characterised by involuntary shaking of a limb. Patients are usually treated using medications which have limited effects on tremor and may cause side-effects. Surgical therapies are effective in reducing essential tremor, however, the invasive nature of these therapies together with the high cost, greatly limit the number of patients benefiting from them. Non-invasive therapies have gained increasing traction to meet this clinical need. Here, we test a non-invasive and closed-loop electrical stimulation paradigm which tracks peripheral tremor and targets thalamic afferents to modulate the central oscillators underlying tremor. To this end, 9 patients had electrical stimulation delivered to the median nerve locked to different phases of tremor. Peripheral stimulation induced a subtle but significant modulation in five out of nine patients-this modulation consisted mainly of amplification rather than suppression of tremor amplitude. Modulatory effects of stimulation were more pronounced when patient's tremor was spontaneously weaker at stimulation onset, when significant modulation became more frequent amongst subjects. This data suggests that for selected individuals, a more sophisticated control policy entailing an online estimate of both tremor phase and amplitude, should be considered in further explorations of the treatment potential of tremor phase-locked peripheral stimulation.
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68
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Morrison MA, Lee AT, Martin AJ, Dietiker C, Brown EG, Wang DD. DBS targeting for essential tremor using intersectional dentato-rubro-thalamic tractography and direct proton density visualization of the VIM: technical note on 2 cases. J Neurosurg 2021; 135:806-814. [PMID: 33450737 DOI: 10.3171/2020.8.jns201378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Direct visualization of the ventral intermediate nucleus (VIM) of the thalamus on standard MRI sequences remains elusive. Therefore, deep brain stimulation (DBS) surgery for essential tremor (ET) indirectly targets the VIM using atlas-derived consensus coordinates and requires awake intraoperative testing to confirm clinical benefits. The objective of this study was to evaluate the utility of proton density (PD)-weighted MRI and tractography of the intersecting dentato-rubro-thalamic tract (DRTT) for direct "intersectional" targeting of the VIM in ET. METHODS DBS targets were selected by identifying the VIM on PD-weighted images relative to the DRTT in 2 patients with ET. Tremor reduction was confirmed with intraoperative clinical testing. Intended target coordinates based on the direct intersectional targeting technique were compared with consensus coordinates obtained with indirect targeting. Pre- and postoperative tremor scores were assessed using the Fahn-Tolosa-Marin tremor rating scale (TRS). RESULTS Planned DBS coordinates based on direct versus indirect targeting of the VIM differed in both the anteroposterior (range 0 to 2.3) and lateral (range -0.7 to 1) directions. For 1 patient, indirect targeting-without PD-weighted visualization of the VIM and DRTT-would have likely resulted in suboptimal electrode placement within the VIM. At the 3-month follow-up, both patients demonstrated significant improvement in tremor symptoms subjectively and according to the TRS (case 1: 68%, case 2: 72%). CONCLUSIONS Direct intersectional targeting of the VIM using PD-weighted imaging and DRTT tractography is a feasible method for DBS placement in patients with ET. These advanced targeting techniques can supplement awake intraoperative testing or be used independently in asleep cases to improve surgical efficiency and confidence.
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Affiliation(s)
- Melanie A Morrison
- 2Department of Radiology & Biomedical Imaging, University of California, San Francisco; and
| | - Anthony T Lee
- 1Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco
| | - Alastair J Martin
- 2Department of Radiology & Biomedical Imaging, University of California, San Francisco; and
| | - Cameron Dietiker
- 3Department of Neurology, Movement Disorders and Neuromodulation Center, Weill Institute for Neurosciences, University of California, San Francisco, California
| | - Ethan G Brown
- 3Department of Neurology, Movement Disorders and Neuromodulation Center, Weill Institute for Neurosciences, University of California, San Francisco, California
| | - Doris D Wang
- 1Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco
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69
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Akkunje PS, Yamini BK, Yadav R, Shivashankar N, Malo PK, Thennarasu K, Hegde S, Pal PK. Phonatory Characteristics of Male Patients with Classic Essential Tremor. J Mov Disord 2021; 14:226-230. [PMID: 34399566 PMCID: PMC10657739 DOI: 10.14802/jmd.21010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/22/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Voice tremor (VT) is one of the characteristics of essential tremor (ET). This study was designed to describe the group and phonatory characteristics of classic ET patients with VT. METHODS This retrospective case-control study compared classic ET patients with age and sex-matched controls. The ET population was subgrouped based on auditory perceptual voice analysis. Electroglottography and acoustic voice samples obtained from both groups were analyzed for contact quotient (CQ) and multidimensional voice program parameters, i.e., fundamental frequency (F0), perturbation, noise, and tremor parameters. RESULTS The CQ, F0, perturbation, noise, and tremor characteristics significantly increased from the moderate VT group to the severe VT group. CONCLUSION The CQ, F0, and noise characteristics reflected the vocal folds' functionality. The perturbation and tremor parameters variation were reasoned considering the tremor-related changes occurring in the laryngeal, vocal tract, and expiratory muscles in patients with ET. Thus, phonatory analysis may help in monitoring the progression of ET.
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Affiliation(s)
- Preetie Shetty Akkunje
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Belur Keshavaprasad Yamini
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nagarajarao Shivashankar
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Palash Kumar Malo
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Kandavel Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Shantala Hegde
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Yang J, Lei D, Peng J, Suo X, Pinaya WHL, Li W, Li J, Kemp GJ, Peng R, Gong Q. Disrupted brain gray matter networks in drug-naïve participants with essential tremor. Neuroradiology 2021; 63:1501-1510. [PMID: 33782719 DOI: 10.1007/s00234-021-02653-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/20/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To use structural magnetic resonance imaging and graph theory approaches to investigate the topological organization of the brain morphological network based on gray matter in essential tremor, and its potential relation to disease severity. METHODS In this prospective study conducted from November 2018 to November 2019, 36 participants with essential tremor and 37 matched healthy controls underwent magnetic resonance imaging. Brain networks based on the morphological similarity of gray matter across regions were analyzed using graph theory. Nonparametric permutation testing was used to assess group differences in topological metrics. Support vector machine was applied to the gray matter morphological matrices to classify participants with essential tremor vs. healthy controls. RESULTS Compared with healthy controls, participants with essential tremor showed increased global efficiency (p < 0.01) and decreased path length (p < 0.01); abnormal nodal properties in frontal, parietal, and cerebellar lobes; and disconnectivity in cerebello-thalamo-cortical network. The abnormal brain nodal centralities (left superior cerebellum gyrus; right caudate nucleus) correlated with clinical measures, both motor (Fahn-Tolosa-Marìn tremor rating, p = 0.017, r = - 0.41) and nonmotor (Hamilton depression scale, p = 0.040, r = - 0.36; Hamilton anxiety scale, p = 0.008, r = - 0.436). Gray matter morphological matrices classified individuals with high accuracy of 80.0%. CONCLUSION Participants with essential tremor showed randomization in global properties and dysconnectivity in the cerebello-thalamo-cortical network. Participants with essential tremor could be distinguished from healthy controls by gray matter morphological matrices.
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Affiliation(s)
- Jing Yang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Du Lei
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Jiaxin Peng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xueling Suo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Walter H L Pinaya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Wenbin Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Junying Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Rong Peng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.
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71
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Pedrosa Carrasco AJ, Mügge F, Pedrosa DJ. Non-lesional treatment options for tremor in idiopathic Parkinson syndrome: a protocol for a systematic literature review. BMJ Open 2021; 11:e048367. [PMID: 34404706 PMCID: PMC8372820 DOI: 10.1136/bmjopen-2020-048367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Idiopathic Parkinson syndrome (iPS) is one of the most common neurodegenerative disorders characterised by the triad of bradykinesia, rigidity and tremor. Tremor at rest predominantly at one side is often perceived by patients as severely disabling and yet ranges among the most difficult symptoms to treat. In medically refractory cases, lesional approaches have proven to be effective alternatives. However, to date, there is no comprehensive analysis of non-surgical therapies to manage iPS-patients' tremor. We therefore present a detailed study protocol for a systematic literature review assessing efficacy/effectiveness and safety of non-lesional treatments for tremor in iPS. METHODS AND ANALYSIS We will search three electronic databases (MEDLINE, EMBASE and PsycINFO) using a combination of title/abstract keywords. Additionally, hand-searched reference and citation lists of key reviews identified through the search strategy will be screened. Eligible studies should investigate the efficacy/effectiveness and safety of therapeutic options for tremor in iPS excluding lesional interventions. Publications will be independently assessed for inclusion criteria by two investigators and study information summarised using a standardised template including quality assessment according to the QualSyst tool. We will provide a narrative synthesis of results and conduct a meta-analysis whenever possible. ETHICS AND DISSEMINATION We commit to present contemporary evidence on the efficacy/effectiveness and safety of non-lesional interventions for tremor in iPS in a future publication. We aim to compile rich data of published studies to inform healthcare professionals in order to ultimately improve patient outcomes. PROSPERO REGISTRATION NUMBER CRD42020202911).
