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Kosmowska B, Paleczna M, Biała D, Kadłuczka J, Wardas J, Witkin JM, Cook JM, Sharmin D, Marcinkowska M, Kuter KZ. GABA-A Alpha 2/3 but Not Alpha 1 Receptor Subunit Ligand Inhibits Harmaline and Pimozide-Induced Tremor in Rats. Biomolecules 2023; 13:biom13020197. [PMID: 36830567 PMCID: PMC9953228 DOI: 10.3390/biom13020197] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 01/20/2023] Open
Abstract
Treatment of tremors, such as in essential tremor (ET) and Parkinson's disease (PD) is mostly ineffective. Exact tremor pathomechanisms are unknown and relevant animal models are missing. GABA-A receptor is a target for tremorolytic medications, but current non-selective drugs produce side effects and have safety liabilities. The aim of this study was a search for GABA-A subunit-specific tremorolytics using different tremor-generating mechanisms. Two selective positive allosteric modulators (PAMs) were tested. Zolpidem, targeting GABA-A α1, was not effective in models of harmaline-induced ET, pimozide- or tetrabenazine-induced tremulous jaw movements (TJMs), while the novel GABA-A α2/3 selective MP-III-024 significantly reduced both the harmaline-induced ET tremor and pimozide-induced TJMs. While zolpidem decreased the locomotor activity of the rats, MP-III-024 produced small increases. These results provide important new clues into tremor suppression mechanisms initiated by the enhancement of GABA-driven inhibition in pathways controlled by α2/3 but not α1 containing GABA-A receptors. Tremor suppression by MP-III-024 provides a compelling reason to consider selective PAMs targeting α2/3-containing GABA-A receptors as novel therapeutic drug targets for ET and PD-associated tremor. The possibility of the improved tolerability and safety of this mechanism over non-selective GABA potentiation provides an additional rationale to further pursue the selective α2/3 hypothesis.
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Affiliation(s)
- Barbara Kosmowska
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna St., 31-343 Krakow, Poland
| | - Martyna Paleczna
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna St., 31-343 Krakow, Poland
| | - Dominika Biała
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna St., 31-343 Krakow, Poland
| | - Justyna Kadłuczka
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna St., 31-343 Krakow, Poland
| | - Jadwiga Wardas
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna St., 31-343 Krakow, Poland
| | - Jeffrey M. Witkin
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
- RespireRx Pharmaceuticals Inc., Glen Rock, NJ 07452, USA
| | - James M. Cook
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
- RespireRx Pharmaceuticals Inc., Glen Rock, NJ 07452, USA
| | - Dishary Sharmin
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Monika Marcinkowska
- Department of Pharmaceutical Chemistry, Jagiellonian University, Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Katarzyna Z. Kuter
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna St., 31-343 Krakow, Poland
- Correspondence: ; Tel.: +48-12-662-32-26
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Louis ED. Essential tremor. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:389-401. [PMID: 37620080 DOI: 10.1016/b978-0-323-98817-9.00012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Essential tremor (ET) is a chronic and progressive neurologic disease. Its central and defining clinical feature is a 4-12Hz kinetic tremor, that is, tremor that occurs during voluntary movements such as drinking from a cup or writing. Patients may also exhibit a range of other tremors-postural, rest, intention, additional motor features (e.g., mild gait ataxia, mild dystonia), as well as nonmotor features. The disease itself seems to be a risk factor for other degenerative diseases such as Alzheimer's disease and Parkinson's disease. Both genetic and toxic environmental factors have been explored as etiologic factors. In addition to a growing appreciation of the presence of clinical, etiologic, and pathologic heterogeneity, there is some support for the notion that ET itself may not be a single disease, but may be a family of diseases whose central defining feature is kinetic tremor of the arms, and which might more accurately be referred to as "the essential tremors." Recent research has increasingly placed the seat of the disease in the cerebellum and cerebellar system and identified a host of neurodegenerative changes within the cerebellum, indicating that this progressive disorder is likely degenerative.
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Affiliation(s)
- Elan D Louis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States.
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3
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Cheng F, Duan Y, Jiang H, Zeng Y, Chen X, Qin L, Zhao L, Yi F, Tang Y, Liu C. Identifying and distinguishing of essential tremor and Parkinson's disease with grouped stability analysis based on searchlight-based MVPA. Biomed Eng Online 2022; 21:81. [PMID: 36443843 PMCID: PMC9703788 DOI: 10.1186/s12938-022-01050-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Since both essential tremor (ET) and Parkinson's disease (PD) are movement disorders and share similar clinical symptoms, it is very difficult to recognize the differences in the presentation, course, and treatment of ET and PD, which leads to misdiagnosed commonly. PURPOSE Although neuroimaging biomarker of ET and PD has been investigated based on statistical analysis, it is unable to assist the clinical diagnosis of ET and PD and ensure the efficiency of these biomarkers. The aim of the study was to identify the neuroimaging biomarkers of ET and PD based on structural magnetic resonance imaging (MRI). Moreover, the study also distinguished ET from PD via these biomarkers to validate their classification performance. METHODS This study has developed and implemented a three-level machine learning framework to identify and distinguish ET and PD. First of all, at the model-level assessment, the searchlight-based machine learning method has been used to identify the group differences of patients (ET/PD) with normal controls (NCs). And then, at the feature-level assessment, the stability of group differences has been tested based on structural brain atlas separately using the permutation test to identify the robust neuroimaging biomarkers. Furthermore, the identified biomarkers of ET and PD have been applied to classify ET from PD based on machine learning techniques. Finally, the identified biomarkers have been compared with the previous findings of the biology-level assessment. RESULTS According to the biomarkers identified by machine learning, this study has found widespread alterations of gray matter (GM) for ET and large overlap between ET and PD and achieved superior classification performance (PCA + SVM, accuracy = 100%). CONCLUSIONS This study has demonstrated the significance of a machine learning framework to identify and distinguish ET and PD. Future studies using a large data set are needed to confirm the potential clinical application of machine learning techniques to discern between PD and ET.
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Affiliation(s)
- FuChao Cheng
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - YuMei Duan
- Department of Computer and Software, Chengdu Jincheng College, Chengdu, China
| | - Hong Jiang
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zeng
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - XiaoDan Chen
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - Ling Qin
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - LiQin Zhao
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - FaSheng Yi
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China ,Key Laboratory of Pattern Recognition and Intelligent Information Processing, Institutions of Higher Education of Sichuan Province, Chengdu, China
| | - YiQian Tang
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - Chang Liu
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
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4
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The differences in clinical characteristics and natural history between essential tremor and essential tremor plus. Sci Rep 2022; 12:7669. [PMID: 35538158 PMCID: PMC9091254 DOI: 10.1038/s41598-022-11775-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/29/2022] [Indexed: 11/08/2022] Open
Abstract
The diverse clinical manifestation of essential tremor (ET) has led to the question whether the different phenotypes may affect the clinical outcome and progression. This study aimed to estimate the clinical characteristics and natural history of ET and ET-plus. A total of 221 patients with ET were included, 117 (52.9%) reclassified as ET and 104 (47.1%) as ET-plus. Patients with ET-plus were significantly older in age at onset (P < 0.001); had a higher frequency of cranial tremors (P < 0.001), neurological comorbidities (P < 0.001) and psychiatric comorbidities (P = 0.025); more tremor progression (P < 0.001); and poorer response to medical treatment (P < 0.001) compared to ET patients. Regression analysis revealed that late-onset tremor (OR 11.02, 95% CI 2.79–43.53), neurological comorbidities (OR 3.38, 95% CI 1.56–7.31), psychiatric comorbidities (OR 4.29, 95% CI 1.48–12.44), cranial tremors (OR 2.10, 95% CI 1.02–4.30), and poor response to medical treatment (OR 3.67, 95% CI 1.87–7.19) were associated with ET-plus diagnosis. ET and ET-plus differ in the age of onset, tremor distribution, comorbidities, treatment response rate, and progression. Identifying the ET phenotypes may increase the clinical value in therapeutic strategies and clinical research in the future.
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Spathopoulou A, Edenhofer F, Fellner L. Targeting α-Synuclein in Parkinson's Disease by Induced Pluripotent Stem Cell Models. Front Neurol 2022; 12:786835. [PMID: 35145469 PMCID: PMC8821105 DOI: 10.3389/fneur.2021.786835] [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: 09/30/2021] [Accepted: 12/24/2021] [Indexed: 11/22/2022] Open
Abstract
Parkinson's disease (PD) is a progressive, neurodegenerative disorder characterized by motor and non-motor symptoms. To date, no specific treatment to halt disease progression is available, only medication to alleviate symptoms can be prescribed. The main pathological hallmark of PD is the development of neuronal inclusions, positive for α-synuclein (α-syn), which are termed Lewy bodies (LBs) or Lewy neurites. However, the cause of the inclusion formation and the loss of neurons remain largely elusive. Various genetic determinants were reported to be involved in PD etiology, including SNCA, DJ-1, PRKN, PINK1, LRRK2, and GBA. Comprehensive insights into pathophysiology of PD critically depend on appropriate models. However, conventional model organisms fall short to faithfully recapitulate some features of this complex disease and as a matter-of-fact access to physiological tissue is limiting. The development of disease models replicating PD that are close to human physiology and dynamic enough to analyze the underlying molecular mechanisms of disease initiation and progression, as well as the generation of new treatment options, is an important and overdue step. Recently, the establishment of induced pluripotent stem cell (iPSC)-derived neural models, particularly from genetic PD-variants, developed into a promising strategy to investigate the molecular mechanisms regarding formation of inclusions and neurodegeneration. As these iPSC-derived neurons can be generated from accessible biopsied samples of PD patients, they carry pathological alterations and enable the possibility to analyze the differences compared to healthy neurons. This review focuses on iPSC models carrying genetic PD-variants of α-syn that will be especially helpful in elucidating the pathophysiological mechanisms of PD. Furthermore, we discuss how iPSC models can be instrumental in identifying cellular targets, potentially leading to the development of new therapeutic treatments. We will outline the enormous potential, but also discuss the limitations of iPSC-based α-syn models.
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Kosmowska B, Wardas J. The Pathophysiology and Treatment of Essential Tremor: The Role of Adenosine and Dopamine Receptors in Animal Models. Biomolecules 2021; 11:1813. [PMID: 34944457 PMCID: PMC8698799 DOI: 10.3390/biom11121813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 12/13/2022] Open
Abstract
Essential tremor (ET) is one of the most common neurological disorders that often affects people in the prime of their lives, leading to a significant reduction in their quality of life, gradually making them unable to independently perform the simplest activities. Here we show that current ET pharmacotherapy often does not sufficiently alleviate disease symptoms and is completely ineffective in more than 30% of patients. At present, deep brain stimulation of the motor thalamus is the most effective ET treatment. However, like any brain surgery, it can cause many undesirable side effects; thus, it is only performed in patients with an advanced disease who are not responsive to drugs. Therefore, it seems extremely important to look for new strategies for treating ET. The purpose of this review is to summarize the current knowledge on the pathomechanism of ET based on studies in animal models of the disease, as well as to present and discuss the results of research available to date on various substances affecting dopamine (mainly D3) or adenosine A1 receptors, which, due to their ability to modulate harmaline-induced tremor, may provide the basis for the development of new potential therapies for ET in the future.
