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Fenoy AJ, Chu ZD, Ritter RJ, Conner CR, Kralik SF. Evaluating functional connectivity differences between DBS ON/OFF states in essential tremor. Neurotherapeutics 2024; 21:e00375. [PMID: 38824101 DOI: 10.1016/j.neurot.2024.e00375] [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: 10/29/2023] [Revised: 05/05/2024] [Accepted: 05/13/2024] [Indexed: 06/03/2024] Open
Abstract
Deep brain stimulation (DBS) targeting the ventral intermediate (Vim) nucleus of the thalamus is an effective treatment for essential tremor (ET). We studied 15 ET patients undergoing DBS to a major input/output tract of the Vim, the dentato-rubro-thalamic tract (DRTt), using resting state functional MRI (rsfMRI) to evaluate connectivity differences between DBS ON and OFF and elucidate significant regions most influential in impacting tremor control and/or concomitant gait ataxia. Anatomical/functional 1.5T MRIs were acquired and replicated for each DBS state. Tremor severity and gait ataxia severity were scored with DBS ON at optimal stimulation parameters and immediately upon DBS OFF. Whole brain analysis was performed using dual regression analysis followed by randomized permutation testing for multiple correction comparison. Regions of interest (ROI) analysis was also performed. All 15 patients had tremor improvement between DBS ON/OFF (p < 0.001). Whole brain analysis revealed significant connectivity changes between states in the left pre-central gyrus and left supplemental motor area. Group analysis of ROIs revealed that, with threshold p < 0.05, in DBS ON vs. OFF both tremor duration and tremor improvement were significantly correlated to changes in connectivity. A sub-group analysis of patients with greater ataxia had significantly decreased functional connectivity between multiple ROIs in the cortex and cerebellum when DBS was ON compared to OFF. Stimulation of the DRTt and concordant improvement of tremor resulted in connectivity changes seen in multiple regions outside the motor network; when combined with both structural and electrophysiologic connectivity, this may help to serve as a biomarker to improve DBS targeting and possibly predict outcome.
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Affiliation(s)
- Albert J Fenoy
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA; Departments of Neurosurgery and Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Zili D Chu
- Edward B. Singleton Department of Radiology, Baylor College of Medicine at Texas Children's Hospital, Houston, TX, USA
| | - Robert J Ritter
- Department of Neurosurgery, McGovern School of Medicine, UTHealth Houston, Houston, TX, USA
| | - Christopher R Conner
- Division of Neurosurgery, Dept. of Surgery, University of Connecticut, Hartford, CT, USA
| | - Stephen F Kralik
- Edward B. Singleton Department of Radiology, Baylor College of Medicine at Texas Children's Hospital, Houston, TX, USA
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Bancel T, Béranger B, Daniel M, Didier M, Santin M, Rachmilevitch I, Shapira Y, Tanter M, Bardinet E, Fernandez Vidal S, Attali D, Galléa C, Dizeux A, Vidailhet M, Lehéricy S, Grabli D, Pyatigorskaya N, Karachi C, Hainque E, Aubry JF. Sustained reduction of essential tremor with low-power non-thermal transcranial focused ultrasound stimulations in humans. Brain Stimul 2024; 17:636-647. [PMID: 38734066 DOI: 10.1016/j.brs.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Transcranial ultrasound stimulation (TUS) is a non-invasive brain stimulation technique; when skull aberrations are compensated for, this technique allows, with millimetric accuracy, circumvention of the invasive surgical procedure associated with deep brain stimulation (DBS) and the limited spatial specificity of transcranial magnetic stimulation. OBJECTIVE /hypothesis: We hypothesize that MR-guided low-power TUS can induce a sustained decrease of tremor power in patients suffering from medically refractive essential tremor. METHODS The dominant hand only was targeted, and two anatomical sites were sonicated in this exploratory study: the ventral intermediate nucleus of the thalamus (VIM) and the dentato-rubro-thalamic tract (DRT). Patients (N = 9) were equipped with MR-compatible accelerometers attached to their hands to monitor their tremor in real-time during TUS. RESULTS VIM neurostimulations followed by a low-duty cycle (5 %) DRT stimulation induced a substantial decrease in the tremor power in four patients, with a minimum of 89.9 % reduction when compared with the baseline power a few minutes after the DRT stimulation. The only patient stimulated in the VIM only and with a low duty cycle (5 %) also experienced a sustained reduction of the tremor (up to 93.4 %). Four patients (N = 4) did not respond. The temperature at target was 37.2 ± 1.4 °C compared to 36.8 ± 1.4 °C for a 3 cm away control point. CONCLUSIONS MR-guided low power TUS can induce a substantial and sustained decrease of tremor power. Follow-up studies need to be conducted to reproduce the effect and better to understand the variability of the response amongst patients. MR thermometry during neurostimulations showed no significant thermal rise, supporting a mechanical effect.