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Affiliation(s)
- Anna Julia Pedrosa Carrasco
- Research Group Ethics in Medicine, Philipps University Marburg, Faculty of Medicine, Marburg, Hessen, Germany
| | - Felicitas Mügge
- Department of Neurology, University Hospital of Giessen and Marburg, Marburg, Hessen, Germany
| | - David José Pedrosa
- Department of Neurology, University Hospital of Giessen and Marburg, Marburg, Hessen, Germany
- Center for Mind, Brain and Behavior, Philipps University Marburg, Marburg, Hessen, Germany
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72
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Lora-Millan JS, Delgado-Oleas G, Benito-León J, Rocon E. A Review on Wearable Technologies for Tremor Suppression. Front Neurol 2021; 12:700600. [PMID: 34434161 PMCID: PMC8380769 DOI: 10.3389/fneur.2021.700600] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/28/2021] [Indexed: 12/29/2022] Open
Abstract
Tremor is defined as a rhythmic, involuntary oscillatory movement of a body part. Although everyone exhibits a certain degree of tremor, some pathologies lead to very disabling tremors. These pathological tremors constitute the most prevalent movement disorder, and they imply severe difficulties in performing activities of daily living. Although tremors are currently managed through pharmacotherapy or surgery, these treatments present significant associated drawbacks: drugs often induce side effects and show decreased effectiveness over years of use, while surgery is a hazardous procedure for a very low percentage of eligible patients. In this context, recent research demonstrated the feasibility of managing upper limb tremors through wearable technologies that suppress tremors by modifying limb biomechanics or applying counteracting forces. Furthermore, recent experiments with transcutaneous afferent stimulation showed significant tremor attenuation. In this regard, this article reviews the devices developed following these tremor management paradigms, such as robotic exoskeletons, soft robotic exoskeletons, and transcutaneous neurostimulators. These works are presented, and their effectiveness is discussed. The article also evaluates the different metrics used for the validation of these devices and the lack of a standard validation procedure that allows the comparison among them.
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Affiliation(s)
- Julio S. Lora-Millan
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
| | - Gabriel Delgado-Oleas
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
- Ingeniería Electrónica, Universidad del Azuay, Cuenca, Ecuador
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
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73
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Kremer NI, Pauwels RWJ, Pozzi NG, Lange F, Roothans J, Volkmann J, Reich MM. Deep Brain Stimulation for Tremor: Update on Long-Term Outcomes, Target Considerations and Future Directions. J Clin Med 2021; 10:3468. [PMID: 34441763 PMCID: PMC8397098 DOI: 10.3390/jcm10163468] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 01/11/2023] Open
Abstract
Deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus is one of the main advanced neurosurgical treatments for drug-resistant tremor. However, not every patient may be eligible for this procedure. Nowadays, various other functional neurosurgical procedures are available. In particular cases, radiofrequency thalamotomy, focused ultrasound and radiosurgery are proven alternatives to DBS. Besides, other DBS targets, such as the posterior subthalamic area (PSA) or the dentato-rubro-thalamic tract (DRT), may be appraised as well. In this review, the clinical characteristics and pathophysiology of tremor syndromes, as well as long-term outcomes of DBS in different targets, will be summarized. The effectiveness and safety of lesioning procedures will be discussed, and an evidence-based clinical treatment approach for patients with drug-resistant tremor will be presented. Lastly, the future directions in the treatment of severe tremor syndromes will be elaborated.
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Affiliation(s)
- Naomi I. Kremer
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (N.I.K.); (R.W.J.P.)
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Wuerzburg, Germany; (N.G.P.); (F.L.); (J.R.); (J.V.)
| | - Rik W. J. Pauwels
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (N.I.K.); (R.W.J.P.)
| | - Nicolò G. Pozzi
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Wuerzburg, Germany; (N.G.P.); (F.L.); (J.R.); (J.V.)
| | - Florian Lange
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Wuerzburg, Germany; (N.G.P.); (F.L.); (J.R.); (J.V.)
| | - Jonas Roothans
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Wuerzburg, Germany; (N.G.P.); (F.L.); (J.R.); (J.V.)
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Wuerzburg, Germany; (N.G.P.); (F.L.); (J.R.); (J.V.)
| | - Martin M. Reich
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Wuerzburg, Germany; (N.G.P.); (F.L.); (J.R.); (J.V.)
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74
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Bayramoglu B, Emre U, Erdal Y, Demirhan H, Yasak I, Yalin OO. Cervical vestibular-evoked myogenic potentials in patients with essential tremor. J Clin Neurosci 2021; 91:365-368. [PMID: 34373053 DOI: 10.1016/j.jocn.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
Although different neuroanatomical structures and pathways are emphasized as possible explanations for essential tremor (ET), there is still an ongoing debate. This study aimed to assess the role of brainstem and reflex pathways with cervical vestibular-evoked myogenic potentials (VEMP) in patients with ET. This prospective study included 34 patients with ET and 25 healthy controls. Cervical VEMP was performed in both groups and latencies, inter-peak latency intervals, peak-to-peak amplitudes and asymmetry ratios were recorded. There was statistically no significant difference between the groups in terms of age (38.9 ± 14.9 years vs. 38.9 ± 14.9 years, p = 0.673) and gender (female to male ratio: 14/11 vs. 20/14, p = 0.828). Right N1 latency and right N1-P1 interval were significantly longer in the patient group (p < 0.05). There was a significant positive correlation between the duration of disease and the right N1-P1 interval (p < 0.05). There was no significant difference between the patient and control groups in terms of bilateral P1 latency, left N1 latency, left N1-P1 interval, and bilateral N1 and P1 amplitudes (p˃0.05). Cervical VEMP may reveal the involvement of brainstem and associated reflex pathways in ET.
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Affiliation(s)
- Banu Bayramoglu
- Health Sciences University, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric and Neurologic Diseases, Neurology Department, Istanbul, Turkey.
| | - Ufuk Emre
- Health Sciences University, Istanbul Training and Research Hospital, Neurology Department, Istanbul, Turkey
| | - Yuksel Erdal
- Health Sciences University, Istanbul Training and Research Hospital, Neurology Department, Istanbul, Turkey
| | - Hasan Demirhan
- Istanbul Medipol University, Otorhinolaryngology Department, Istanbul, Turkey
| | - Ilknur Yasak
- Health Sciences University, Istanbul Training and Research Hospital, Neurology Department, Istanbul, Turkey
| | - Osman Ozgur Yalin
- Health Sciences University, Istanbul Training and Research Hospital, Neurology Department, Istanbul, Turkey
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75
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Ibrahim A, Zhou Y, Jenkins ME, Trejos AL, Naish MD. Real-Time Voluntary Motion Prediction and Parkinson's Tremor Reduction Using Deep Neural Networks. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1413-1423. [PMID: 34255631 DOI: 10.1109/tnsre.2021.3097007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Wearable tremor suppression devices (WTSD) have been considered as a viable solution to manage parkinsonian tremor. WTSDs showed their ability to improve the quality of life of individuals suffering from parkinsonian tremor, by helping them to perform activities of daily living (ADL). Since parkinsonian tremor has been shown to be nonstationary, nonlinear, and stochastic in nature, the performance of the tremor models used by WTSDs is affected by their inability to adapt to the nonlinear behaviour of tremor. Another drawback that the models have is their limitation to estimate or predict one step ahead, which introduces delay when used in real time with WTSDs, which compromises performance. To address these issues, this work proposes a deep neural network model that learns the correlations and nonlinearities of tremor and voluntary motion, and is capable of multi-step prediction with minimal delay. A generalized model that is task and user-independent is presented. The model achieved an average estimation percentage accuracy of 99.2%. The average future voluntary motion prediction percentage accuracy with 10, 20, 50, and 100 steps ahead was 97.0%, 94.0%, 91.6%, and 89.9%, respectively, with prediction time as low as 1.5 ms for 100 steps ahead. The proposed model also achieved an average of 93.8% ± 1.5% in tremor reduction when it was tested in an experimental setup in real time. The tremor reduction showed an improvement of 25% over the Weighted Fourier Linear Combiner (WFLC), an estimator commonly used with WTSDs.