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Affiliation(s)
| | - Jadwiga Wardas
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology Polish Academy of Sciences, 31-343 Kraków, Poland;
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7
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Carmona-Almazan A, Dorantes-Mendez G, Rodriguez-Arellano JF, Mejia-Rodriguez AR. Triaxial Accelerometry Wireless System for Characterization of Parkinsonian Tremor. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7320-7323. [PMID: 34892788 DOI: 10.1109/embc46164.2021.9630367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Parkinsonian Tremor (PT) is the most common symptom of Parkinson's disease. Its early detection plays an important role in the diagnosis of the disease as it is often mistaken for another type of tremor, called Essential Tremor (ET). Accelerometry analysis has proven to be a trustworthy method for determining the frequency, amplitude, and occurrence of tremor. In addition, the use of portable and wearable sensors has increased due to the rapid growth of Internet of Things (IoT) technology, allowing data to be collected, processed, stored, and transmitted. In this paper, a wearable system consisting of a digital 3-axis accelerometer ADXL345 and micro-controller unit ESP32 was implemented to transmit accelerometry (ACC) signals from each upper limb simultaneously to a Graphical User Interface (GUI), that was developed in Python as an MQTT client, allowing the user to visualize both real-time and offline signals as well as to add markers to indicate events during the acquisition. Furthermore, this GUI is capable of performing an offline analysis consisting of the computing of Power Spectral Density (PSD) using Welch's method and a Spectrogram to visualize a time-frequency distribution of the ACC signals.
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8
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Parkinsonism and tremor syndromes. J Neurol Sci 2021; 433:120018. [PMID: 34686357 DOI: 10.1016/j.jns.2021.120018] [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: 04/21/2021] [Revised: 06/06/2021] [Accepted: 09/29/2021] [Indexed: 01/22/2023]
Abstract
Tremor, the most common movement disorder, may occur in isolation or may co-exist with a variety of other neurologic and movement disorders including parkinsonism, dystonia, and ataxia. When associated with Parkinson's disease, tremor may be present at rest or as an action tremor overlapping in phenomenology with essential tremor. Essential tremor may be associated not only with parkinsonism but other neurological disorders, suggesting the possibility of essential tremor subtypes. Besides Parkinson's disease, tremor can be an important feature of other parkinsonian disorders, such as atypical parkinsonism and drug-induced parkinsonism. In addition, tremor can be a prominent feature in patients with other movement disorders such as fragile X-associated tremor/ataxia syndrome, and Wilson's disease in which parkinsonian features may be present. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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9
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Hoq M, Uddin MN, Park SB. Vocal Feature Extraction-Based Artificial Intelligent Model for Parkinson's Disease Detection. Diagnostics (Basel) 2021; 11:diagnostics11061076. [PMID: 34208330 PMCID: PMC8231105 DOI: 10.3390/diagnostics11061076] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
As a neurodegenerative disorder, Parkinson’s disease (PD) affects the nerve cells of the human brain. Early detection and treatment can help to relieve the symptoms of PD. Recent PD studies have extracted the features from vocal disorders as a harbinger for PD detection, as patients face vocal changes and impairments at the early stages of PD. In this study, two hybrid models based on a Support Vector Machine (SVM) integrating with a Principal Component Analysis (PCA) and a Sparse Autoencoder (SAE) are proposed to detect PD patients based on their vocal features. The first model extracted and reduced the principal components of vocal features based on the explained variance of each feature using PCA. For the first time, the second model used a novel Deep Neural Network (DNN) of an SAE, consisting of multiple hidden layers with L1 regularization to compress the vocal features into lower-dimensional latent space. In both models, reduced features were fed into the SVM as inputs, which performed classification by learning hyperplanes, along with projecting the data into a higher dimension. An F1-score, a Mathews Correlation Coefficient (MCC), and a Precision-Recall curve were used, along with accuracy to evaluate the proposed models due to highly imbalanced data. With its highest accuracy of 0.935, F1-score of 0.951, and MCC value of 0.788, the probing results show that the proposed model of the SAE-SVM surpassed not only the former model of the PCA-SVM and other standard models including Multilayer Perceptron (MLP), Extreme Gradient Boosting (XGBoost), K-Nearest Neighbor (KNN), and Random Forest (RF), but also surpassed two recent studies using the same dataset. Oversampling and balancing the dataset with SMOTE boosted the performance of the models.
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Affiliation(s)
- Muntasir Hoq
- Department of Computer Science and Engineering, East Delta University, Chattogram 4209, Bangladesh;
| | - Mohammed Nazim Uddin
- Department of Computer Science and Engineering, East Delta University, Chattogram 4209, Bangladesh;
- Correspondence:
| | - Seung-Bo Park
- Department of Software Convergence Engineering, Inha University, Incheon 22201, Korea;
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10
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Choi SM, Cho SH, Kang KW, Kim JM, Kim BC. Family history of hand tremor in patients with early Parkinson's disease. J Clin Neurosci 2021; 90:161-164. [PMID: 34275543 DOI: 10.1016/j.jocn.2021.05.041] [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: 01/28/2021] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
Some patients with Parkinson's disease (PD) report hand tremors in their relatives. This study aimed to compare the clinical characteristics of early PD in patients with and without a family history of hand tremor. This study included 337 early and drug-naïve patients with PD. The family history of hand tremor was obtained from the patients and their caregivers. Motor and non-motor symptoms of PD were assessed using the appropriate scales. A family history of hand tremor was present in 27 of 337 patients with PD (8.0%). Patients with a family history of hand tremor had significantly higher scores for rest tremors than those without. No significant differences were found in action tremor, bradykinesia, rigidity, gait, or posture scores between the two groups. The proportion of tremor-dominant subtypes was higher in patients with a family history of hand tremor than in those without (51.8% vs. 28.7%). Patients with PD, with a family history of hand tremor, had significantly lower scores in the urinary and sexual subdomains of the Non-Motor Symptoms Scale for PD than in those without. A family history of hand tremor affects the motor and non-motor symptoms in patients with early PD. It is necessary to investigate the family history of hand tremor in patients with PD.
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Affiliation(s)
- Seong-Min Choi
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, South Korea; National Research Center for Dementia, Gwangju, South Korea
| | - Soo Hyun Cho
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Kyung Wook Kang
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Jae-Myung Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Byeong C Kim
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, South Korea; National Research Center for Dementia, Gwangju, South Korea.
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Can Plasma α-Synuclein Help Us to Differentiate Parkinson's Disease from Essential Tremor? Tremor Other Hyperkinet Mov (N Y) 2021; 11:20. [PMID: 34113478 PMCID: PMC8162285 DOI: 10.5334/tohm.600] [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] [Indexed: 01/20/2023] Open
Abstract
Background Studies have revealed controversial results regarding the diagnostic accuracy of plasma α-synuclein levels in patients with Parkinson's disease (PD). This study was aimed to analyze the diagnostic accuracy of plasma α-synuclein in PD versus healthy controls and patients with essential tremor (ET). Methods In this cross-sectional study, we included de novo (n = 19) and advanced PD patients [OFF (n = 33), and On (n = 35) states], patients with ET (n = 19), and controls (n = 35). The total plasma α-synuclein levels were determined using an ELISA sandwich method. We performed adjusted multivariate regression analysis to estimate the association of α-synuclein levels with group conditions [controls, ET, and de novo, OFF and ON-PD]. We studied the diagnostic accuracy of plasma α-synuclein using the area under the curve (AUC). Results The plasma α-synuclein levels were higher in controls compared to PD and ET (p < 0.0001), discriminating de novo PD from controls (AUC = 0.74, 95% CI 0.60-0.89), with a trend towards in advanced PD (OFF state) from ET (AUC = 0.69, 95% CI 0.53-0.84). Conclusions This is the first study examining and comparing plasma α-synuclein levels in ET vs. PD and controls. Preliminary findings suggest that plasma α-synuclein levels might help to discriminate de novo and advanced PD from controls and ET.
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12
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Wang X, Cao Z, Liu G, Liu Z, Jiang Y, Ma H, Wang Z, Yang Y, Chen H, Feng T. Clinical Characteristics and Electrophysiological Biomarkers of Parkinson's Disease Developed From Essential Tremor. Front Neurol 2020; 11:582471. [PMID: 33193041 PMCID: PMC7658334 DOI: 10.3389/fneur.2020.582471] [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: 07/12/2020] [Accepted: 09/22/2020] [Indexed: 01/16/2023] Open
Abstract
Background and Objective: Parkinson's disease developed from essential tremor (ET-PD) is a distinct clinical syndrome that is different from essential tremor (ET) and Parkinson's disease (PD). There is currently a lack of research on ET-PD. Tremor characteristics (amplitude and frequency) are primary quantitative indexes for diagnosing and monitoring of tremors. In this study, we aimed to explore specific clinical and electrophysiological biomarkers for the identification of ET-PD. Methods: The study included patients with ET-PD (n = 22), ET (n = 42), and tremor-dominant PD (t-PD, n = 47). We collected demographic data, clinical characteristics (including motor and non-motor symptoms), and tremor analysis. The frequency, amplitude, contracting patterns of resting tremor and postural tremor were collected. The analysis of ET-PD and ET/t-PD was compared. The receiver operating characteristic (ROC) curve was used to analyze the electrophysiological features in distinguishing ET-PD from ET or t-PD. Results: Compared with ET, hyposmia, bradykinesia, rigidity, postural abnormality, and resting tremor were more common in the ET-PD group (P = 0.01, 0.003, 0.001, 0.001, 0.019, respectively). The postural tremor frequencies of the head, upper limbs, and lower limbs were significantly lower in the ET-PD than in the ET (P = 0.007, 0.003, 0.035, respectively), which were the most appropriate variables for distinguishing ET-PD from ET (AUC: 0.775, 0.727, and 0.701, respectively). Compared with t-PD, bradykinesia, rigidity, postural abnormality (both P < 0.001), and resting tremor (P = 0.024) were less common in the ET-PD. The postural tremor amplitudes of the head and upper limbs were significantly higher in the ET-PD than in the t-PD (P = 0.022, 0.001, respectively), which were the most appropriate variables for distinguishing ET-PD from t-PD (AUC: 0.793 and 0.716). Conclusions: Hyposmia and electrophysiological biomarkers (postural tremor frequencies and amplitudes) help early recognition of ET-PD.