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Affiliation(s)
- Thomas Bancel
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, Paris, France
| | - Benoît Béranger
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France
| | - Maxime Daniel
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, Paris, France
| | - Mélanie Didier
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France
| | - Mathieu Santin
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France
| | | | | | - Mickael Tanter
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, Paris, France
| | - Eric Bardinet
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France
| | - Sara Fernandez Vidal
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France
| | - David Attali
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, Paris, France; Université Paris Cité, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, F-75014, Paris, France
| | - Cécile Galléa
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France
| | - Alexandre Dizeux
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, Paris, France
| | - Marie Vidailhet
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France; Department of Neurology, Hôpital de la Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Stéphane Lehéricy
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France; Department of Neuroradiology, Hôpital de la Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - David Grabli
- Department of Neurology, Hôpital de la Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Nadya Pyatigorskaya
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France; Department of Neuroradiology, Hôpital de la Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Carine Karachi
- Department of Neurosurgery, Hôpital de la Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Elodie Hainque
- Department of Neurology, Hôpital de la Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Jean-François Aubry
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, Paris, France.
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Martinez-Nunez AE, Sarmento FP, Chandra V, Hess CW, Hilliard JD, Okun MS, Wong JK. Management of essential tremor deep brain stimulation-induced side effects. Front Hum Neurosci 2024; 18:1353150. [PMID: 38454907 PMCID: PMC10918853 DOI: 10.3389/fnhum.2024.1353150] [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: 12/10/2023] [Accepted: 02/01/2024] [Indexed: 03/09/2024] Open
Abstract
Deep brain stimulation (DBS) is an effective surgical therapy for carefully selected patients with medication refractory essential tremor (ET). The most popular anatomical targets for ET DBS are the ventral intermedius nucleus (VIM) of the thalamus, the caudal zona incerta (cZI) and the posterior subthalamic area (PSA). Despite extensive knowledge in DBS programming for tremor suppression, it is not uncommon to experience stimulation induced side effects related to DBS therapy. Dysarthria, dysphagia, ataxia, and gait impairment are common stimulation induced side effects from modulation of brain tissue that surround the target of interest. In this review, we explore current evidence about the etiology of stimulation induced side effects in ET DBS and provide several evidence-based strategies to troubleshoot, reprogram and retain tremor suppression.