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76
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Abstract
Tremor is the most commonly encountered movement disorder in clinical practice. A wide range of pathologies may manifest with tremor either as a presenting or predominant symptom. Considering the marked etiological and phenomenological heterogeneity, it would be desirable to develop a classification of tremors that reflects their underlying pathophysiology. The tremor task force of the International Parkinson Disease and Movement Disorders Society has worked toward this goal and proposed a new classification system. This system has remained a prime topic of scientific communications on tremor in recent times. The new classification is based on two axes: 1. based on the clinical features, history, and tremor characteristics and 2. based on the etiology of tremor. In this article, we discuss the key aspects of the new classification, review various tremor syndromes, highlight some of the controversies in the field of tremor, and share the potential future perspectives.
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Affiliation(s)
- Abhishek Lenka
- Department of Neurology, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States
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77
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Pérez-de-Heredia-Torres M, Huertas-Hoyas E, Trugeda-Pedrajo N, Serrada-Tejeda S, Gómez-Gil-Díaz-Río A, Martínez-Castrillo JC. Personality Profile in Focal Hand Dystonia: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7863. [PMID: 34360154 PMCID: PMC8345782 DOI: 10.3390/ijerph18157863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022]
Abstract
It has been suggested that focal hand dystonia (FHD) should be viewed as a neuropsychiatric disorder rather than as a pure movement disorder. We aimed to compare the personality factors that are common to people with FHD and evaluate how personality factors could affect the functionality of the upper limbs and community participation. We conducted a cross-sectional case-control study in which 12 people with FHD were matched with 12 age and gender matched healthy control participants. The Big Five Questionnaire; the Quick Disabilities, Arm, Shoulder, and Hand questionnaire; and the Jebsen-Taylor Test of Hand Function were used as assessment measures. Control of emotions was the only variable for which a significant difference was found, with participants with FHD displaying lesser control. Correlations were not observed between different personality profiles, the functionality of the upper limbs and the perceived participation of people with FHD in activities of daily living. People with FHD may present with low emotional stability, but this does not have a negative impact on the functionality of the upper limbs and activities of daily living. These findings have clinical implications to be considered for interventions, as they suggest that personality aspects, such as extraversion, may not predict for better functionality and perceived participation in activities of daily living.
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Affiliation(s)
- Marta Pérez-de-Heredia-Torres
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Av. Atenas s/n, 28922 Madrid, Spain; (M.P.-d.-H.-T.); (N.T.-P.); (S.S.-T.)
| | - Elisabet Huertas-Hoyas
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Av. Atenas s/n, 28922 Madrid, Spain; (M.P.-d.-H.-T.); (N.T.-P.); (S.S.-T.)
| | - Nuria Trugeda-Pedrajo
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Av. Atenas s/n, 28922 Madrid, Spain; (M.P.-d.-H.-T.); (N.T.-P.); (S.S.-T.)
| | - Sergio Serrada-Tejeda
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Av. Atenas s/n, 28922 Madrid, Spain; (M.P.-d.-H.-T.); (N.T.-P.); (S.S.-T.)
| | - Alfonso Gómez-Gil-Díaz-Río
- Community Occupational Therapy Team, Essex Partnership Trus, National Health Service, Grays Hall, Cm12ws, Chelmsford RM17 5TT, UK;
| | - Juan C. Martínez-Castrillo
- Movement Disorders Unit, Department of Neurology, Universitario Ramón y Cajal Hospital, 28034 Madrid, Spain;
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78
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Louis ED, McCreary M. How Common is Essential Tremor? Update on the Worldwide Prevalence of Essential Tremor. Tremor Other Hyperkinet Mov (N Y) 2021; 11:28. [PMID: 34277141 PMCID: PMC8269764 DOI: 10.5334/tohm.632] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background Essential tremor (ET) is among the most prevalent movement disorders. Comprehensive reviews of disease prevalence were published in 1998 and 2010 but not since then. We reviewed the prevalence of ET in population-based epidemiological studies, derived a precise summary estimate of prevalence from these studies, and examined differences in prevalence across studies. We used two methods: a descriptive-analytical approach and a meta-analysis. Methods A PUBMED search yielded 14 published papers since the 2010 review. Results There were 42 population-based prevalence studies (23 countries and 6 continents). In a meta-analysis, pooled prevalence (all ages) = 1.33%, with statistically significant heterogeneity across studies (I2 = 99.3%, p < 0.0001). In additional descriptive analyses, median crude prevalence (all ages) = 0.4% and mean = 0.67%. Prevalence increased markedly with age, and especially with advanced age. In the meta-analysis, prevalence (age ≥ 65 years) = 5.79%, and in descriptive analyses, median crude prevalence (age ≥ 60-65) = 5.9% and mean = 8.0%. In the oldest age groups, median prevalence = 9.3%, with several studies reporting values >20%. The prevalence increased by 74% for every decade increase in age (p < 0.0001). Gender did not impact the prevalence of ET (p = 0.90). Discussion Precise prevalence estimates are important because they form the numerical basis for public health initiatives and offer clues about underlying biological factors of mechanistic importance. The prevalence of ET among those age ≥ 65 is similar to that reported for Alzheimer's disease in elders, suggesting that ET may be the most common neurodegenerative disease.
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Affiliation(s)
- Elan D. Louis
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Morgan McCreary
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
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Tripathi M, Mehta S, Singla R, Ahuja CK, Tandalya N, Tuleasca C, Batish A, Mohindra S, Agrahari A, Kaur R. Vim stereotactic radiosurgical thalamotomy for drug-resistant idiopathic Holmes tremor: a case report. Acta Neurochir (Wien) 2021; 163:1867-1871. [PMID: 32676689 DOI: 10.1007/s00701-020-04489-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022]
Abstract
We share our experience with stereotactic gamma knife thalamotomy (GKT) for medically refractory Holmes tremor (HT). A 22-year-old patient underwent gamma knife thalamotomy at ventrointermediate nucleus for disabling HT of the right upper limb. A single 4-mm isocenter was used to target the ventral intermediate nucleus with 130 Gy radiation. At 4 months follow up, we observed 84% improvement in his Fahn-Tolosa-Marin (FTM) rating scale with significant improvement in the right upper limb dystonic tremor. There was only subtle improvement in the ataxic component of the right lower limb. At 1 year after stereotactic GKT, there was sustained neurological improvement with no side effect, We present the stereotactic GKT as a treatment modality for drug-resistant HT. Moreover, it may be considered an alternate treatment modality especially in patients reluctant or contraindicated for any invasive surgical technique. CLINICAL TRIAL REGISTRATION NUMBER: Not required.
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80
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Kakei S, Manto M, Tanaka H, Mitoma H. Pathophysiology of Cerebellar Tremor: The Forward Model-Related Tremor and the Inferior Olive Oscillation-Related Tremor. Front Neurol 2021; 12:694653. [PMID: 34262527 PMCID: PMC8273235 DOI: 10.3389/fneur.2021.694653] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/18/2021] [Indexed: 01/14/2023] Open
Abstract
Lesions in the Guillain-Mollaret (G-M) triangle frequently cause various types of tremors or tremor-like movements. Nevertheless, we know relatively little about their generation mechanisms. The deep cerebellar nuclei (DCN), which is a primary node of the triangle, has two main output paths: the primary excitatory path to the thalamus, the red nucleus (RN), and other brain stem nuclei, and the secondary inhibitory path to the inferior olive (IO). The inhibitory path contributes to the dentato-olivo-cerebellar loop (the short loop), while the excitatory path contributes to the cerebrocerebellar loop (the long loop). We propose a novel hypothesis: each loop contributes to physiologically distinct type of tremors or tremor-like movements. One type of irregular tremor-like movement is caused by a lesion in the cerebrocerebellar loop, which includes the primary path. A lesion in this loop affects the cerebellar forward model and deteriorates its accuracy of prediction and compensation of the feedback delay, resulting in irregular instability of voluntary motor control, i.e., cerebellar ataxia (CA). Therefore, this type of tremor, such as kinetic tremor, is usually associated with other symptoms of CA such as dysmetria. We call this type of tremor forward model-related tremor. The second type of regular tremor appears to be correlated with synchronized oscillation of IO neurons due, at least in animal models, to reduced degrees of freedom in IO activities. The regular burst activity of IO neurons is precisely transmitted along the cerebellocerebral path to the motor cortex before inducing rhythmical reciprocal activities of agonists and antagonists, i.e., tremor. We call this type of tremor IO-oscillation-related tremor. Although this type of regular tremor does not necessarily accompany ataxia, the aberrant IO activities (i.e., aberrant CS activities) may induce secondary maladaptation of cerebellar forward models through aberrant patterns of long-term depression (LTD) and/or long-term potentiation (LTP) of the cerebellar circuitry. Although our hypothesis does not cover all tremors or tremor-like movement disorders, our approach integrates the latest theories of cerebellar physiology and provides explanations how various lesions in or around the G-M triangle results in tremors or tremor-like movements. We propose that tremor results from errors in predictions carried out by the cerebellar circuitry.