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Affiliation(s)
- Xuemei Wang
- Center for Movement Disorders Disease, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhentang Cao
- Center for Movement Disorders Disease, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Genliang Liu
- Center for Movement Disorders Disease, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhu Liu
- Center for Movement Disorders Disease, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ying Jiang
- Center for Movement Disorders Disease, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Huizi Ma
- Center for Movement Disorders Disease, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhan Wang
- Center for Movement Disorders Disease, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yaqin Yang
- Center for Movement Disorders Disease, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Huimin Chen
- Center for Movement Disorders Disease, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tao Feng
- Center for Movement Disorders Disease, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Parkinson's Disease Center, Beijing Institute for Brain Disorders, Beijing, China
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Is There Any Clinical Value of Adding 123I-Metaiodobenzylguanidine Myocardial Scintigraphy to 123I-Ioflupane (DaTscan) in the Differential Diagnosis of Parkinsonism? Clin Nucl Med 2020; 45:588-593. [PMID: 32404715 DOI: 10.1097/rlu.0000000000003098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the study is to evaluate the impact of myocardial I-metaiodobenzylguanidine (MIBG) in the diagnosis, clinical management, and differential diagnosis of Parkinson disease (PD) and non-PD parkinsonism. METHODS The study enrolled 41 patients with parkinsonism. An initial diagnosis was reached after thorough clinical and imaging evaluation. After 2 to 5 years of follow-up, a final diagnosis was established. All patients underwent, soon after their initial visit, presynaptic striatal DaT scintigraphy with I-FP-CIT (DaTscan) and I-MIBG myocardial scintigraphy. DaTscan is not specific to distinguish among different types of neurodegenerative parkinsonism. I-MIBG myocardial scintigraphy displays the functional status of cardiac sympathetic nerves, which is reduced in PD/dementia with Lewy bodies (DLB) and normal in atypical parkinsonian syndromes and secondary or nondegenerative parkinsonism. RESULTS No patients showed adverse effects during or after both scintigraphies. A positive DaTscan was found in all patients in the PD/DLB group (17/17) and in 15 of 24 patients in the non-PD group. Myocardial I-MIBG scintigraphy was associated with lower sensitivity (82% vs 100%) but higher specificity than DaTscan (79% vs 38%) in diagnosis PD/DLB from non-PD parkinsonism. A positive scan result on both techniques, to confirm diagnosis of PD/DLB, significantly improved the specificity of DaTscan, from 38% to 75%, with no reduction in sensitivity. CONCLUSIONS Myocardial I-MIBG imaging provides complementary value to I-FP-CIT in the proper diagnosis, treatment plan, and differential diagnosis between PD and other forms of parkinsonism.
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Váradi C. Clinical Features of Parkinson's Disease: The Evolution of Critical Symptoms. BIOLOGY 2020; 9:biology9050103. [PMID: 32438686 PMCID: PMC7285080 DOI: 10.3390/biology9050103] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/16/2020] [Indexed: 01/19/2023]
Abstract
Parkinson’s disease (PD) is a multi-attribute neurodegenerative disorder combining motor and nonmotor symptoms without well-defined diagnostic clinical markers. The presence of primary motor features (bradykinesia, rest tremor, rigidity and loss of postural reflexes) are the most characteristic signs of PD that are also utilized to identify patients in current clinical practice. The successful implementation of levodopa treatment revealed that nonmotor features are the main contributors of patient disability in PD, and their occurrence might be earlier than motor symptoms during disease progression. Targeted detection of prodromal PD symptoms can open up new possibilities in the identification of PD patients and provide potential patient populations for developing novel neuroprotective therapies. In this review, the evolution of critical features in PD diagnosis is described with special attention to nonmotor symptoms and their possible detection.
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Affiliation(s)
- Csaba Váradi
- Institute of Chemistry, Faculty of Materials Science and Engineering, University of Miskolc, 3515 Miskolc, Hungary
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15
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Tugcu B, Melikov A, Yildiz GB, Gökcal E, Ercan R, Uysal O, Ozdemir H. Evaluation of retinal alterations in Parkinson disease and tremor diseases. Acta Neurol Belg 2020; 120:107-113. [PMID: 31679150 DOI: 10.1007/s13760-019-01228-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
Abstract
Optical coherence tomography (OCT) has been suggested as a method for detection of retinal alterations in neurodegenerative diseases. The usefulness of OCT as a diagnostic tool to differentiate Parkinson's disease (PD) from other tremor diseases, remains unknown. We aimed to evaluate morphological changes of the retina in patients with PD, essential tremor (ET), essential tremor-Parkinson's disease (ET-PD) using OCT. Forty-two eyes of 21 patients with PD, 24 eyes of 12 patients with ET, 24 eyes of 12 patients with ET-PD and 44 eyes of 22 age-matched healthy controls were included in the study. All participants underwent detailed neurological and ophthalmological examination. Measurements in all quadrants of macula and retinal nerve fiber layer (RNFL) thickness using OCT were recorded. There was no significant difference among the groups regarding age, sex. The average RNFL thickness was thinner in PD patients than that of ET (p = 0.032). The RNFL thickness in superior quadrant was lower in PD group compared with the ET and control group (p = 0.001, p = 0.016). Significant differences were observed in most of the macular thickness parameters excluding foveolar and foveal thickness (p = 0.865, 0.394). Correlations were found among several OCT parameters and disease duration or severity in all patient groups (p > 0.05). Retinal alterations were found in PD patients compared to ET. However, no significant retinal changes were detected by OCT in patients with ET and ET-PD compared to controls. According to our data, retinal assessments by OCT do not seem to be satisfactory for differentiation of these disorders.
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Affiliation(s)
- Betul Tugcu
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakıf Üniversitesi Tıp Fakültesi, Bezmialem Vakif University, Göz Hastalıkları A.D. Adnan Menderes Bulvarı, 34093, Istanbul, Turkey.
| | - Arif Melikov
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakıf Üniversitesi Tıp Fakültesi, Bezmialem Vakif University, Göz Hastalıkları A.D. Adnan Menderes Bulvarı, 34093, Istanbul, Turkey
| | - Gulsen Babacan Yildiz
- Department of Neurology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Elif Gökcal
- Department of Neurology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Rukiye Ercan
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Omer Uysal
- Department of Medical Statistics and Informatics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Hakan Ozdemir
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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16
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Balestrino R, Schapira A. Parkinson disease. Eur J Neurol 2019; 27:27-42. [DOI: 10.1111/ene.14108] [Citation(s) in RCA: 382] [Impact Index Per Article: 76.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022]
Affiliation(s)
- R. Balestrino
- Department of Neuroscience University of Turin Turin Italy
| | - A.H.V. Schapira
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London UK
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Cardaioli G, Ripandelli F, Paolini Paoletti F, Nigro P, Simoni S, Brahimi E, Romoli M, Filidei M, Eusebi P, Calabresi P, Tambasco N. Substantia nigra hyperechogenicity in essential tremor and Parkinson's disease: a longitudinal study. Eur J Neurol 2019; 26:1370-1376. [PMID: 31094036 DOI: 10.1111/ene.13988] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/23/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Essential tremor (ET) and Parkinson's disease (PD) sometimes overlap in their clinical expression with ET preceding PD onset, often leading to misdiagnosis. Transcranial sonography (TCS) has been shown to be a valid and non-invasive diagnostic tool to identify early idiopathic PD and to differentiate it from ET. The purpose of this study was to investigate the relevance of substantia nigra hyperechogenicity in patients with ET. METHODS A total of 138 patients (79 with PD, 59 with ET) and 50 matched controls underwent TCS examination at baseline. All patients were followed in a 3-year longitudinal assessment. RESULTS A total of 10 subjects were excluded from the analysis due to the bilateral absence of a temporal acoustic window. During the follow-up period, 11 of the patients with ET developed new-onset parkinsonian features, without fulfilling criteria for PD diagnosis (ET+). Nine patients developed clinical features meeting diagnostic criteria for probable PD (ET-PD). Patients with ET- did not develop parkinsonian features. For each group, the maximum size of the substantia nigra hyperechogenicity was as follows: 5.62 ± 5.40 mm2 in the control group, 19.02 ± 14.27 mm2 in patients with PD, 9.15 ± 11.26 mm2 in patients with ET-, 20.05 ± 13.78 mm2 in patients with ET+ and 20.13 ± 13.51 mm2 in patients with ET-PD. ET-PD maximum values were significantly different from controls. Maximum values in patients with ET+ were different from both controls and patients with ET-. CONCLUSION Substantia nigra hyperechogenicity in ET seems to represent a risk marker for developing early parkinsonian symptoms or signs in the 3 years following TCS assessment.
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Affiliation(s)
- G Cardaioli
- Neurology Clinic, University of Perugia, Perugia, Italy
| | - F Ripandelli
- Neurology Clinic, University of Perugia, Perugia, Italy
| | | | - P Nigro
- Neurology Clinic, University of Perugia, Perugia, Italy
| | - S Simoni
- Neurology Clinic, University of Perugia, Perugia, Italy
| | - E Brahimi
- Neurology Clinic, University of Perugia, Perugia, Italy
| | - M Romoli
- Neurology Clinic, University of Perugia, Perugia, Italy
| | - M Filidei
- Neurology Clinic, University of Perugia, Perugia, Italy
| | - P Eusebi
- Neurology Clinic, University of Perugia, Perugia, Italy
| | - P Calabresi
- Neurology Clinic, University of Perugia, Perugia, Italy.,IRCCS, Fondazione Santa Lucia, Rome, Italy
| | - N Tambasco
- Neurology Clinic, University of Perugia, Perugia, Italy
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18
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Perez Akly MS, Stefani CV, Ciancaglini L, Bestoso JS, Funes JA, Bauso DJ, Besada CH. Accuracy of nigrosome-1 detection to discriminate patients with Parkinson's disease and essential tremor. Neuroradiol J 2019; 32:395-400. [PMID: 31149866 DOI: 10.1177/1971400919853787] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The use of susceptibility weighted imaging in high field magnetic resonance imaging scanners can detect the nigrosome-1 area located in the caudo-lateral region of the pars compacta in the substantia nigra. This structure comprises a significant amount of dopaminergic neurons and degenerates in the early stages of Parkinson's disease. Essential tremor is a neurological condition that in some cases could be confused with the early stages of Parkinson's disease with a possible error in clinical diagnosis. Our purpose is to evaluate the accuracy of nigrosome-1 detection by high resolution magnetic resonance imaging to discriminate Parkinson's disease from essential tremor. METHODS A case-control study compared patients with a clinical diagnosis of Parkinson's disease and essential tremor. Magnetic resonance imaging studies were performed using a 3T magnetic resonance imaging scanner. The susceptibility weighted imaging sequence was obtained in the axial plane with an isotropic voxel of 0.75 mm. Two independent neuroradiologists evaluated the images without access to clinical patient data. RESULTS Sixteen patients were included in each group (Parkinson's disease and essential tremor). Average age: Parkinson's disease group: 71.3 (SD 6.3) and essential tremor group: 68.3 (SD 12.3). For the first evaluator, the nigrosome-1 area was absent in 15 patients with Parkinson's disease and in two with essential tremor and for the second evaluator was absent in 15 patients with Parkinson's disease and four with essential tremor. The sensitivity/specificity for the diagnosis of Parkinson's disease was 93.75%/87.5% for the first evaluator and 93.75%/75% for the second evaluator. CONCLUSION The detection of the nigrosome-1 area is a useful tool in the differential diagnosis between Parkinson's disease and essential tremor, with high sensitivity and specificity.