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Affiliation(s)
- Alfonso Enrique Martinez-Nunez
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Filipe P. Sarmento
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL, United States
| | - Vyshak Chandra
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Christopher William Hess
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Justin David Hilliard
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL, United States
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Michael S. Okun
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Joshua K. Wong
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
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Tuleasca C, Carey G, Barriol R, Touzet G, Dubus F, Luc D, Carriere N, Reyns N. Impact of biologically effective dose on tremor decrease after stereotactic radiosurgical thalamotomy for essential tremor: a retrospective longitudinal analysis. Neurosurg Rev 2024; 47:73. [PMID: 38296852 PMCID: PMC10830596 DOI: 10.1007/s10143-024-02296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/03/2024] [Accepted: 01/14/2024] [Indexed: 02/02/2024]
Abstract
Stereotactic radiosurgery (SRS) is one of the surgical alternatives for drug-resistant essential tremor (ET). Here, we aimed at evaluating whether biologically effective dose (BEDGy2.47) is relevant for tremor improvement after stereotactic radiosurgical thalamotomy in a population of patients treated with one (unplugged) isocenter and a uniform dose of 130 Gy. This is a retrospective longitudinal single center study. Seventy-eight consecutive patients were clinically analyzed. Mean age was 69.1 years (median 71, range 36-88). Mean follow-up period was 14 months (median 12, 3-36). Tremor improvement was assessed at 12 months after SRS using the ET rating assessment scale (TETRAS, continuous outcome) and binary (binary outcome). BED was defined for an alpha/beta of 2.47, based upon previous studies considering such a value for the normal brain. Mean BED was 4573.1 Gy2.47 (median 4612, 4022.1-4944.7). Mean beam-on time was 64.7 min (median 61.4; 46.8-98.5). There was a statically significant correlation between delta (follow-up minus baseline) in TETRAS (total) with BED (p = 0.04; beta coefficient - 0.029) and beam-on time (p = 0.03; beta coefficient 0.57) but also between TETRAS (ADL) with BED (p = 0.02; beta coefficient 0.038) and beam-on time (p = 0.01; beta coefficient 0.71). Fractional polynomial multivariate regression suggested that a BED > 4600 Gy2.47 and a beam-on time > 70 min did not further increase clinical efficacy (binary outcome). Adverse radiation events (ARE) were defined as larger MR signature on 1-year follow-up MRI and were present in 7 out of 78 (8.9%) cases, receiving a mean BED of 4650 Gy2.47 (median 4650, range 4466-4894). They were clinically relevant with transient hemiparesis in 5 (6.4%) patients, all with BED values higher than 4500 Gy2.47. Tremor improvement was correlated with BED Gy2.47 after SRS for drug-resistant ET. An optimal BED value for tremor improvement was 4300-4500 Gy2.47. ARE appeared for a BED of more than 4500 Gy2.47. Such finding should be validated in larger cohorts.
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Affiliation(s)
- Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Rue du Bugnon 44-46, BH-08, CH-1011, Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
- Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Lausanne, Switzerland.
| | - Guillaume Carey
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Romain Barriol
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Gustavo Touzet
- Neurosurgery Department, CHU-Lille, Roger Salengro Hospital, 1, Rue Emile Laine, 59000, Lille, France
| | - Francois Dubus
- Medical Physics Department, University Hospital, Lille, France
| | - Defebvre Luc
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Nicolas Carriere
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Nicolas Reyns
- Neurosurgery Department, CHU-Lille, Roger Salengro Hospital, 1, Rue Emile Laine, 59000, Lille, France
- U1189-ONCO-THAI-Assisted Laser Therapy and Immunotherapy for Oncology, University of Lille, INSERM, CHU-Lille, 59000, Lille, France
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Gurgone S, De Salvo S, Bonanno L, Muscarà N, Acri G, Caridi F, Paladini G, Borzelli D, Brigandì A, La Torre D, Sorbera C, Anfuso C, Di Lorenzo G, Venuti V, d'Avella A, Marino S. Changes in cerebral cortex activity during a simple motor task after MRgFUS treatment in patients affected by essential tremor and Parkinson's disease: a pilot study using functional NIRS. Phys Med Biol 2024; 69:025014. [PMID: 38100845 DOI: 10.1088/1361-6560/ad164e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/15/2023] [Indexed: 12/17/2023]
Abstract
Objective.Magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) is a non-invasive thermal ablation method that involves high-intensity focused ultrasound surgery (FUS) and Magnetic Resonance Imaging for anatomical imaging and real-time thermal mapping. This technique is widely employed for the treatment of patients affected by essential tremor (ET) and Parkinson's disease (PD). In the current study, functional near-infrared spectroscopy (fNIRS) was used to highlight hemodynamics changes in cerebral cortex activity, during a simple hand motor task, i.e. unimanual left and right finger-tapping, in ET and PD patients.Approach.All patients were evaluated before, one week and one month after MRgFUS treatment.Main results.fNIRS revealed cerebral hemodynamic changes one week and one month after MRgFUS treatment, especially in the ET group, that showed a significant clinical improvement in tremor clinical scores.Significance.To our knowledge, our study is the first that showed the use of fNIRS system to measure the cortical activity changes following unilateral ventral intermediate nucleus thalamotomy after MRgFUS treatment. Our findings showed that therapeutic MRgFUS promoted the remodeling of neuronal networks and changes in cortical activity in association with symptomatic improvements.