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Affiliation(s)
- Shinji Kakei
- Department of Anatomy and Physiology, Jissen Women's University, Tokyo, Japan
| | - Mario Manto
- Service de Neurologie, Médiathèque Jean Jacquy, CHU-Charleroi, Charleroi, Belgium
- Service des Neurosciences, University of Mons, Mons, Belgium
| | - Hirokazu Tanaka
- Faculty of Information Technology, Tokyo City University, Tokyo, Japan
| | - Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan
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Becktepe JS, Busse J, Jensen-Kondering U, Toedt I, Wolff S, Zeuner KE, Berg D, Granert O, Deuschl G. White Matter Hyperintensities Are Associated With Severity of Essential Tremor in the Elderly. Front Neurol 2021; 12:694286. [PMID: 34262526 PMCID: PMC8273287 DOI: 10.3389/fneur.2021.694286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Essential tremor (ET) occurs with steeply increasing prevalence in the elderly, and apart from disease duration, age is independently associated with an increase of tremor amplitude and a decrease of frequency. White matter hyperintensities (WMHs) are a common finding in the elderly, and their role in the pathophysiology of ET is unknown. The aims of this study were to examine whether ET patients differ in their total or region-specific WMH volumes from healthy controls and to determine the impact of WMH on tremor characteristics. Methods: A total of 47 elderly ET patients with a mean age of 72 years and 39 age-matched healthy controls underwent a thorough clinical assessment and 3T MRI. Total WMH volumes were derived from T2-weighted fluid-attenuated inversion recovery (FLAIR) MR images. Additionally, region of interest-based WMH volumes for the Johns Hopkins University (JHU) white matter tracts and labels were calculated, and WMHs were assessed semiquantitatively using the Fazekas scale. Results: Essential tremor patients and healthy controls did not differ in their total or tract-specific WMH volumes or Fazekas scores. However, WMH volume was significantly positively correlated with tremor severity on the TETRAS scale, and there was a significant negative correlation with the mean accelerometric tremor frequency. In a multiple linear regression model including disease duration, age, and age-adjusted total WMH volume, only the WMH volume significantly predicted tremor severity, while age and disease duration were not significant. Conclusion: We found evidence for a direct association between WMH volume and tremor severity. If confirmed by larger studies, our findings could explain the well-known relation between age and tremor severity.
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Affiliation(s)
- Jos S Becktepe
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Johannes Busse
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Ulf Jensen-Kondering
- Department of Neuroradiology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Inken Toedt
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Stephan Wolff
- Department of Neuroradiology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Kirsten E Zeuner
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Oliver Granert
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
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Yu QW, Ye TF, Qian WJ. Rare coexistence of multiple manifestations secondary to thalamic hemorrhage: A case report. World J Clin Cases 2021; 9:4817-4822. [PMID: 34222453 PMCID: PMC8223845 DOI: 10.12998/wjcc.v9.i18.4817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/26/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A growing body of literature indicates that the occurrence of thalamic lesions could lead to various dysfunctions, such as somatosensory disturbances, hemiparesis, language deficits, and movement disorders. However, clinical cases describing the coexistence of these types of manifestations have not been reported. Herein, we report a patient who exhibited these rare complications secondary to thalamic hemorrhage.
CASE SUMMARY A 53-year-old right-handed man experienced sudden left hemiparesis, numbness of the left side of body, and language alterations due to an acute hemorrhage located in the right basal ganglia and thalamus 18 mo ago. Approximately 17 mo after the onset of stroke, he exhibited rare complications including dysphasia, kinetic tremor confined to the left calf, and mirror movement of the left arm which are unique and interesting, and a follow-up computed tomography scan revealed an old hemorrhagic lesion in the right thalamus and posterior limb of the internal capsule.
CONCLUSION Hypophonia may be a recognizable clinical sign of thalamus lesions; thalamus injury could cause tremor confined to the lower extremity and mimicking extremity movements.
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Affiliation(s)
- Qi-Wei Yu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu Province, China
| | - Tian-Fen Ye
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu Province, China
| | - Wen-Jun Qian
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu Province, China
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Nuvoli S, Spanu A, Fravolini ML, Bianconi F, Cascianelli S, Madeddu G, Palumbo B. [ 123I]Metaiodobenzylguanidine (MIBG) Cardiac Scintigraphy and Automated Classification Techniques in Parkinsonian Disorders. Mol Imaging Biol 2021; 22:703-710. [PMID: 31309370 DOI: 10.1007/s11307-019-01406-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To provide reliable and reproducible heart/mediastinum (H/M) ratio cut-off values for parkinsonian disorders using two machine learning techniques, Support Vector Machines (SVM) and Random Forest (RF) classifier, applied to [123I]MIBG cardiac scintigraphy. PROCEDURES We studied 85 subjects, 50 with idiopathic Parkinson's disease, 26 with atypical Parkinsonian syndromes (P), and 9 with essential tremor (ET). All patients underwent planar early and delayed cardiac scintigraphy after [123I]MIBG (111 MBq) intravenous injection. Images were evaluated both qualitatively and quantitatively; the latter by the early and delayed H/M ratio obtained from regions of interest (ROIt1 and ROIt2) drawn on planar images. SVM and RF classifiers were finally used to obtain the correct cut-off value. RESULTS SVM and RF produced excellent classification performances: SVM classifier achieved perfect classification and RF also attained very good accuracy. The better cut-off for H/M value was 1.55 since it remains the same for both ROIt1 and ROIt2. This value allowed to correctly classify PD from P and ET: patients with H/M ratio less than 1.55 were classified as PD while those with values higher than 1.55 were considered as affected by parkinsonism and/or ET. No difference was found when early or late H/M ratio were considered separately thus suggesting that a single early evaluation could be sufficient to obtain the final diagnosis. CONCLUSIONS Our results evidenced that the use of SVM and CT permitted to define the better cut-off value for H/M ratios both in early and in delayed phase thus underlining the role of [123I]MIBG cardiac scintigraphy and the effectiveness of H/M ratio in differentiating PD from other parkinsonism or ET. Moreover, early scans alone could be used for a reliable diagnosis since no difference was found between early and late. Definitely, a larger series of cases is needed to confirm this data.
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Affiliation(s)
- Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medicine, Surgical and Experimental Science, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy.
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medicine, Surgical and Experimental Science, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy
| | | | | | | | - Giuseppe Madeddu
- Unit of Nuclear Medicine, Department of Medicine, Surgical and Experimental Science, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy
| | - Barbara Palumbo
- Section of Nuclear Medicine and Health Physics, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
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Paparella G, Angelini L, De Biase A, Cannavacciuolo A, Colella D, Di Bonaventura C, Giallonardo AT, Berardelli A, Bologna M. Clinical and Kinematic Features of Valproate-Induced Tremor and Differences with Essential Tremor. CEREBELLUM (LONDON, ENGLAND) 2021; 20:374-383. [PMID: 33200286 PMCID: PMC8213593 DOI: 10.1007/s12311-020-01216-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
Tremor is a common movement disorder that can be induced by medications, including valproate, which is used for the treatment of epilepsy. However, the clinical and neurophysiological features of valproate-induced tremor are still under-investigated. We performed a clinical and kinematic assessment of valproate-induced tremor by considering tremor body distribution and activation conditions. We investigated possible correlations between demographic and clinical data and kinematic features. Valproate-induced tremor results were also compared with those collected in a large sample of patients with essential tremor. Sixteen valproate-induced tremor patients and 93 essential tremor patients were enrolled. All participants underwent a standardised neurological examination and video recording. Patients also underwent an objective assessment of postural, kinetic and rest tremor of the upper limbs and head tremor through kinematic analysis. Nonparametric tests were used for statistical comparisons between the two groups. Clinical evaluation showed a higher occurrence of rest tremor as well as head or voice, and lower limb involvement in patients with valproate-induced tremor. Kinematic analysis showed a substantial variability in the tremor features of patients with valproate-induced tremor. Compared to essential tremor, we found a higher occurrence of rest tremor of the upper limbs and the involvement of more body segments in valproate-induced tremor patients. Valproate-induced tremor has distinctive clinical and kinematic features, which may suggest that valproate interferes with the cerebellar functions.
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Affiliation(s)
| | - Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Alessandro De Biase
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Antonio Cannavacciuolo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Anna Teresa Giallonardo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli (IS), Italy.