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Affiliation(s)
- Manuel S Perez Akly
- Department of Diagnostic Imaging, Hospital Italiano de Buenos Aires, Argentina
| | - Carla V Stefani
- Department of Neurology, Hospital Italiano de Buenos Aires, Argentina
| | - Lucía Ciancaglini
- Department of Neurology, Hospital Italiano de Buenos Aires, Argentina
| | - José S Bestoso
- Department of Neurology, Hospital Italiano de Buenos Aires, Argentina
| | - Jorge A Funes
- Department of Diagnostic Imaging, Hospital Italiano de Buenos Aires, Argentina
| | - Diego J Bauso
- Department of Neurology, Hospital Italiano de Buenos Aires, Argentina
| | - Cristina H Besada
- Department of Diagnostic Imaging, Hospital Italiano de Buenos Aires, Argentina
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Luft F, Sharifi S, Mugge W, Schouten AC, Bour LJ, van Rootselaar AF, Veltink PH, Heida T. Deficits in tapping accuracy and variability in tremor patients. J Neuroeng Rehabil 2019; 16:54. [PMID: 31064378 PMCID: PMC6505201 DOI: 10.1186/s12984-019-0528-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/30/2019] [Indexed: 12/02/2022] Open
Abstract
Background The basal ganglia and cerebellum are brain structures involved in movement initiation, execution and termination. They are thought to be involved in the tremor generation and movement deficits in Parkinson’s disease (PD) and essential tremor (ET). Especially in PD, maintaining cyclic movement, such as walking or tapping can be significantly disturbed. Providing external cues improves timing of these movements in PD but its effect on ET has not yet been studied in depth. The aim of this study is to evaluate the usefulness of a bimanual tapping task as a tool during clinical decision making. Method Hand movements and tremor was recorded using accelerometers and EMG (m. extensor carpi ulnaris) from PD and ET patients and healthy controls during a bimanual tapping task as a way to distinguish PD from ET. All subjects performed the tapping task at two different frequencies, 2 Hz and 4 Hz, with and without the presence of auditory cues. Results No significant intra-group differences were found in the patient groups. Acceleration data revealed significantly less accurate tapping and more variable tapping in PD than in ET and healthy controls. ET subjects tapped less accurate and with a greater variability than healthy controls during the 4 Hz tapping task. Most interestingly the tapping accuracy improved in PD patients when kinetic tremor was recorded with EMG during the task. Conclusion Providing ET and PD patients with an external cue results in different tapping performances between patient groups and healthy controls. Furthermore, the findings suggest that kinetic tremor in PD enables patients to perform the task with a greater accuracy. So far this has not been shown in other studies.
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Affiliation(s)
- Frauke Luft
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands.
| | - Sarvi Sharifi
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Winfred Mugge
- Department of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Alfred C Schouten
- Department of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Lo J Bour
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne-Fleur van Rootselaar
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter H Veltink
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - Tijtske Heida
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
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Tarakad A, Jankovic J. Essential Tremor and Parkinson's Disease: Exploring the Relationship. Tremor Other Hyperkinet Mov (N Y) 2019; 8:589. [PMID: 30643667 PMCID: PMC6329774 DOI: 10.7916/d8md0gvr] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/04/2018] [Indexed: 12/31/2022] Open
Abstract
Background There is longstanding controversy surrounding the possible link between essential tremor (ET) and Parkinson's disease (PD). Inconsistent and unreliable diagnostic criteria may in part account for some of the difficulties in defining the relationship between these two common movement disorders. Methods References for this systematic review were identified using PubMed with the search terms "essential tremor" AND "Parkinson's disease" with articles published in English between 1960 and September 2018 included. Results In this review we provide evidence that some patients diagnosed with ET have an increased risk of developing PD years or decades after onset of action tremor. There are several still unresolved questions about the link between the two disorders including lack of verifiable diagnostic criteria for the two disorders and marked overlap in phenomenology. Here we review clinical, epidemiologic, imaging, pathologic, and genetic studies that address the ET-PD relationship. Several lines of evidence support the association between ET and PD, including overlapping motor and non-motor features, relatively high prevalence of rapid eye movement sleep behavior disorder (26-43%) in ET patients, increased prevalence of PD in patients with longstanding antecedent ET, increased prevalence of ET in family members of patients with PD, and the presence of Lewy bodies in the brains of some ET patients (15-24%). Discussion There is a substantial body of evidence supporting the association between ET and PD within at least a subset of patients, although the nature and possible pathogenic mechanisms of the relationship are not well understood.
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Affiliation(s)
- Arjun Tarakad
- Parkinson’s Disease Center and Movement Disorders Clinic, Baylor College of Medicine Houston, TX, USA
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Baylor College of Medicine Houston, TX, USA
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Roizenblatt M, Grupenmacher AT, Belfort Junior R, Maia M, Gehlbach PL. Robot-assisted tremor control for performance enhancement of retinal microsurgeons. Br J Ophthalmol 2018; 103:1195-1200. [DOI: 10.1136/bjophthalmol-2018-313318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 12/25/2022]
Abstract
Pars plana vitrectomy is a challenging, minimally invasive microsurgical procedure due to its intrinsic manoeuvres and physiological limits that constrain human capability. An important human limitation is physiological hand tremor, which can significantly increase the risk of iatrogenic retinal damage resulting from unintentional manoeuvres that affect anatomical and functional surgical outcomes. The limitations imposed by normal physiological tremor are more evident and challenging during ‘micron-scale’ manoeuvres such as epiretinal membrane and internal limiting membrane peeling, and delicate procedures requiring coordinated bimanual surgery such as tractional retinal detachment repair. Therefore, over the previous three decades, attention has turned to robot-assisted surgical devices to overcome these challenges. Several systems have been developed to improve microsurgical accuracy by cancelling hand tremor and facilitating faster, safer and more effective microsurgeries. By markedly reducing tremor, microsurgical precision is improved to a level beyond present human capabilities. In conclusion, robotics offers potential advantages over free-hand microsurgery as it is currently performed during ophthalmic surgery and opens the door to a new class of revolutionary microsurgical modalities. The skills transfer that is beyond human capabilities to robotic technology is a logical next step in microsurgical evolution.
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Vasechkin SV, Levin OS. [Diagnosis and management of essential tremor]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:64-72. [PMID: 30346436 DOI: 10.17116/jnevro201811806264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Essential tremor (ET) is the most common extrapyramidal disease and one of the most frequent neurological diseases. The main presentation of ET is a progressive bilateral (kinetic-postural) hand tremor. The prevalence in people over 65 years is 5%, it increases with age up to 22% in people over 95 years. About half of patients with ET have family history. The modern concepts of the pathogenesis, clinical features and differential diagnosis are considered. Possible methods of medical and surgical management are described.
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Affiliation(s)
- S V Vasechkin
- Centre of Extrapyramidal Diseases Department of Neurology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - O S Levin
- Centre of Extrapyramidal Diseases Department of Neurology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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23
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Pan MK, Ni CL, Wu YC, Li YS, Kuo SH. Animal Models of Tremor: Relevance to Human Tremor Disorders. Tremor Other Hyperkinet Mov (N Y) 2018; 8:587. [PMID: 30402338 PMCID: PMC6214818 DOI: 10.7916/d89s37mv] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/10/2018] [Indexed: 12/17/2022] Open
Abstract
Background Tremor is the most common movement disorder; however, the pathophysiology of tremor remains elusive. While several neuropathological alterations in tremor disorders have been observed in post-mortem studies of human brains, a full understanding of the relationship between brain circuitry alterations and tremor requires testing in animal models. Additionally, tremor animal models are critical for our understanding of tremor pathophysiology, and/or to serve as a platform for therapy development. Methods A PubMed search was conducted in May 2018 to identify published papers for review. Results The methodology used in most studies on animal models of tremor lacks standardized measurement of tremor frequency and amplitude; instead, these studies are based on the visual inspection of phenotypes, which may fail to delineate tremor from other movement disorders such as ataxia. Of the animal models with extensive tremor characterization, harmaline-induced rodent tremor models provide an important framework showing that rhythmic and synchronous neuronal activities within the olivocerebellar circuit can drive action tremor. In addition, dopamine-depleted monkey and mouse models may develop rest tremor, highlighting the role of dopamine in rest tremor generation. Finally, other animal models of tremor have involvement of the cerebellar circuitry, leading to altered Purkinje cell physiology. Discussion Both the cerebellum and the basal ganglia are likely to play a role in tremor generation. While the cerebellar circuitry can generate rhythmic movements, the nigrostriatal system is likely to modulate the tremor circuit. Tremor disorders are heterogeneous in nature. Therefore, each animal model may represent a subset of tremor disorders, which collectively can advance our understanding of tremor.
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Affiliation(s)
- Ming-Kai Pan
- Department of Medical Research, National Taiwan University, Taipei, TW
| | - Chun-Lun Ni
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Yeuh-Chi Wu
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Yong-Shi Li
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Arabia G, Lupo A, Manfredini LI, Vescio B, Nisticò R, Barbagallo G, Salsone M, Morelli M, Novellino F, Nicoletti G, Quattrone A, Cascini GL, Louis ED, Quattrone A. Clinical, electrophysiological, and imaging study in essential tremor-Parkinson's disease syndrome. Parkinsonism Relat Disord 2018; 56:20-26. [PMID: 29885986 DOI: 10.1016/j.parkreldis.2018.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/17/2018] [Accepted: 06/03/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Essential tremor-Parkinson's disease (ET-PD) syndrome is a clinical condition in which individuals with a long-lasting history of Essential tremor (ET) eventually develop Parkinson's disease (PD). The aim of the study was to investigate the accuracy performances of clinical, neurophysiological, and imaging biomarkers in differentiating patients affected by ET-PD syndrome from patients with ET or PD. METHODS Nineteen patients affected by ET-PD syndrome, 48 ET patients, and 37 tremor-dominant PD (t-PD) patients were included. Electrophysiological studies, including blink-reflex recovery cycle and tremor parameters analyses, were performed in all groups. Nigro-striatal and cardiac sympathetic denervation were also investigated. Sensitivity, specificity and accuracy of clinical, electrophysiological, and radiological features in differentiating ET-PD syndrome from ET and PD were calculated. RESULTS ET-PD patients had significantly lower rigidity (p = 0.007) and higher postural/kinetic tremor (p = 0.007) scores, in comparison to t-PD patients. ET-PD patients, differently from PD patients, had a synchronous pattern of resting tremor and, differently from ET patients, had abnormal blink-reflex recovery cycle. ET-PD patients also showed reduced nigro-striatal and cardiac sympathetic uptakes, albeit to a lesser extent than in PD patients. The highest accuracy values were found for the synchronous pattern of resting tremor (97.1%) in distinguishing ET-PD from PD, and for presence of abnormal blink-recovery cycle (100%) in distinguishing ET-PD syndrome from ET. CONCLUSION Our study demonstrates that some electrophysiological parameters, such as a synchronous resting tremor pattern and the abnormal blink-recovery cycle were the most accurate biomarkers in distinguishing patient with ET-PD syndrome from those with ET or those with PD.
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Affiliation(s)
- Gennarina Arabia
- Institute of Neurology, Department of Medical Sciences, University "Magna Graecia" of Catanzaro, Italy
| | - Angela Lupo
- Institute of Neurology, Department of Medical Sciences, University "Magna Graecia" of Catanzaro, Italy
| | - Lucia Ilaria Manfredini
- Institute of Neurology, Department of Medical Sciences, University "Magna Graecia" of Catanzaro, Italy
| | | | - Rita Nisticò
- Neuroimaging Research Unit, IBFM, National Research Council, Catanzaro, Italy
| | - Gaetano Barbagallo
- Institute of Neurology, Department of Medical Sciences, University "Magna Graecia" of Catanzaro, Italy
| | - Maria Salsone
- Neuroimaging Research Unit, IBFM, National Research Council, Catanzaro, Italy
| | - Maurizio Morelli
- Institute of Neurology, Department of Medical Sciences, University "Magna Graecia" of Catanzaro, Italy
| | - Fabiana Novellino
- Neuroimaging Research Unit, IBFM, National Research Council, Catanzaro, Italy
| | - Giuseppe Nicoletti
- Neuroimaging Research Unit, IBFM, National Research Council, Catanzaro, Italy
| | - Andrea Quattrone
- Institute of Neurology, Department of Medical Sciences, University "Magna Graecia" of Catanzaro, Italy
| | | | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Aldo Quattrone
- Neuroimaging Research Unit, IBFM, National Research Council, Catanzaro, Italy; Neuroscience Center, University "Magna Graecia" of Catanzaro, Italy.