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Affiliation(s)
- Sergio Gurgone
- Center for Information and Neural Networks (CiNet), Advanced ICT Research Institute, National Institute of Information and Communications Technology, 1-4, Yamadaoka, Suita City, 565-0871 Osaka, Japan
| | - Simona De Salvo
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
| | - Lilla Bonanno
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
| | - Nunzio Muscarà
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
| | - Giuseppe Acri
- Dipartimento di Scienze Biomediche, Odontoiatriche, e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, c/o A.O.U. Policlinico 'G. Martino' Via Consolare Valeria 1, I-98125 Messina, Italy
| | - Francesco Caridi
- Dipartimento di Scienze Matematiche e Informatiche, Scienze Fisiche e Scienze della Terra, Università degli Studi di Messina, V.le F. Stagno D'Alcontres 31, I-98166 Messina, Italy
| | - Giuseppe Paladini
- Dipartimento di Fisica e Astronomia 'Ettore Majorana', Università degli Studi di Catania, Via S. Sofia 64, I-95123 Catania, Italy
| | - Daniele Borzelli
- Dipartimento di Scienze Biomediche, Odontoiatriche, e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, c/o A.O.U. Policlinico 'G. Martino' Via Consolare Valeria 1, I-98125 Messina, Italy
- Laboratorio di Fisiologia Neuromotoria, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, I-00179 Roma, Italy
| | - Amelia Brigandì
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
| | - Domenico La Torre
- Dipartimento di Scienze Mediche e Chirurgiche, Istituto di Neurochirurgia, Università degli Studi 'Magna Graecia' di Catanzaro, Viale Europa, I-88100 Catanzaro, Italy
| | - Chiara Sorbera
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
| | - Carmelo Anfuso
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
| | - Giuseppe Di Lorenzo
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
| | - Valentina Venuti
- Dipartimento di Scienze Matematiche e Informatiche, Scienze Fisiche e Scienze della Terra, Università degli Studi di Messina, V.le F. Stagno D'Alcontres 31, I-98166 Messina, Italy
| | - Andrea d'Avella
- Dipartimento di Scienze Biomediche, Odontoiatriche, e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, c/o A.O.U. Policlinico 'G. Martino' Via Consolare Valeria 1, I-98125 Messina, Italy
- Laboratorio di Fisiologia Neuromotoria, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, I-00179 Roma, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
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Isaacson SH, Pahwa R, Brillman S, Lu C, Kent AR. Clinical benefit of transcutaneous afferent patterned stimulation (TAPS) in essential tremor patients with high unmet need: a secondary analysis of TAPS studies. Expert Rev Med Devices 2023; 20:1211-1218. [PMID: 37878352 DOI: 10.1080/17434440.2023.2274604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Transcutaneous afferent patterned stimulation (TAPS) is a noninvasive neuromodulation therapy that improves hand tremor in essential tremor (ET) patients. The benefits of TAPS in ET patients with high unmet need (severe tremor, non-responsive to medication, age ≥65 years) and early responders (substantial TAPS tremor improvement in the first month) remains unknown. RESEARCH DESIGN AND METHODS Literature was surveyed for TAPS studies to assess the response in the high unmet need subgroup and early responders. Analyses were performed using previously collected Tremor Research Group Essential Tremor Rating Scale (TETRAS) scores, Bain & Findley activities of daily living (BF-ADL) scores, and tremor power. RESULTS Significant differences in BF-ADL and TETRAS improvement were observed with TAPS over sham for the high unmet need subgroup in a randomized controlled study (P<0.03). During a 3-month open-label study, the high unmet need subgroup and early responders showed significant improvements in BF-ADL, TETRAS, and tremor power (P<0.001). Analysis of previous real-world evidence demonstrated that early responders maintained effectiveness and usage at 3 and 12 months (P<0.001). CONCLUSIONS TAPS showed comparable improvements in ET with high unmet need as reported in the original studies, and greater efficacy in early responders. These findings inform patient selection and the trial process for identifying TAPS responders.