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
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Su D, Zhang F, Liu Z, Yang S, Wang Y, Ma H, Manor B, Hausdorff JM, Lipsitz LA, Pan H, Feng T, Zhou J. Different effects of essential tremor and Parkinsonian tremor on multiscale dynamics of hand tremor. Clin Neurophysiol 2021; 132:2282-2289. [PMID: 34148777 DOI: 10.1016/j.clinph.2021.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/23/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Essential tremor (ET) and Parkinsonian tremor (PT) are often clinically misdiagnosed due to the overlapping characteristics of their hand tremor. We aim to examine if ET and PT influence the multiscale dynamics of hand tremor, as quantified using complexity, differently, and if such complexity metric is of promise to help identify ET from PT. METHODS Forty-eight participants with PT and 48 with ET performed two 30-second tests within each of the following conditions: sitting while resting arms or outstretching arms horizontally. The hand tremor was captured by accelerometers secured to the dorsum of each hand. The complexity was quantified using multiscale entropy. RESULTS Compared to PT group, ET group had lower complexity of both hands across conditions (F > 34.2, p < 0.001). Lower complexity was associated with longer disease duration (r2 > 0.15, p < 0.009) in both PT and ET, and within PT, greater Unified Parkinson's Disease Rating Scale-III UPDRS-III scores (r2 > 0.18, p < 0.009). Receiver-operating-characteristic curves revealed that the complexity metric can distinguish ET from PT (area-under-the-curve > 0.77, cut-off value = 48 (postural), 49 (resting)), which was confirmed in a separate dataset with ET and PT that were clearly diagnosed in prior work. CONCLUSIONS The PT and ET have different effects on hand tremor complexity, and this metric is promising to help the identification of ET and PT, which still needs to be confirmed in future studies. SIGNIFICANCE The characteristics of multiscale dynamics of the hand tremor, as quantified by complexity, provides novel insights into the different pathophysiology between ET and PT.
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Affiliation(s)
- Dongning Su
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | | | - Zhu Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuo Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ying Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Huizi Ma
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience and Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center; Chicago, IL, USA
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Hua Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Tao Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Harvard Medical School, Boston, MA, USA
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Karamesinis A, Sillitoe RV, Kouzani AZ. Wearable Peripheral Electrical Stimulation Devices for the Reduction of Essential Tremor: A Review. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2021; 9:80066-80076. [PMID: 34178561 PMCID: PMC8224473 DOI: 10.1109/access.2021.3084819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Essential tremor is the most common pathological tremor, with a prevalence of 6.3% in people over 65 years of age. This disorder interferes with a patient's ability to carry out activities of daily living independently, and treatment with medical and surgical interventions is often insufficient or contraindicated. Mechanical orthoses have not been widely adopted by patients due to discomfort and lack of discretion. Over the past 30 years, peripheral electrical stimulation has been investigated as a possible treatment for patients who have not found other treatment options to be satisfactory, with wearable devices revolutionizing this emerging approach in recent years. In this paper, an overview of essential tremor and its current medical and surgical treatment options are presented. Following this, tremor detection, measurement and characterization methods are explored with a focus on the measurement options that can be incorporated into wearable devices. Then, novel interventions for essential tremor are described, with a detailed review of open and closed-loop peripheral electrical stimulation methods. Finally, discussion of the need for wearable closed-loop peripheral electrical stimulation devices for essential tremor, approaches in their implementation, and gaps in the literature for further research are presented.
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Affiliation(s)
| | - Roy V Sillitoe
- Department of Pathology and Immunology, Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX 77030, USA
| | - Abbas Z Kouzani
- School of Engineering, Deakin University, Geelong, VIC 3216, Australia
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Peres LB, Calil BC, da Silva APSPB, Dionísio VC, Vieira MF, de Oliveira Andrade A, Pereira AA. Discrimination between healthy and patients with Parkinson's disease from hand resting activity using inertial measurement unit. Biomed Eng Online 2021; 20:50. [PMID: 34022895 PMCID: PMC8141164 DOI: 10.1186/s12938-021-00888-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/11/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a neurological disease that affects the motor system. The associated motor symptoms are muscle rigidity or stiffness, bradykinesia, tremors, and gait disturbances. The correct diagnosis, especially in the initial stages, is fundamental to the life quality of the individual with PD. However, the methods used for diagnosis of PD are still based on subjective criteria. As a result, the objective of this study is the proposal of a method for the discrimination of individuals with PD (in the initial stages of the disease) from healthy groups, based on the inertial sensor recordings. METHODS A total of 27 participants were selected, 15 individuals previously diagnosed with PD and 12 healthy individuals. The data collection was performed using inertial sensors (positioned on the back of the hand and on the back of the forearm). Different numbers of features were used to compare the values of sensitivity, specificity, precision, and accuracy of the classifiers. For group classification, 4 classifiers were used and compared, those being [Random Forest (RF), Support Vector Machine (SVM), K-Nearest Neighbor (KNN), and Naive Bayes (NB)]. RESULTS When all individuals with PD were analyzed, the best performance for sensitivity and accuracy (0.875 and 0.800, respectively) was found in the SVM classifier, fed with 20% and 10% of the features, respectively, while the best performance for specificity and precision (0.933 and 0.917, respectively) was associated with the RF classifier fed with 20% of all the features. When only individuals with PD and score 1 on the Hoehn and Yahr scale (HY) were analyzed, the best performances for sensitivity, precision and accuracy (0.933, 0.778 and 0.848, respectively) were from the SVM classifier, fed with 40% of all features, and the best result for precision (0.800) was connected to the NB classifier, fed with 20% of all features. CONCLUSION Through an analysis of all individuals in this study with PD, the best classifier for the detection of PD (sensitivity) was the SVM fed with 20% of the features and the best classifier for ruling out PD (specificity) was the RF classifier fed with 20% of the features. When analyzing individuals with PD and score HY = 1, the SVM classifier was superior across the sensitivity, precision, and accuracy, and the NB classifier was superior in the specificity. The obtained result indicates that objective methods can be applied to help in the evaluation of PD.
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Affiliation(s)
- Luciano Brinck Peres
- Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Centre for Innovation and Technology Assessment in Health, Federal University of Uberlândia, Uberlândia, Brazil
| | - Bruno Coelho Calil
- Department of Information Technology, UNA Uberlândia University Center, Uberlândia, Brazil
| | | | - Valdeci Carlos Dionísio
- Faculty of Physical Education and Physiotherapy, Federal University of Uberlândia, Uberlândia, Brazil
| | - Marcus Fraga Vieira
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Brazil
| | - Adriano de Oliveira Andrade
- Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Centre for Innovation and Technology Assessment in Health, Federal University of Uberlândia, Uberlândia, Brazil
| | - Adriano Alves Pereira
- Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Centre for Innovation and Technology Assessment in Health, Federal University of Uberlândia, Uberlândia, Brazil
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Agrawal M, Garg K, Samala R, Rajan R, Naik V, Singh M. Outcome and Complications of MR Guided Focused Ultrasound for Essential Tremor: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:654711. [PMID: 34025558 PMCID: PMC8137896 DOI: 10.3389/fneur.2021.654711] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Magnetic resonance guided focused ultrasound (MRgFUS) is a relatively novel technique to treat essential tremor (ET). The objective of this review was to analyze the efficacy and the safety profile of MRgFUS for ET. Methods: A systematic literature review was done. The post procedure changes in the Clinical Rating Scale for Tremor (CRST) score, hand score, disability and quality of life scores were analyzed. Results: We found 29 studies evaluating 617 patients. DTI based targeting was utilized in six cohorts. A significant difference was observed in the pooled standard mean difference between the pre and postoperative total CRST score (p-value < 0.001 and 0.0002), hand score (p-value 0.03 and 0.02); and the disability at 12 months (p-value 0.01). Head pain and dizziness were the most in procedure complications. The immediate pooled proportion of ataxia was 50%, while it was 20% for sensory complications, which, respectively, declined to 31 and 13% on long term follow up. A significant reduction (p = 0.03) in immediate ataxia related complications was seen with DTI targeting. Conclusion: MRgFUS for ET seems to be an effective procedure for relieving unilateral tremor. Use of DTI based targeting revealed a significant reduction in post procedure ataxia related complications as compared to traditional targeting techniques. Analysis of other complications further revealed a decreasing trend on follow up.