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Schaeffer EL, Liu DY, Guerin J, Ahn M, Lee S, Asaad WF. A low-cost solution for quantification of movement during DBS surgery. J Neurosci Methods 2018; 303:136-145. [PMID: 29605668 DOI: 10.1016/j.jneumeth.2018.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/23/2018] [Accepted: 03/24/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND During the deep brain stimulation (DBS) electrode implantation operation with microelectrode recordings (MER) in awake patients, somatotopic testing and test stimulation are performed to improve electrode placement and provide the most beneficial symptom reduction possible, while minimizing side effects. As this procedure is commonly used to alleviate abnormal movements associated with Parkinson's disease (PD) and Essential Tremor (ET), intraoperative assessment of a patient's movements is critical to optimizing surgical benefit. However, despite its importance, movement assessment is typically subjective and qualitative. NEW METHOD Here, we present a detailed description of a low-cost, open-source system as a solution. RESULTS The described system measures movements intraoperatively and in synchrony with neurophysiological recordings for both online visualization and offline analysis. COMPARISON WITH EXISTING METHOD(S) Few movement quantification systems are designed to interface with intraoperative neurophysiological recordings; the widespread application of such systems may be limited by their cost and proprietary, closed-source nature. The system presented provides a low-cost, open-source alternative. CONCLUSIONS The system outlined in this work may improve the DBS procedure by adding valuable objectivity in movement quantification.
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Affiliation(s)
- Erin L Schaeffer
- Department of Neuroscience, Brown University, Providence, RI, 02903, United States
| | - Daniel Y Liu
- Department of Neuroscience, Brown University, Providence, RI, 02903, United States
| | - Julie Guerin
- Department of Neuroscience, Brown University, Providence, RI, 02903, United States
| | - Minkyu Ahn
- School of Computer Science and Electrical Engineering, Handong Global University, Pohang, 37554, South Korea
| | - Shane Lee
- Department of Neuroscience, Brown University, Providence, RI, 02903, United States; Brown Institute for Brain Science (BIBS), Brown University, Providence, RI, 02903, United States
| | - Wael F Asaad
- Department of Neuroscience, Brown University, Providence, RI, 02903, United States; Brown Institute for Brain Science (BIBS), Brown University, Providence, RI, 02903, United States; Department of Neurosurgery, The Warren Alpert Medical School, Providence, RI, 02903, United States; Department of Neuosurgry, Rhode Island Hospital, Providence, RI, 02903, United States; Norman Prince Neurosciences Institute, Lifespan, Providence, RI, 02903, United States.
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26
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Chen H, Yuan L, Song Z, Deng X, Yang Z, Gong L, Zi X, Deng H. Genetic Analysis of LRRK1 and LRRK2 Variants in Essential Tremor Patients. Genet Test Mol Biomarkers 2018; 22:398-402. [PMID: 29812962 DOI: 10.1089/gtmb.2017.0277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIMS Essential tremor (ET) is one of the most common adult-onset movement disorders. ET and Parkinson's disease (PD) overlap clinically and pathologically, which prompted this investigation into the association of PD risk variants in ET patients. This study was designed to explore the role of variants of two PD-related genes LRRK1 and LRRK2 in a Han Chinese ET population. MATERIALS AND METHODS Genetic analysis of LRRK1, rs2924835, and LRRK2, rs34594498, rs34410987, and rs33949390 variants was conducted on 200 Han Chinese patients with ET and 434 ethnically matched normal controls. RESULTS No statistically significant differences were identified in either genotypic or allelic frequencies of variants between the ET patients and the control cohort (all p > 0.05). Haplotype analysis of three LRRK2 variants (rs34594498, rs34410987, and rs33949390) showed no haplotypes displayed an association with ET risk (all p > 0.05). CONCLUSIONS The data suggest that LRRK1 variant (rs2924835) and LRRK2 variants (rs34594498, rs34410987, and rs33949390) are not associated with ET in this Han Chinese population.
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Affiliation(s)
- Han Chen
- 1 Department of Neurology, The Third Xiangya Hospital, Central South University , Changsha, China
| | - Lamei Yuan
- 2 Center for Experimental Medicine, The Third Xiangya Hospital, Central South University , Changsha, China
| | - Zhi Song
- 1 Department of Neurology, The Third Xiangya Hospital, Central South University , Changsha, China
| | - Xiong Deng
- 2 Center for Experimental Medicine, The Third Xiangya Hospital, Central South University , Changsha, China
| | - Zhijian Yang
- 2 Center for Experimental Medicine, The Third Xiangya Hospital, Central South University , Changsha, China
| | - Lina Gong
- 1 Department of Neurology, The Third Xiangya Hospital, Central South University , Changsha, China
| | - Xiaohong Zi
- 1 Department of Neurology, The Third Xiangya Hospital, Central South University , Changsha, China
| | - Hao Deng
- 1 Department of Neurology, The Third Xiangya Hospital, Central South University , Changsha, China .,2 Center for Experimental Medicine, The Third Xiangya Hospital, Central South University , Changsha, China
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Abstract
Essential tremor (ET) is a progressive and highly prevalent neurologic disease. Along with the tremors, mild to moderate gait ataxia and other signs of cerebellar dysfunction may occur (i.e., subtle saccadic eye movement abnormalities and abnormalities of motor timing) as well as cognitive features, some of which may be due to cerebellar dysfunction. Numerous neuroimaging studies indicate the presence of functional, metabolic, and structural abnormalities in the cerebellum of a patient with ET. In tandem with these clinical and imaging studies, which were gathering increasing support for the notion that the cerebellum and/or cerebellar systems seemed to be at the root of ET, a growing postmortem literature is for the first time beginning to identify microscopic abnormalities in the ET brain, most of which are centered on the Purkinje cells and connected neuronal populations, and are likely to be degenerative. In terms of treatment, most of these pharmacotherapeutic agents serve to enhance GABAergic neurotransmission, further bolstering the notion that ET may very well be a disorder with a primary Purkinje cell dysfunction resulting in reduced cerebellar cortical inhibition. Similarly, the interruption of presumably abnormal cerebellar outflow pathways to the thalamus is the mechanism of deep-brain stimulation surgery, which is highly effective in treating ET.
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Affiliation(s)
- Elan D Louis
- Department of Neurology and Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, United States; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States.
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Jagadeesan AJ, Murugesan R, Vimala Devi S, Meera M, Madhumala G, Vishwanathan Padmaja M, Ramesh A, Banerjee A, Sushmitha S, Khokhlov AN, Marotta F, Pathak S. Current trends in etiology, prognosis and therapeutic aspects of Parkinson's disease: a review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:249-262. [PMID: 29083328 PMCID: PMC6142835 DOI: 10.23750/abm.v88i3.6063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/01/2017] [Accepted: 02/06/2017] [Indexed: 02/07/2023]
Abstract
Parkinson's disease (PD) is a movement disorder, mainly affecting population consisting of the aged. PD occurs chiefly due to progressive loss of dopaminergic neurons in nigrostriatal pathway. Largely, PD patients suffer from non-motor symptoms, such as depression, anxiety, fatigue, and sleep disorders, that needs further investigation and addressing during PD research. Depression in PD is a predominant and complex symptom, and its pathology exists extrinsic to the nigrostriatal system. This disease can ultimately be managed by a combination of regular physiotherapy and proper medication. Taking together the present scenario of PD, including the nature of disease, characteristics, treatment, diagnosis of the patients with PD, these outcomes were reviewed to be explored along with many speech-based solutions to PD in this study. This neurodegenerative disorder needs advancement in research and development which can help patients with PD to lead a normal life.
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Nishimura Y, Tagawa M, Ito H, Tsuruma K, Hara H. Overcoming Obstacles to Drug Repositioning in Japan. Front Pharmacol 2017; 8:729. [PMID: 29075191 PMCID: PMC5641581 DOI: 10.3389/fphar.2017.00729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/28/2017] [Indexed: 12/12/2022] Open
Abstract
Drug repositioning (DR) is the process of identifying new indications for existing drugs. DR usually focuses on drugs that have cleared phase-I safety trials but has yet to show efficacy for the intended indication. Therefore, DR can probably skip the preclinical and phase-I study, which can reduce the cost throughout drug development. However, the expensive phase-II/III trials are required to establish efficacy. The obstacles to DR include identification of new indications with a high success rate in clinical studies, obtaining funding for clinical studies, patent protection, and approval systems. To tackle these obstacles, various approaches have been applied to DR worldwide. In this perspective, we provide representative examples of DR and discuss the ongoing efforts to overcome obstacles to DR in Japan.
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Affiliation(s)
- Yuhei Nishimura
- Department of Integrative Pharmacology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaaki Tagawa
- Medical Affairs, Sumitomo Dainippon Pharma Co., Ltd., Tokyo, Japan
| | - Hideki Ito
- Department of CNS Research, Otsuka Pharmaceutical Co., Ltd., Tokushima, Japan
| | - Kazuhiro Tsuruma
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Hideaki Hara
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
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30
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di Biase L, Brittain JS, Shah SA, Pedrosa DJ, Cagnan H, Mathy A, Chen CC, Martín-Rodríguez JF, Mir P, Timmerman L, Schwingenschuh P, Bhatia K, Di Lazzaro V, Brown P. Tremor stability index: a new tool for differential diagnosis in tremor syndromes. Brain 2017; 140:1977-1986. [PMID: 28459950 PMCID: PMC5493195 DOI: 10.1093/brain/awx104] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 03/06/2017] [Indexed: 11/12/2022] Open
Abstract
See Vidailhet et al. (doi:10.1093/brain/awx140) for a scientific commentary on this article. Misdiagnosis among tremor syndromes is common, and can impact on both clinical care and research. To date no validated neurophysiological technique is available that has proven to have good classification performance, and the diagnostic gold standard is the clinical evaluation made by a movement disorders expert. We present a robust new neurophysiological measure, the tremor stability index, which can discriminate Parkinson’s disease tremor and essential tremor with high diagnostic accuracy. The tremor stability index is derived from kinematic measurements of tremulous activity. It was assessed in a test cohort comprising 16 rest tremor recordings in tremor-dominant Parkinson’s disease and 20 postural tremor recordings in essential tremor, and validated on a second, independent cohort comprising a further 55 tremulous Parkinson’s disease and essential tremor recordings. Clinical diagnosis was used as gold standard. One hundred seconds of tremor recording were selected for analysis in each patient. The classification accuracy of the new index was assessed by binary logistic regression and by receiver operating characteristic analysis. The diagnostic performance was examined by calculating the sensitivity, specificity, accuracy, likelihood ratio positive, likelihood ratio negative, area under the receiver operating characteristic curve, and by cross-validation. Tremor stability index with a cut-off of 1.05 gave good classification performance for Parkinson’s disease tremor and essential tremor, in both test and validation datasets. Tremor stability index maximum sensitivity, specificity and accuracy were 95%, 95% and 92%, respectively. Receiver operating characteristic analysis showed an area under the curve of 0.916 (95% confidence interval 0.797–1.000) for the test dataset and a value of 0.855 (95% confidence interval 0.754–0.957) for the validation dataset. Classification accuracy proved independent of recording device and posture. The tremor stability index can aid in the differential diagnosis of the two most common tremor types. It has a high diagnostic accuracy, can be derived from short, cheap, widely available and non-invasive tremor recordings, and is independent of operator or postural context in its interpretation.
