Digitized spiral analysis may be a potential biomarker for brachial dystonia

Spiral drawing: Quantitative analysis and artificial-intelligence-based diagnosis using a smartphone

BACKGROUND

The evaluation of neurological examination in clinical practice still remains qualitative or semi-quantitative, and the results often vary depending on an examiner's skill level and are less objective. In this study, we developed a smartphone-based application to investigate quantifying neurological examinations using hand-drawn spirals and diagnose patients with tremor using artificial intelligence (AI).

METHODS

This study included 24 and 26 patients with essential tremor (ET) and cerebellar disease (CD), respectively, and 41 age-matched normal controls (NCs). We obtained 69, 46, and 56 hand-drawn spirals from the NC, ET, and CD groups, respectively, as image data captured by smartphones. The patients traced a printed reference spiral. The length of this spiral was compared with the reference spiral length (% of spiral length) and the total deviation area between these spirals was calculated. The server also estimates the diagnostic probability through AI.

RESULTS

The quantified spiral analysis (% of spiral length and deviation area) significantly correlated with disease severity in each disease group, and significant differences in the deviation area were observed among all groups. The AI diagnosis showed 79%, 70%, and 73% accuracies for the NC, ET, and CD groups, respectively.

CONCLUSION

This study indicates the possibility of using a smartphone as a medical examination tool and demonstrates the application of AI in neurological examinations.

Holmes Tremor due to Artery of Percheron Infarct: Clinical Case and Treatment Using Deep Brain Stimulation of the Vim and ZI Targets

BACKGROUND

Holmes tremor (HT) arises from disruption of the cerebellothalamocortical pathways. A lesion can interrupt the projection at any point, resulting in this tremor. We describe a case of HT due to the rare artery of Percheron infarct and its successful treatment using deep brain stimulation.

CASE REPORT

A 62-year-old woman with a right medial cerebral peduncle and bilateral thalamic stroke developed HT. Ventral intermediate nucleus (Vim) zona incerta (ZI) deep brain stimulation (DBS) surgery was performed, with improvement in her tremor.

DISCUSSION

Our case supports the theory that the more caudal ZI target in combination with Vim is beneficial in treating poorly DBS-responsive tremors such as HT.