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Affiliation(s)
- Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raghu Samala
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Naik
- Department of Neurosurgery, Bangalore Medical College, Bangalore, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Nguyen HS, Luu TP. Tremor-Suppression Orthoses for the Upper Limb: Current Developments and Future Challenges. Front Hum Neurosci 2021; 15:622535. [PMID: 33994975 PMCID: PMC8119649 DOI: 10.3389/fnhum.2021.622535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Pathological tremor is the most common motor disorder in adults and characterized by involuntary, rhythmic muscular contraction leading to shaking movements in one or more parts of the body. Functional Electrical Stimulation (FES) and biomechanical loading using wearable orthoses have emerged as effective and non-invasive methods for tremor suppression. A variety of upper-limb orthoses for tremor suppression have been introduced; however, a systematic review of the mechanical design, algorithms for tremor extraction, and the experimental design is still missing. Methods: To address this gap, we applied a standard systematic review methodology to conduct a literature search in the PubMed and PMC databases. Inclusion criteria and full-text access eligibility were used to filter the studies from the search results. Subsequently, we extracted relevant information, such as suppression mechanism, system weights, degrees of freedom (DOF), algorithms for tremor estimation, experimental settings, and the efficacy. Results: The results show that the majority of tremor-suppression orthoses are active with 47% prevalence. Active orthoses are also the heaviest with an average weight of 561 ± 467 g, followed by semi-active 486 ± 395 g, and passive orthoses 191 ± 137 g. Most of the orthoses only support one DOF (54.5%). Two-DOF and three-DOF orthoses account for 33 and 18%, respectively. The average efficacy of tremor suppression using wearable orthoses is 83 ± 13%. Active orthoses are the most efficient with an average efficacy of 83 ± 8%, following by the semi-active 77 ± 19%, and passive orthoses 75 ± 12%. Among different experimental setups, bench testing shows the highest efficacy at 95 ± 5%, this value dropped to 86 ± 8% when evaluating with tremor-affected subjects. The majority of the orthoses (92%) measured voluntary and/or tremorous motions using biomechanical sensors (e.g., IMU, force sensor). Only one system was found to utilize EMG for tremor extraction. Conclusions: Our review showed an improvement in efficacy of using robotic orthoses in tremor suppression. However, significant challenges for the translations of these systems into clinical or home use remain unsolved. Future challenges include improving the wearability of the orthoses (e.g., lightweight, aesthetic, and soft structure), and user control interfaces (i.e., neural machine interface). We also suggest addressing non-technical challenges (e.g., regulatory compliance, insurance reimbursement) to make the technology more accessible.
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Affiliation(s)
- Hoai Son Nguyen
- Group of Advanced Computations in Engineering Science, HCMC University of Technology and Education, Ho Chi Minh City, Vietnam
| | - Trieu Phat Luu
- Noninvasive Brain-Machine Interface System Laboratory, Department of Electrical and Computer Engineering, University of Houston, Houston, TX, United States
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Becktepe J, Gövert F, Balint B, Schlenstedt C, Bhatia K, Elble R, Deuschl G. Exploring Interrater Disagreement on Essential Tremor Using a Standardized Tremor Elements Assessment. Mov Disord Clin Pract 2021; 8:371-376. [PMID: 33816665 PMCID: PMC8015892 DOI: 10.1002/mdc3.13150] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Patients with upper limb action tremor frequently exhibit additional neurological signs of uncertain significance. Clinicians vary in their interpretation, and interrater agreement on the final diagnosis is poor. Objectives A new clinical tool for assessing the presence or absence of clinical signs that are important in axis‐1 classification of tremor patients is introduced: the Standardized Tremor Elements Assessment (STEA). Interrater agreement is determined, and signs leading to disagreement in the final diagnosis are identified. Methods Three tremor‐focussed and one dystonia‐focussed movement disorder specialists rated 59 videos of patients with upper limb action tremor syndromes using STEA. Interrater agreements for final diagnosis and STEA items were calculated. Results Interrater agreement regarding the final diagnosis was higher within the group of tremor specialists and poor between dystonia and tremor specialists. Greater agreement was found for items characterizing tremor than for signs of dystonia. Conclusions Clinical signs leading to diagnostic disagreement were identified with STEA, and STEA should therefore be useful in future studies of diagnostic disagreement. The thresholds for considering neurological signs as soft versus significant for ataxia, parkinsonism, dystonia, etc. are critically important in tremor classification and must be studied across movement disorder subspecialties, not simply within a pool of tremor specialists.
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Affiliation(s)
- Jos Becktepe
- Department of Neurology University Hospital Schleswig-Holstein, Christian-Albrechts-University Kiel Germany
| | - Felix Gövert
- Department of Neurology University Hospital Schleswig-Holstein, Christian-Albrechts-University Kiel Germany
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London London UK.,Department of Neurology University Hospital Heidelberg Heidelberg Germany
| | - Christian Schlenstedt
- Department of Neurology University Hospital Schleswig-Holstein, Christian-Albrechts-University Kiel Germany
| | - Kailash Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London London UK
| | - Rodger Elble
- Department of Neurology Southern Illinois University School of Medicine Springfield Illinois USA
| | - Günther Deuschl
- Department of Neurology University Hospital Schleswig-Holstein, Christian-Albrechts-University Kiel Germany
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Lamy JC, Varriale P, Apartis E, Mehdi S, Blancher-Meinadier A, Kosutzka Z, Degos B, Frismand S, Simonetta-Moreau M, Meunier S, Roze E, Vidailhet M. Trans-Spinal Direct Current Stimulation for Managing Primary Orthostatic Tremor. Mov Disord 2021; 36:1835-1842. [PMID: 33772851 DOI: 10.1002/mds.28581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Primary orthostatic tremor (POT) is a rare disorder, characterized by 13 to 18 Hz tremor in the legs when standing and is often refractory to medical treatment. Epidural spinal cord stimulation has been proposed as an alternative treatment. However, this approach is invasive, which limits its application. OBJECTIVE Trans-spinal direct current stimulation (tsDCS) is a non-invasive method to modulate spinal cord circuits. The aim of this proof-of-concept study was to investigate the potential beneficial effect of tsDCS in POT. METHODS We conducted a double-blind, sham-controlled study in 16 patients with POT. In two separate visits, patients received sham tsDCS first followed by active (either cathodal or anodal) tsDCS. The primary outcome was the change in time in standing position. Secondary outcomes comprised quantitative assessment of tremor, measurement of corticospinal excitability including short-latency afferent inhibition, and clinical global impression-improvement (CGI-I). Measurements were made at baseline, after sham tsDCS, 0-30 min, and 30-60 min after active conditions. RESULTS Cathodal-tsDCS reduced tremor amplitude and frequency and lowered corticospinal excitability whereas anodal-tsDCS reduced tremor frequency only. CGI-I scores positively correlated with the time in standing position after both active tsDCS conditions. CONCLUSION A single session of tsDCS can improve instability in POT. This opens a new vista for experimental treatment options using multiple sessions of spinal DC stimulation. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jean-Charles Lamy
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France
| | - Pasquale Varriale
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France
| | - Emmanuelle Apartis
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France.,Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | - Sophien Mehdi
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France
| | - Anne Blancher-Meinadier
- Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | - Zuzana Kosutzka
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France.,2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Bertrand Degos
- Department of Neurology, Avicenne Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Sorbonne Paris Nord, Bobigny, France.,Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, Université PSL, Paris, France
| | - Solène Frismand
- Department of Neurology, University Hospital of Nancy, Nancy, France
| | - Marion Simonetta-Moreau
- Department of Neurology Toulouse Hospital, Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - Sabine Meunier
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France
| | - Emmanuel Roze
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France.,Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | - Marie Vidailhet
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France.,Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
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92
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Cerda-Gonzalez S, Packer RA, Garosi L, Lowrie M, Mandigers PJJ, O'Brien DP, Volk HA. International veterinary canine dyskinesia task force ECVN consensus statement: Terminology and classification. J Vet Intern Med 2021; 35:1218-1230. [PMID: 33769611 PMCID: PMC8162615 DOI: 10.1111/jvim.16108] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023] Open
Abstract
Movement disorders are a heterogeneous group of clinical syndromes in humans and animals characterized by involuntary movements without changes in consciousness. Canine movement disorders broadly include tremors, peripheral nerve hyperexcitability disorders, paroxysmal dyskinesia, and dystonia. Of these, canine paroxysmal dyskinesias remain one of the more difficult to identify and characterize in dogs. Canine paroxysmal dyskinesias include an array of movement disorders in which there is a recurrent episode of abnormal, involuntary, movement. In this consensus statement, we recommend standard terminology for describing the various movement disorders with an emphasis on paroxysmal dyskinesia, as well as a preliminary classification and clinical approach to reporting cases. In the clinical approach to movement disorders, we recommend categorizing movements into hyperkinetic vs hypokinetic, paroxysmal vs persistent, exercise‐induced vs not related to exercise, using a detailed description of movements using the recommended terminology presented here, differentiating movement disorders vs other differential diagnoses, and then finally, determining whether the paroxysmal dyskinesia is due to either inherited or acquired etiologies. This consensus statement represents a starting point for consistent reporting of clinical descriptions and terminology associated with canine movement disorders, with additional focus on paroxysmal dyskinesia. With consistent reporting and identification of additional genetic mutations responsible for these disorders, our understanding of the phenotype, genotype, and pathophysiology will continue to develop and inform further modification of these recommendations.