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Affiliation(s)
- Lazzaro di Biase
- Neurology Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy.,Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, OX3 9DU, Oxford, UK.,Medical Research Council Brain Network Dynamics Unit, Department of Pharmacology, University of Oxford, Mansfield Road, OX1 3TH, Oxford, UK
| | - John-Stuart Brittain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, OX3 9DU, Oxford, UK.,Medical Research Council Brain Network Dynamics Unit, Department of Pharmacology, University of Oxford, Mansfield Road, OX1 3TH, Oxford, UK
| | - Syed Ahmar Shah
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, OX3 9DU, Oxford, UK.,Medical Research Council Brain Network Dynamics Unit, Department of Pharmacology, University of Oxford, Mansfield Road, OX1 3TH, Oxford, UK
| | - David J Pedrosa
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, OX3 9DU, Oxford, UK.,Medical Research Council Brain Network Dynamics Unit, Department of Pharmacology, University of Oxford, Mansfield Road, OX1 3TH, Oxford, UK.,Department of Neurology, University Hospital of Cologne, Kerpener Straße 62, 50924 Cologne, Germany
| | - Hayriye Cagnan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, OX3 9DU, Oxford, UK.,Medical Research Council Brain Network Dynamics Unit, Department of Pharmacology, University of Oxford, Mansfield Road, OX1 3TH, Oxford, UK
| | - Alexandre Mathy
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, OX3 9DU, Oxford, UK
| | - Chiung Chu Chen
- Department of Neurology and Neuroscience Research Center, Chang Gung Memorial Hospital and University, Taipei, Taiwan
| | - Juan Francisco Martín-Rodríguez
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, OX3 9DU, Oxford, UK.,Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Lars Timmerman
- Department of Neurology, University Hospital of Cologne, Kerpener Straße 62, 50924 Cologne, Germany.,Department of Neurology, University Hospital Marburg, Germany
| | - Petra Schwingenschuh
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria
| | - Kailash Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, Queen Square, WC1N 3BG, London, UK
| | - Vincenzo Di Lazzaro
- Neurology Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Peter Brown
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, OX3 9DU, Oxford, UK.,Medical Research Council Brain Network Dynamics Unit, Department of Pharmacology, University of Oxford, Mansfield Road, OX1 3TH, Oxford, UK
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Surangsrirat D, Thanawattano C, Pongthornseri R, Dumnin S, Anan C, Bhidayasiri R. Support vector machine classification of Parkinson's disease and essential tremor subjects based on temporal fluctuation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:6389-6392. [PMID: 28269710 DOI: 10.1109/embc.2016.7592190] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tremor is a common symptom shared in both Parkinson's disease (PD) and Essential tremor (ET) subjects. The differential diagnosis of PD and ET tremor is important since the realization of treatment depends on specific medication. A novel feature is developed based on a hypothesis that tremor of PD subject has a larger fluctuation during resting than action task. Tremor signal is collected using a triaxial gyroscope sensor attached to subject's finger during kinetic and resting task. The angular velocity signal is analyzed by transforming a one-dimensional to two-dimensional signal using a relation of signal and its delay versions. Tremor fluctuation is defined as the area of 95% confidence ellipse covering the two-dimensional signal. The tremor fluctuation during kinetic and resting task is used as classification features. The support vector machine is used as a classifier and tested with 10-fold cross-validation. This novel feature provides a perfect PD/ET classification with 100% accuracy, sensitivity and specificity.
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Marsala SZ, Pistacchi M, Gioulis M, Ferracci F, Capus L. Clinical and Imaging Study of Isolated and Mixed Rest and Action Tremor-Essential Tremor versus Parkinson's Disease. Ann Indian Acad Neurol 2017; 20:138-141. [PMID: 28615899 PMCID: PMC5470149 DOI: 10.4103/aian.aian_497_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Some patients present an unusual association of both action tremor (AT) and rest tremor (RT) making the differential diagnosis between essential tremor (ET) and Parkinson's disease (PD) difficult. AIM To investigate this particular clinical picture trying to focus on possible peculiar clinical inferences. PATIENTS AND METHODS Twenty-three patients with atypical tremor syndrome were selected for the study. They underwent neurological examination, neuroimaging study, and brain DaTSCAN single-photon emission computed tomography. RESULTS Twenty-three patients were evaluated; 17 presented mixed-tremor syndrome, while six patients showed only isolated AT or RT. DaTSCAN was pathological in 19 patients and normal in 3 patients. The emerging statistical data highlighted a positive correlation between disease duration and DaTSCAN abnormalities; Fisher's exact test showed a marked difference in evolution toward a dysfunction of dopaminergic pathways in patients with both AT and RT phenotype. CONCLUSION The possible correlation between PD and ET has often been discussed without any clear findings. Are these patients suffering from ET prone to develop PD? Or are they the expression of a specific clinical phenotype? Our clinical survey has not led to absolute considerations; however, it seeks to highlight the clinical markers that might arouse the suspicion of extrapyramidal disease in patients with atypical tremor syndrome.
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Affiliation(s)
- Sandro Zambito Marsala
- Department of Neurology, Ospedale San Martino, Neurology Service, San Martino Hospital, Belluno, Italy
| | | | - Manuela Gioulis
- Department of Internal, Neurology Service, San Martino Hospital, Belluno, Italy
| | - Franco Ferracci
- Department of Internal, Neurology Service, San Martino Hospital, Belluno, Italy
| | - Livio Capus
- Department of Neurology, University of Trieste, Trieste, Italy
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Ryu DW, Lee SH, Oh YS, An JY, Park JW, Song IU, Lee KS, Kim JS. Clinical Characteristics of Parkinson’s Disease Developed from Essential Tremor. JOURNAL OF PARKINSONS DISEASE 2017; 7:369-376. [DOI: 10.3233/jpd-160992] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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34
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Lu MK, Chen CM, Duann JR, Ziemann U, Chen JC, Chiou SM, Tsai CH. Investigation of Motor Cortical Plasticity and Corticospinal Tract Diffusion Tensor Imaging in Patients with Parkinsons Disease and Essential Tremor. PLoS One 2016; 11:e0162265. [PMID: 27603204 PMCID: PMC5014415 DOI: 10.1371/journal.pone.0162265] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 08/21/2016] [Indexed: 01/29/2023] Open
Abstract
Parkinson's disease (PD) and essential tremor (ET) are characterized with motor dysfunctions. Motor circuit dysfunctions can be complementarily investigated by paired associative stimulation (PAS)-induced long-term potentiation (LTP)-like plasticity and diffusion tensor imaging (DTI) of the corticospinal tract (CST). Three groups of twelve subjects with moderate severity PD, ET with intention tremor and healthy controls (HC) were studied. The primary motor cortex (M1) excitability, measured by motor evoked potential (MEP) amplitude and by short-interval and long-interval intracortical inhibition (SICI and LICI) was compared between the three groups before and after PAS. The DTI measures of fractional anisotropy (FA) and mean diffusivity (MD) were acquired. PAS effects and DTI data were simultaneously examined between groups. PAS increased MEP amplitude in HC but not in PD and ET. SICI and LICI were significantly reduced after PAS irrespective of groups. No significant differences of the mean FA and MD were found between groups. There was no significant correlation between the PAS effects and the DTI measures. Findings suggest that both PD and ET with intention tremor have impairment of the associative LTP-like corticospinal excitability change in M1. The microstructure of the CST is not relevant to the deficiency of M1 associative plasticity in PD and ET.
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Affiliation(s)
- Ming-Kuei Lu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, Medical College, China Medical University, Taichung, Taiwan
- Graduate Institute of Neural and Cognitive Sciences, Medical College, China Medical University, Taichung, Taiwan
| | - Chun-Ming Chen
- Graduate Institute of Neural and Cognitive Sciences, Medical College, China Medical University, Taichung, Taiwan
- Department of Radiology, China Medical University Hospital, Taichung, Taiwan
| | - Jeng-Ren Duann
- Institute of Cognitive Neuroscience, National Central University, Zhongli, Taiwan
- Institute for Neural Computation, University of California San Diego, La Jolla, California, United States of America
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University, Tübingen, Germany
| | - Jui-Cheng Chen
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, Medical College, China Medical University, Taichung, Taiwan
- Graduate Institute of Neural and Cognitive Sciences, Medical College, China Medical University, Taichung, Taiwan
| | - Shang-Ming Chiou
- School of Medicine, Medical College, China Medical University, Taichung, Taiwan
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
| | - Chon-Haw Tsai
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, Medical College, China Medical University, Taichung, Taiwan
- Graduate Institute of Neural and Cognitive Sciences, Medical College, China Medical University, Taichung, Taiwan
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Yoon JH, Kim MS, Lee SM, Kim HJ, Hong JM. Heart rate variability to differentiate essential tremor from early-stage tremor-dominant Parkinson's disease. J Neurol Sci 2016; 368:55-8. [PMID: 27538602 DOI: 10.1016/j.jns.2016.06.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/30/2016] [Accepted: 06/27/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Essential tremor (ET) and Parkinson's disease (PD) are the most common movement disorders in the elderly, but it is difficult to differentiate ET from early-stage tremor-dominant Parkinson's disease (TDPD). METHODS We investigated heart rate variability (HRV) in 23 patients with ET, 27 patients with TDPD, and 23 healthy controls. HRV was determined using the RR intervals of a 5-min electrocardiogram recording. Measurements of beat-to-beat RR variability, including time domains [(standard deviation of the normal-to-normal RR interval (SDNN), and the root mean square difference of successive RR intervals (RMSSD)] and frequency domains [low-frequency (LF) and high-frequency (HF) components and total spectral power (TP)], were assessed retrospectively.x RESULTS In the TDPD group, SDNN, LF, HF, and TP were significantly lower than those in the ET group. In a receiver operating characteristic area under the curve (AUC) analysis, LF was the best potential diagnostic marker (AUC=0.87). CONCLUSION Non-invasive and routine electrocardiography may be helpful in differentiating ET from TDPD during the early disease stage.
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Affiliation(s)
- Jung Han Yoon
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea.
| | - Min Seung Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Sun Min Lee
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Hyun Jae Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
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Bouwmans AEP, Weber WEJ, Leentjens AFG, Mess WH. Transcranial sonography findings related to depression in parkinsonian disorders: cross-sectional study in 126 patients. PeerJ 2016; 4:e2037. [PMID: 27231659 PMCID: PMC4878362 DOI: 10.7717/peerj.2037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/23/2016] [Indexed: 12/02/2022] Open
Abstract
Background. Transcranial sonography (TCS) has emerged as a potential diagnostic tool for Parkinson’s disease. Recent research has suggested that abnormal echogenicity of substantia nigra, raphe nuclei and third ventricle is associated with increased risk of depression among these patients. We sought to reproduce these findings in an ongoing larger study of patients with parkinsonian syndromes. Methods. A total of 126 patients with parkinsonian symptoms underwent the Hamilton Depression Scale, and TCS of the substantia nigra (SN) (n = 126), the raphe nuclei (RN) (n = 80) and the third ventricle (n = 57). We then calculated the correlation between depression and hyper-echogenic SN, hypo-echogenic RN and a wider third ventricle. Results. In patients with PD we found no significant difference of the SN between non-depressed and depressed patients (46% vs. 22%; p = 0.18). Non-depressed patients with other parkinsonisms more often had hyperechogenicity of the SN than depressed patients (51% vs. 0%; p = 0.01). We found no relation between depression and the echogenicity of the RN or the width of the third ventricle. Conclusions. In patients with parkinsonian syndromes, we found no association between depression and hyper-echogenic SN, hypo-echogenic RN or a wider third ventricle, as determined by transcranial sonography.