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Affiliation(s)
| | - Rebecca A Packer
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | | | - Mark Lowrie
- Dovecote Veterinary Hospital, Derby, United Kingdom
| | - Paul J J Mandigers
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Dennis P O'Brien
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
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93
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Papapetropoulos S, Lee MS, Versavel S, Newbold E, Jinnah HA, Pahwa R, Lyons KE, Elble R, Ondo W, Zesiewicz T, Hedera P, Handforth A, Elder J, Versavel M. A Phase 2 Proof-of-Concept, Randomized, Placebo-Controlled Trial of CX-8998 in Essential Tremor. Mov Disord 2021; 36:1944-1949. [PMID: 33764619 PMCID: PMC8451783 DOI: 10.1002/mds.28584] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/29/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background Available essential tremor (ET) therapies have limitations. Objectives The objective of this study was to evaluate CX‐8998, a selective T‐type calcium channel modulator, in essential tremor. Methods Patients 18–75 years old with moderate to severe essential tremor were randomized 1:1 to receive CX‐8998 (titrated to 10 mg twice daily) or placebo. The primary end point was change from baseline to day 28 in The Essential Tremor Rating Assessment Scale performance subscale scored by independent blinded video raters. Secondary outcomes included in‐person blinded investigator rating of The Essential Tremor Rating Assessment Scale performance subscale, The Essential Tremor Rating Assessment Scale activities of daily living subscale, and Kinesia ONE accelerometry. Results The video‐rated The Essential Tremor Rating Assessment Scale performance subscale was not different for CX‐8998 (n = 39) versus placebo (n = 44; P = 0.696). CX‐8998 improved investigator‐rated The Essential Tremor Rating Assessment Scale performance subscale (P = 0.017) and The Essential Tremor Rating Assessment Scale activities of daily living (P = 0.049) but not Kinesia ONE (P = 0.421). Adverse events with CX‐8998 included dizziness (21%), headache (8%), euphoric mood (6%), and insomnia (6%). Conclusions The primary efficacy end point was not met; however, CX‐8998 improved some assessments of essential tremor, supporting further clinical investigation. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. This article has been contributed to by US Government employees and their work is in the public domain in the USA.
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Affiliation(s)
| | | | | | - Evan Newbold
- Jazz Pharmaceuticals, Philadelphia, Pennsylvania, USA
| | - Hyder A Jinnah
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rajesh Pahwa
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kelly E Lyons
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Rodger Elble
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - William Ondo
- Houston Methodist Neurological Institute, Houston, Texas, USA
| | - Theresa Zesiewicz
- University of South Florida Ataxia Research Center, Tampa, Florida, USA
| | - Peter Hedera
- Department of Neurology, University of Louisville, Louisville, Kentucky, USA
| | - Adrian Handforth
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Jenna Elder
- PharPoint Research, Inc., Wilmington, North Carolina, USA
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94
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Hett K, Lyu I, Trujillo P, Lopez AM, Aumann M, Larson KE, Hedera P, Dawant B, Landman BA, Claassen DO, Oguz I. Anatomical texture patterns identify cerebellar distinctions between essential tremor and Parkinson's disease. Hum Brain Mapp 2021; 42:2322-2331. [PMID: 33755270 PMCID: PMC8090778 DOI: 10.1002/hbm.25331] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/25/2020] [Accepted: 12/16/2020] [Indexed: 01/15/2023] Open
Abstract
Voxel-based morphometry is an established technique to study focal structural brain differences in neurologic disease. More recently, texture-based analysis methods have enabled a pattern-based assessment of group differences, at the patch level rather than at the voxel level, allowing a more sensitive localization of structural differences between patient populations. In this study, we propose a texture-based approach to identify structural differences between the cerebellum of patients with Parkinson's disease (n = 280) and essential tremor (n = 109). We analyzed anatomical differences of the cerebellum among patients using two features: T1-weighted MRI intensity, and a texture-based similarity feature. Our results show anatomical differences between groups that are localized to the inferior part of the cerebellar cortex. Both the T1-weighted intensity and texture showed differences in lobules VIII and IX, vermis VIII and IX, and middle peduncle, but the texture analysis revealed additional differences in the dentate nucleus, lobules VI and VII, vermis VI and VII. This comparison emphasizes how T1-weighted intensity and texture-based methods can provide a complementary anatomical structure analysis. While texture-based similarity shows high sensitivity for gray matter differences, T1-weighted intensity shows sensitivity for the detection of white matter differences.
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Affiliation(s)
- Kilian Hett
- Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| | - Ilwoo Lyu
- Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| | - Paula Trujillo
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Alexander M. Lopez
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Megan Aumann
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Kathleen E. Larson
- Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| | - Peter Hedera
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA,Department of NeurologyUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Benoit Dawant
- Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| | - Bennett A. Landman
- Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| | - Daniel O. Claassen
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Ipek Oguz
- Department of Electrical Engineering and Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
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95
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Spinal astroglial cannabinoid receptors control pathological tremor. Nat Neurosci 2021; 24:658-666. [PMID: 33737752 PMCID: PMC7610740 DOI: 10.1038/s41593-021-00818-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/17/2021] [Indexed: 12/21/2022]
Abstract
Cannabinoids reduce tremor associated with motor disorders induced by injuries and neurodegenerative disease. Here we show that this effect is mediated by cannabinoid receptors on astrocytes in the ventral horn of the spinal cord, where alternating limb movements are initiated. We first demonstrate that tremor is reduced in a mouse model of essential tremor after intrathecal injection of the cannabinoid analog WIN55,212-2. We investigate the underlying mechanism using electrophysiological recordings in spinal cord slices and show that endocannabinoids released from depolarized interneurons activate astrocytic cannabinoid receptors, causing an increase in intracellular Ca2+, subsequent release of purines and inhibition of excitatory neurotransmission. Finally, we show that the anti-tremor action of WIN55,212-2 in the spinal cords of mice is suppressed after knocking out CB1 receptors in astrocytes. Our data suggest that cannabinoids reduce tremor via their action on spinal astrocytes.
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96
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Riskin-Jones HH, Kashanian A, Sparks H, Tsolaki E, Pouratian N. Increased structural connectivity of thalamic stimulation sites to motor cortex relates to tremor suppression. NEUROIMAGE-CLINICAL 2021; 30:102628. [PMID: 33773164 PMCID: PMC8024765 DOI: 10.1016/j.nicl.2021.102628] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/17/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Abstract
Clinically weighted tractography reveals key patterns of therapeutic brain stimulation. Thalamic stimulation for tremor preferentially connects to precentral gyrus and cerebellum. Thalamic DBS of areas most connected to motor cortex results in superior outcomes. Acute and chronic therapeutic outcomes demonstrate converging connectivity patterns.
Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM-DBS) is a highly successful treatment for medication-refractory essential tremor (ET). Clinical outcomes are dependent on accurate targeting. Here, we aim to develop a framework for connectivity-guided DBS targeting by evaluating probabilistic tractography and clinical response at both initial programming (IP) and clinical follow-up (CF). Magnetic resonance imaging and clinical outcomes were evaluated in 23 ET patients who were treated by VIM-DBS at the University of California Los Angeles (20 at IP, 18 at CF, 14 at both). Lead-DBS was used to model the volume of tissue activated tissue (VTA) based on programming configurations at both IP and CF. Probabilistic tractography, calculated in FSL, was used to evaluate 1) clinically weighted whole brain connectivity of VTA; 2) connectivity between VTA and freesurfer-derived target regions of interest (ROI) including primary motor, premotor, and prefrontal cortices, and cerebellum; and 3) volume of intersection between VTA and probabilistic tractography-based segmentation of the thalamus. At IP, individual contacts were scored as high or low efficacy based on acute tremor improvement. At CF, clinical response was measured by percent of change of the Clinical Rating Scale for Tremor (CRST) compared to preoperative scores. Contributions from each target ROI to clinical response was measured using logistic regression for IP and linear regression for CF. The clinically weighted map of whole brain connectivity of VTA shows preferential connectivity to precentral gyrus and brainstem/cerebellum. The volume of intersection between VTA and thalamic segmentation map based on probabilistic connectivity to primary motor cortex was a significant predictor of contact efficacy at IP (OR = 2.26 per 100 mm3 of overlap, p = .04) and percent change in CRST at CF (β = 14.67 per 100 mm3 of overlap, p = .003). Targeting DBS to the area of thalamus most connected to primary motor cortex based on probabilistic tractography is associated with superior outcomes, providing a potential guide not only for lead targeting but also therapeutic programming.
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Affiliation(s)
- Hannah H Riskin-Jones
- Department of Neurosurgery, 300 UCLA Stein Plaza, Suite 562, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles, CA, United States
| | - Alon Kashanian
- Department of Neurosurgery, 300 UCLA Stein Plaza, Suite 562, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles, CA, United States
| | - Hiro Sparks
- Department of Neurosurgery, 300 UCLA Stein Plaza, Suite 562, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles, CA, United States
| | - Evangelia Tsolaki
- Department of Neurosurgery, 300 UCLA Stein Plaza, Suite 562, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles, CA, United States
| | - Nader Pouratian
- Department of Neurosurgery, 300 UCLA Stein Plaza, Suite 562, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles, CA, United States.