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Affiliation(s)
| | - Wim E J Weber
- Department of Neurology, Maastricht University Medical Centre , Maastricht , Netherlands
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Centre , Maastricht , Netherlands
| | - Werner H Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Centre , Maastricht , Netherlands
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Hamed SA, Abdellah MM. The relationship between valproate induced tremors and circulating neurotransmitters: a preliminary study. Int J Neurosci 2016; 127:236-242. [PMID: 27161592 DOI: 10.1080/00207454.2016.1181631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Louis ED, Wise A, Alcalay RN, Rao AK, Factor-Litvak P. Essential tremor-Parkinson's disease: A double whammy. J Neurol Sci 2016; 366:47-51. [PMID: 27288775 DOI: 10.1016/j.jns.2016.04.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/29/2016] [Accepted: 04/22/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surprisingly little has been written about the combined clinical entity, essential tremor-Parkinson's disease (ET-PD), which is the result of a double disease hit. We carefully quantified tremor burden using a wide range of measures (tremor severity, tremor-related disability, tremor-related quality of life) and furthermore, studied additional motor and non-motor features in ET-PD. METHODS In this prospective, clinical-epidemiological study, we performed a standardized, structured clinical evaluation of 27 ET-PD patients, comparing them to age-matched samples of 35 PD and 109 ET patients. RESULTS The number of hours/day shaking was lowest in PD (median=3.0), intermediate in ET (median=10.0) and highest in ET-PD (median=14.0) (p<0.001). All measures of mobility and balance (Berg Balance test, Activities-specific Balance Confidence Scale, Timed Up and Go test) worsened across groups in a stepwise manner from ET to PD to ET-PD (p<0.05). Mini-mental state test scores worsened (p=0.002) and daytime sleepiness increased (p=0.002) across groups from ET to PD to ET-PD. CONCLUSIONS The ET-PD patient seems to be more than just a PD patient with a little more kinetic tremor. Aside from a significantly greater tremor burden, ET-PD patients exhibited more cognitive and sleep problems and more mobility and balance problems than patients with isolated PD.
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Affiliation(s)
- Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Adina Wise
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Roy N Alcalay
- Program in Physical Therapy, Department of Rehabilitation & Regenerative Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ashwini K Rao
- Program in Physical Therapy, Department of Rehabilitation & Regenerative Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA; G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Herrnstadt G, Menon C. Voluntary-Driven Elbow Orthosis with Speed-Controlled Tremor Suppression. Front Bioeng Biotechnol 2016; 4:29. [PMID: 27066477 PMCID: PMC4814799 DOI: 10.3389/fbioe.2016.00029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/17/2016] [Indexed: 12/04/2022] Open
Abstract
Robotic technology is gradually becoming commonplace in the medical sector and in the service of patients. Medical conditions that have benefited from significant technological development include stroke, for which rehabilitation with robotic devices is administered, and surgery assisted by robots. Robotic devices have also been proposed for assistance of movement disorders. Pathological tremor, among the most common movement disorders, is one such example. In practice, the dissemination and availability of tremor suppression robotic systems has been limited. Devices in the marketplace tend to either be non-ambulatory or to target specific functions, such as eating and drinking. We have developed a one degree-of-freedom (DOF) elbow orthosis that could be worn by an individual with tremor. A speed-controlled, voluntary-driven suppression approach is implemented with the orthosis. Typically tremor suppression methods estimate the tremor component of the signal and produce a canceling counterpart signal. The suggested approach instead estimates the voluntary component of the motion. A controller then actuates the orthosis based on the voluntary signal, while simultaneously rejecting the tremorous motion. In this work, we tested the suppressive orthosis using a one DOF robotic system that simulates the human arm. The suggested suppression approach does not require a model of the human arm. Moreover, the human input along with the orthosis forearm gravitational forces, of non-linear nature, are considered as part of the disturbance to the suppression system. Therefore, the suppression system can be modeled linearly. Nevertheless, the orthosis forearm gravitational forces can be compensated by the suppression system. The electromechanical design of the orthosis is presented, and data from an essential tremor patient is used as the human input. Velocity tracking results demonstrate an RMS error of 0.31 rad/s, and a power spectral density shows a reduction of the tremor signal by 99.8%, while the intentional component power was reduced by <1%.
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Affiliation(s)
- Gil Herrnstadt
- MENRVA Lab, Engineering Science Department, Simon Fraser University , Burnaby, BC , Canada
| | - Carlo Menon
- MENRVA Lab, Engineering Science Department, Simon Fraser University , Burnaby, BC , Canada
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The relationship between essential tremor and Parkinson's disease. Parkinsonism Relat Disord 2016; 22 Suppl 1:S162-5. [DOI: 10.1016/j.parkreldis.2015.09.032] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 09/13/2015] [Accepted: 09/15/2015] [Indexed: 11/18/2022]
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Lafo JA, Jones JD, Okun MS, Bauer RM, Price CC, Bowers D. Memory Similarities Between Essential Tremor and Parkinson's Disease: A Final Common Pathway? Clin Neuropsychol 2015; 29:985-1001. [PMID: 26689342 DOI: 10.1080/13854046.2015.1118553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE A growing body of literature supports the view that essential tremor (ET) involves alteration of cerebellar-thalamo-cortical networks which can result in working memory and executive deficits. In this study, we tested the hypothesis that individuals with ET would exhibit worse performance on memory tasks requiring more intrinsic organization and structuring (i.e., word lists) relative to those with fewer 'executive' demands (i.e., stories), similar to that previously observed in individuals with Parkinson's disease (PD). METHOD Participants included a convenience sample of 68 ET patients and 68 idiopathic PD patients, retrospectively matched based on age, education, and sex. All patients underwent routine neuropsychological evaluation assessing recent memory, auditory attention/working memory, language, and executive function. Memory measures included the Hopkins Verbal Learning Test-R and WMS-III Logical Memory. RESULTS Both ET and PD patients performed significantly worse on word list than story memory recall tasks. The magnitude of the difference between these two memory tasks was similar for ET and PD patients. In both patient groups, performance on measures of executive function and auditory attention/working memory was not distinctly correlated with word list vs. story recall. CONCLUSIONS These findings suggest that frontal-executive dysfunction in both ET and PD may negatively influence performance on memory tests that are not inherently organized. Although the pathophysiology of these two 'movement disorders' are quite distinct, both have downstream effects on thalamo-frontal circuitry which may provide a common pathway for a similar memory phenotype. Findings are discussed in terms of neuroimaging evidence, conceptual models, and best practice.
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Affiliation(s)
- Jacob A Lafo
- a Department of Clinical and Health Psychology, College of Public Health & Health Professions , University of Florida , Gainesville , FL , USA.,c Center for Movement Disorders and Neurorestoration , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA
| | - Jacob D Jones
- a Department of Clinical and Health Psychology, College of Public Health & Health Professions , University of Florida , Gainesville , FL , USA.,c Center for Movement Disorders and Neurorestoration , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA
| | - Michael S Okun
- b Department of Neurology , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA.,c Center for Movement Disorders and Neurorestoration , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA
| | - Russell M Bauer
- a Department of Clinical and Health Psychology, College of Public Health & Health Professions , University of Florida , Gainesville , FL , USA.,c Center for Movement Disorders and Neurorestoration , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA
| | - Catherine C Price
- a Department of Clinical and Health Psychology, College of Public Health & Health Professions , University of Florida , Gainesville , FL , USA.,c Center for Movement Disorders and Neurorestoration , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA
| | - Dawn Bowers
- b Department of Neurology , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA.,c Center for Movement Disorders and Neurorestoration , University of Florida College of Medicine, University of Florida , Gainesville , FL , USA
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Ghika A, Kyrozis A, Potagas C, Louis ED. Motor and Non-motor Features: Differences between Patients with Isolated Essential Tremor and Patients with Both Essential Tremor and Parkinson's Disease. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2015; 5:335. [PMID: 26336614 PMCID: PMC4548968 DOI: 10.7916/d83777wk] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/08/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patients with essential tremor (ET) who develop Parkinson's disease (PD) (i.e., ET→PD) may differ with respect to motor features (MFs) and non-motor features (NMFs) from patients with isolated ET. Few studies have assessed this issue. METHODS In this retrospective chart review, we analyzed data on MFs and NMFs of 175 patients, including 54 ET→PD and 121 ET, actively followed in the Athens University 1st Neurology Department. RESULTS Significantly more ET→PD than ET patients reported asymmetric tremor at ET onset (68.5% vs. 14.9%, p<0.001). Significantly more ET than ET→PD patients had head tremor (43.5% vs. 13.2%, p<0.001) and cerebellar signs (41.3% vs. 9.3%, p<0.001). More ET than ET→PD patients reported hearing impairment (65.3% vs. 28.3%, p<0.001) and restless legs syndrome (34.8% vs. 3.7%, p<0.001). Conversely, a larger proportion of ET→PD than ET patients reported rapid eye movement behavior disorder (51.9% vs. 10.0%, p<0.001), constipation (67.9% vs. 36.4%, p<0.001), and olfactory dysfunction (83.3% vs. 36.4%, p<0.001). DISCUSSION The subset of ET→PD patients may have distinct MFs and NMFs that should be assessed further for the possible predictive value for the emergence of PD.
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Affiliation(s)
- Apostolia Ghika
- 1st Neurology Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Kyrozis
- 1st Neurology Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Potagas
- 1st Neurology Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA ; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA ; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
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Waln O, Wu Y, Perlman R, Wendt J, Van AK, Jankovic J. Dopamine transporter imaging in essential tremor with and without parkinsonian features. J Neural Transm (Vienna) 2015; 122:1515-21. [PMID: 26133163 DOI: 10.1007/s00702-015-1419-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/22/2015] [Indexed: 12/16/2022]
Abstract
Mild parkinsonian features can be observed in patients with essential tremor (ET). Although dopamine transporter (DAT) imaging is usually normal in ET, some studies found mild dopaminergic deficit in ET patients compared to healthy controls (HC). We analyzed clinical and DAT imaging data in ET patients with and without parkinsonian features. Thirty-nine ET patients with and without parkinsonian features and 13 HC underwent detailed examination by a movement disorders neurologist and 123-I ioflupane SPECT. Two independent radiologists "blinded" to the clinical diagnosis analyzed images visually and by semi-quantitative calculation of striatal binding ratios in different volumes of interests. ET patients were divided into pure ET group (no parkinsonian features, n = 22), ET-P [one parkinsonian feature not sufficient for the clinical diagnosis of Parkinson's disease (PD), n = 9], and ET + PD (two or more parkinsonian features meeting diagnostic criteria for PD, n = 8). As expected, ET + PD patients had the lowest striatal binding ratios. We also found a trend toward slightly lower striatal binding ratios in ET patients ET compared to HC, especially in caudate nucleus. There was no significant correlation between striatal binding ratios, ET severity or duration. Patients with ET and parkinsonian features represent a heterogeneous group that includes ET + PD and ET-P. The latter group shares some clinical features with PD but has no dopaminergic deficit on DAT imaging as determined by visual image interpretation. On the other hand, minimal dopaminergic deficit (as compared to controls) is detected in some ET patients with semi-quantitative image analysis, although the pattern may be different from that of PD.