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97
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Son HJ, Oh JS, Oh M, Lee SJ, Oh SJ, Chung SJ, Kim JS. Test-retest reproducibility of dopamine transporter density measured with [ 18F]FP-CIT PET in patients with essential tremor and Parkinson's disease. Ann Nucl Med 2021; 35:299-306. [PMID: 33387281 DOI: 10.1007/s12149-020-01561-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/29/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE 18F-labeled fluoropropyl-carbomethoxylodopropyl-nor-ß-tropane ([18F]FP-CIT) positron emission tomography (PET) is a useful tool for evaluating disease progression in Parkinson's disease (PD) patients. We evaluated the test-retest reproducibility of [18F]FP-CIT PET measures in essential tremor (ET) and PD patients. METHODS Fifteen ET (68.9 ± 6.6 years) and 10 PD patients (70.5 ± 6.3 years; Hoehn and Yahr stage, 2.3 ± 0.8) underwent two [18F]FP-CIT PET/CT scans with an interval of 48 ± 7 day. For both the test and retest studies, standardized uptake value ratios were estimated for 90-min and 3-h acquisitions for the caudate, anterior putamen, and posterior putamen using T1-MRI-based normalization (automatic) and fixed-VOI (manual) methods, with the occipital lobe as a reference. Reproducibility was evaluated by the bias, variability, percent test-retest, within-subject coefficient of variation, repeatability coefficient, and intraclass correlation coefficient (ICC). RESULTS Reproducibility was excellent, with low variability (ET: 6.99-8.02%, PD: 3.51-6.94%) and high reliability (ICC; ET: 0.88-0.96, PD: 0.98-0.99). The ET group showed higher variability and lower ICCs than the PD group. The variability in the 90-min images (ET: 7.85-8.59%, PD: 1.52-2.75%) was comparable to that in the 3-h images (ET: 6.99-8.02%, PD: 3.51-6.94%). There were no differences in variability among the subregions in the ET group. In the PD group, the variability was high in the posterior putamen (automatic method: 6.94%, manual method: 11.80%). The test-retest variability and ICCs were similar for the manual and automatic methods. CONCLUSION [18F]FP-CIT PET is reproducible for the quantitative measurement of DAT binding in both ET and PD individuals, independent of the acquisition time or analysis method. Also, the automatic method is more suitable for evaluating early loss of DAT binding in patients with PD.
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Affiliation(s)
- Hye Joo Son
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jungsu S Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minyoung Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Ju Lee
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Jun Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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98
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Teufl S, Preston J, van Wijck F, Stansfield B. Quantifying upper limb tremor in people with multiple sclerosis using Fast Fourier Transform based analysis of wrist accelerometer signals. J Rehabil Assist Technol Eng 2021; 8:2055668320966955. [PMID: 33614109 PMCID: PMC7869147 DOI: 10.1177/2055668320966955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/28/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Tremor is a disabling symptom of Multiple Sclerosis (MS). The development of objective methods of tremor characterisation to assess intervention efficacy and disease progression is therefore important. The possibility of using a Fast Fourier Transform (FFT) method for tremor detection was explored. Methods Acceleration from a wrist-worn device was analysed using FFTs to identify and characterise tremor magnitude and frequency. Processing parameters were explored to provide insight into the optimal algorithm. Participants wore a wrist tri-axial accelerometer during 9 tasks. The FAHN clinical assessment of tremor was used as the reference standard. Results Five people with MS and tremor (57.6 ± 15.3 years, 3 F/2M) and ten disease-free controls (42.4 ± 10.9 years, 5 M/5F) took part. Using specific algorithm settings tremor identification was possible (peak frequency 3–15Hz; magnitude greater than 0.06 g; 2 s windows with 50% overlap; using 2 of 3 axes of acceleration), giving sensitivity 0.974 and specificity 0.971 (38 tremor occurrences out of 108 tasks, 1 false positive, 2 false negatives). Tremor had frequency 3.5–13.0 Hz and amplitude 0.07–2.60g. Conclusions Upper limb tremor in people with MS can be detected using a FFT approach based on acceleration recorded at the wrist, demonstrating the possibility of using this minimally encumbering technique within clinical practice.
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Affiliation(s)
- Stefan Teufl
- School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Jenny Preston
- Douglas Grant Rehabilitation Centre, Ayrshire Central Hospital, Irvine, UK
| | | | - Ben Stansfield
- School of Health and Life Sciences, Glasgow Caledonian University, UK
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99
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Tremor measurements in a 22-year cohort study of workers exposed to hand-held vibrating tools. Int Arch Occup Environ Health 2021; 94:1049-1059. [PMID: 33606098 PMCID: PMC8238707 DOI: 10.1007/s00420-020-01612-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 11/11/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objectives of this cohort study were to evaluate possible long-term effects of occupational exposure to hand-arm vibration (HAV) in terms of increased tremor. The aims were to evaluate whether exposure during follow-up, baseline hand-arm vibration syndrome (HAVS), baseline manual dexterity or current medical conditions or life-style habits might be associated with increased tremor. A further aim was to compare two different activation conditions: postural vs rest tremor. METHODS Forty men (current age: 60.4 years) who had previously worked as manual workers in a specialized engineering and construction company enrolled in the study. Their hand functions had been examined in 1994. At the baseline examination, 27 had been diagnosed with HAVS, while 13 were not exposed. The follow-up examination in 2016-2017 comprised the CATSYS Tremor Pen® for measuring postural and rest tremor and the Grooved Pegboard Test for assessing manual dexterity. Blood samples were taken for assessing biomarkers that might have impact on tremor. RESULTS Neither cumulative exposure to HAV during follow-up nor HAVS at baseline were associated with increased tremor. A test for manual dexterity at baseline was significantly associated with increased tremor (Tremor Intensity) at follow-up. Blood markers of current medical conditions and tobacco consumption were associated with increased tremor. Rest tremor frequency was higher than postural tremor frequency (p < 0.001). CONCLUSIONS The main findings of this 22-year cohort study were no indications of long-term effects on tremor related to HAV exposure and previous HAVS status. However, baseline manual dexterity was significantly associated with increased tremor at follow-up. Activation conditions (e.g., hand position) are important when testing tremor.
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100
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Duan X, Fang Z, Tao L, Chen H, Zhang X, Li Y, Wang H, Li A, Zhang X, Pang Y, Gu M, Wu J, Lv F, Luo T, Cheng O, Luo J, Xiao Z, Fang W. Altered local and matrix functional connectivity in depressed essential tremor patients. BMC Neurol 2021; 21:68. [PMID: 33573615 PMCID: PMC7879612 DOI: 10.1186/s12883-021-02100-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/02/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Depression in essential tremor (ET) has been constantly studied and reported, while the associated brain activity changes remain unclear. Recently, regional homogeneity (ReHo), a voxel-wise local functional connectivity (FC) analysis of resting-state functional magnetic resonance imaging, has provided a promising way to observe spontaneous brain activity. METHODS Local FC analyses were performed in forty-one depressed ET patients, 49 non-depressed ET patients and 43 healthy controls (HCs), and then matrix FC and clinical depression severity correlation analyses were further performed to reveal spontaneous neural activity changes in depressed ET patients. RESULTS Compared with the non-depressed ET patients, the depressed ET patients showed decreased ReHo in the bilateral cerebellum lobules IX, and increased ReHo in the bilateral anterior cingulate cortices and middle prefrontal cortices. Twenty-five significant changes of ReHo clusters were observed in the depressed ET patients compared with the HCs, and matrix FC analysis further revealed that inter-ROI FC differences were also observed in the frontal-cerebellar-anterior cingulate cortex pathway. Correlation analyses showed that clinical depression severity was positively correlated with the inter-ROI FC values between the anterior cingulate cortex and bilateral middle prefrontal cortices and was negatively correlated with the inter-ROI FC values of the anterior cingulate cortex and bilateral cerebellum lobules IX. CONCLUSION Our findings revealed local and inter-ROI FC differences in frontal-cerebellar-anterior cingulate cortex circuits in depressed ET patients, and among these regions, the cerebellum lobules IX, middle prefrontal cortices and anterior cingulate cortices could function as pathogenic structures underlying depression in ET patients.
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Affiliation(s)
- Xiyue Duan
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Zhou Fang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Li Tao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Huiyue Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xiaoyu Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yufen Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Hansheng Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Aotian Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xueyan Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Ya Pang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Min Gu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Jiahui Wu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Tianyou Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Oumei Cheng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jin Luo
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zheng Xiao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Weidong Fang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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