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Affiliation(s)
- Olga Waln
- Department of Neurology, Methodist Neurological Institute, Houston, TX, USA.
| | - Ying Wu
- Department of Radiology, NorthShore University Health System, Evanston, IL, USA.,Department of Radiology, Pritzker School of Medicine, Chicago, IL, USA
| | - Reid Perlman
- Department of Radiology, NorthShore University Health System, Evanston, IL, USA.,Department of Radiology, Pritzker School of Medicine, Chicago, IL, USA
| | - Juliet Wendt
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Anh K Van
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorder Clinic, Baylor College of Medicine, 7200 Cambridge, Suite 9A, MS: BCM 609, Houston, TX, 77030-4202, USA.
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Andrews JL, Fernandez-Enright F. A decade from discovery to therapy: Lingo-1, the dark horse in neurological and psychiatric disorders. Neurosci Biobehav Rev 2015; 56:97-114. [PMID: 26143511 DOI: 10.1016/j.neubiorev.2015.06.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 05/15/2015] [Accepted: 06/02/2015] [Indexed: 01/19/2023]
Abstract
Leucine-rich repeat and immunoglobulin domain-containing protein (Lingo-1) is a potent negative regulator of neuron and oligodendrocyte survival, neurite extension, axon regeneration, oligodendrocyte differentiation, axonal myelination and functional recovery; all processes highly implicated in numerous brain-related functions. Although playing a major role in developmental brain functions, the potential application of Lingo-1 as a therapeutic target for the treatment of neurological disorders has so far been under-estimated. A number of preclinical studies have shown that various methods of antagonizing Lingo-1 results in neuronal and oligodendroglial survival, axonal growth and remyelination; however to date literature has only detailed applications of Lingo-1 targeted therapeutics with a focus primarily on myelination disorders such as multiple sclerosis and spinal cord injury; omitting important information regarding Lingo-1 signaling co-factors. Here, we provide for the first time a complete and thorough review of the implications of Lingo-1 signaling in a wide range of neurological and psychiatric disorders, and critically examine its potential as a novel therapeutic target for these disorders.
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Affiliation(s)
- Jessica L Andrews
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, NSW, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong 2522, NSW, Australia; Schizophrenia Research Institute, 405 Liverpool St, Darlinghurst 2010, NSW, Australia.
| | - Francesca Fernandez-Enright
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong 2522, NSW, Australia; Faculty of Social Sciences, University of Wollongong, Wollongong 2522, NSW, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong 2522, NSW, Australia; Schizophrenia Research Institute, 405 Liverpool St, Darlinghurst 2010, NSW, Australia.
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Georgiopoulos C, Davidsson A, Engström M, Larsson EM, Zachrisson H, Dizdar N. The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes. J Neurol 2015; 262:2154-63. [PMID: 26122543 DOI: 10.1007/s00415-015-7830-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/10/2015] [Accepted: 06/17/2015] [Indexed: 11/27/2022]
Abstract
The aim of the study was to compare the efficacy of olfactory testing and presynaptic dopamine imaging in diagnosing Parkinson's disease (PD) and atypical parkinsonian syndromes (APS); to evaluate if the combination of these two diagnostic tools can improve their diagnostic value. A prospective investigation of 24 PD patients, 16 APS patients and 15 patients with non-parkinsonian syndromes was performed during an 18-month period. Single photon emission computed tomography with the presynaptic radioligand (123)I-FP-CIT (DaTSCAN(®)) and olfactory testing with the Brief 12-item Smell Identification Test (B-SIT) were performed in all patients. DaTSCAN was analysed semi-quantitatively, by calculating two different striatal uptake ratios, and visually according to a predefined ranking scale. B-SIT score was significantly lower for PD patients, but not significantly different between APS and non-parkinsonism. The visual assessment of DaTSCAN had higher sensitivity, specificity and diagnostic accuracy compared to olfactory testing. Most PD patients (75%) had visually predominant dopamine depletion in putamen, while most APS patients (56%) had visually severe dopamine depletion both in putamen and in caudate nucleus. The combination of DaTSCAN and B-SIT led to a higher rate of correctly classified patients. Olfactory testing can distinguish PD from non-parkinsonism, but not PD from APS or APS from non-parkinsonism. DaTSCAN is more efficient than olfactory testing and can be valuable in differentiating PD from APS. However, combining olfactory testing and DaTSCAN imaging has a higher predictive value than these two methods separately.
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Affiliation(s)
- Charalampos Georgiopoulos
- Department of Radiology, Linköping University, 581 85, Linköping, Sweden. .,Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden. .,Center for Medical Image Science and Visualization (CMIV), Linköping University, 581 85, Linköping, Sweden.
| | - Anette Davidsson
- Department of Clinical Physiology, Linköping University, 581 85, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden
| | - Maria Engström
- Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, 581 85, Linköping, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences/Radiology, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden
| | - Helene Zachrisson
- Department of Clinical Physiology, Linköping University, 581 85, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden
| | - Nil Dizdar
- Department of Neurology, Linköping University, 581 85, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, 581 85, Linköping, Sweden
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Louis ED, Rohl B, Collins K, Cosentino S. Poorer Cognitive Performance in Patients with Essential Tremor-Parkinson's Disease vs. Patients with Parkinson's Disease. Front Neurol 2015; 6:106. [PMID: 26042084 PMCID: PMC4435069 DOI: 10.3389/fneur.2015.00106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/28/2015] [Indexed: 11/17/2022] Open
Abstract
Background Patients with essential tremor (ET) seem to be at increased risk of developing Parkinson’s disease (PD). Surprisingly, little has been written about this clinical entity, ET-PD. Cognitive dysfunction is a well-known feature of PD, and can also be an issue in patients with ET. Whether the presence of the combined diagnosis, ET-PD, is associated with additive cognitive effects as compared with PD has not been studied. Methods Thirty ET-PD patients and 53 age-matched PD patients were enrolled in a clinical-epidemiological study. Two cognitive screens, the Telephone Interview for Cognitive Status (TICS, score = 0–41) and Folstein Mini-Mental State Examination (MMSE; range 0–30), were administered. Results The MMSE score was lower in ET-PD than PD [26.5 ± 3.1 (median 28.0) vs. 28.4 ± 2.2 (median 29.0), p = 0.001]. The TICS score was lower in ET-PD than PD [31.7 ± 3.9 (32.0) vs. 35.0 ± 2.0 (35.0), p < 0.001]. Subscores of these tests that related to orientation (p < 0.001), language (p < 0.001), and working memory (p = 0.001) were lower in ET-PD than PD, whereas the delayed memory subscore was only marginally lower in ET-PD than PD (p = 0.06), and the two groups did not differ with respect to the motor/construction subscore (p = 0.22). Both global cognitive scores were inversely correlated with disease duration (for MMSE score, Spearman’s r = −0.46, p < 0.001; for TICS score, Spearman’s r = −0.53, p < 0.001). Conclusion The combined diagnosis, ET-PD, seemed to be associated with additive cognitive effects as compared with PD alone.
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Affiliation(s)
- Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University , New Haven, CT , USA ; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University , New Haven, CT , USA
| | - Brittany Rohl
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University , New Haven, CT , USA
| | - Kathleen Collins
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University , New Haven, CT , USA
| | - Stephane Cosentino
- Department of Neurology, College of Physicians and Surgeons, Columbia University , New York, NY , USA ; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University , New York, NY , USA
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News and controversies regarding essential tremor. Rev Neurol (Paris) 2015; 171:415-25. [DOI: 10.1016/j.neurol.2015.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/01/2015] [Accepted: 02/02/2015] [Indexed: 01/08/2023]
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Štenc Bradvica I, Mihaljević I, Butković-Soldo S, Kadojić D, Titlić M, Bradvica M, Kralik K. Transcranial sonography and the pocket smell test in the differential diagnosis between parkinson's disease and essential tremor. Neurol Sci 2015; 36:1403-10. [PMID: 25787809 DOI: 10.1007/s10072-015-2152-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/05/2015] [Indexed: 11/29/2022]
Abstract
The aim of this study was to determine the specificity and sensitivity of transcranial sonography (TCS) and the Pocket Smell Test (PST) in differing Parkinson's disease from essential tremor. The results were compared with the dopamin transporter scan (DaTSCAN) findings. Based on the DaTSCAN finding we formed a group of patients with essential tremor (51 patients) and a group with the Parkinson's disease (59 patients). The control group consisted of 26 healthy one. To evaluate the olfactory dysfunction the PST was used, whereas by TCS the substantia nigra hyperechogenicity was marked. The sensitivity and specificity of each diagnostic method was statistically calculated. In confirming Parkinson's disease the specificity of TCS was 88.2 % and the sensitivity 94.9 %. The specificity of PST was 80.4 % whereas the sensitivity was 74.6 %. TCS and PST should be performed to evaluate which patients need to be examined by DaTSCAN.
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Affiliation(s)
- Ivanka Štenc Bradvica
- Department of Neurology, Faculty of Medicine, Osijek University Hospital, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia,
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Thanawattano C, Anan C, Pongthornseri R, Dumnin S, Bhidayasiri R. Temporal fluctuation analysis of tremor signal in Parkinson's disease and Essential tremor subjects. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:6054-6057. [PMID: 26737672 DOI: 10.1109/embc.2015.7319772] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tremor is a common symptom shared in both Parkinson's disease (PD) and Essential tremor (ET) subjects. The differential diagnosis of PD and ET tremor is important since the treatment depends on specific medication. A novel feature was developed based on a hypothesis stating that the tremor of PD subject has a larger fluctuation while performing resting task than action task. Tremor signal was collected using a gyroscope sensor attached to subject's finger. The angular velocity signal was analyzed by transforming a one-dimensional to two-dimensional signal based on relation of different units of time-delay. The tremor fluctuation was defined as the area of 95% confidence ellipse covering the two-dimensional signal. Experimenting with 32 PD and 20 ET subjects, a ratio of fluctuation of resting to kinetic task can be a sensitive feature to discriminate PD from ET with 100% accuracy.
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Benge J, Phillips-Sabol J, Phenis R. The neuropsychological assessment battery categories test as a measure of executive dysfunction in patients with Parkinson's disease and essential tremor: an exploratory study. Clin Neuropsychol 2014; 28:1008-18. [PMID: 25181389 DOI: 10.1080/13854046.2014.950985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Patients with Parkinson's disease (PD) and essential tremor (ET) can experience deficits in executive functioning (EF) secondary to abnormalities in fronto-striatal and cerebellar-frontal pathways respectively. The assessment of EF can be confounded in these patients due to motor difficulties and slowed processing speed. Thus, instruments which do not require speeded motor responses are potentially attractive in this population. The Neuropsychological Assessment Battery-Categories Test (NABCAT) is one such instrument. This study evaluated the convergent and divergent validity of this measure as well as its diagnostic accuracy in comparison to other commonly administered tests. Records for 28 patients with PD and/or ET who presented for evaluation pre-deep brain stimulation surgery were analyzed. The NABCAT had modest correlations with other measures of EF, as well as memory. However, it demonstrated relatively poor sensitivity and modest specificity to executive dysfunction. The NABCAT did not demonstrate adequate psychometric properties to replace traditional measures of EF in this population; however, it may have utility as a screening instrument for more significant dysfunction.
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Affiliation(s)
- Jared Benge
- a Baylor Scott & White Neurosciences Institute and Plummer Movement Disorders Center , Temple , TX 76508 , USA
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