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Affiliation(s)
- Stuart H Isaacson
- Parkinson's Disease and Movement Disorders of Boca Raton, Boca Raton, FL, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Salima Brillman
- Parkinson's Disease and Movement Disorders Center of Silicon Valley, Palo Alto, CA, USA
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Silek H, Dogan M. Voice Analysis in Patients with Essential Tremor. J Voice 2023:S0892-1997(23)00144-3. [PMID: 37336699 DOI: 10.1016/j.jvoice.2023.04.019] [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: 01/25/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE The objective of this study was to reveal the phonetic characteristics of patients with or without voice tremor in patients with essential tremor (ET), determine whether these phonetic features are ET specific, and test the influence of ET on vocal tremor. METHODS The study included a total of 30 patients with ET and 29 healthy volunteers. The severity of ET was evaluated using the Washington Heights Inwood Genetic Study of Essential Tremor (WHIGET) tremor rating scale. Patients with major tremor complaints for at least 3years, WHIGET scoring scores below 15, and patients newly diagnosed in our clinic and for whom drug therapy has not yet been started were selected. RESULTS A total of 59 participants (n = 34 with ET and n = 25 as control) were included in the study. The ages of the participants ranged from 20 to 82years, with a mean age of 54.50 ± 15.04years. The gender distribution was 57.6% male and 42.4% female, and there was no statistically significant difference between the two groups in terms of age and gender. The study found that individuals with ET had significantly higher jitter, shimmer, S/Z, Pataka, frequency tremor intensity index, amplitude tremor intensity index, and frequency tremor power index values than the control group. However, there was no statistically significant difference between the two groups in terms of MPT, frequency tremor cyclicality, amplitude tremor cyclicality, frequency tremor frequency, and amplitude tremor frequency values. CONCLUSION Our study shows that, even in the absence of essential voice tremor, there is an effect of ET on voice quality. These findings contribute to the understanding of the nonmotor symptoms of ET and may aid in the diagnosis and management of this condition. Further research is needed to explore the potential use of acoustic analysis parameters in the diagnosis and monitoring of ET.
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Affiliation(s)
- Hakan Silek
- Department of Neurology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey.
| | - Muzeyyen Dogan
- Department of Otolaryngology and Head & Neck Surgery, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
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8
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Duque DH, Racca JM, Manzanera Esteve IV, Yang PF, Gore JC, Chen LM. Machine-learning-based video analysis of grasping behavior during recovery from cervical spinal cord injury. Behav Brain Res 2023; 443:114150. [PMID: 36216141 PMCID: PMC10733977 DOI: 10.1016/j.bbr.2022.114150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/05/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022]
Abstract
Comprehensive characterizations of hand grasping behaviors after cervical spinal cord injuries are fundamental for developing rehabilitation strategies to promote recovery in spinal-cord-injured primates. We used the machine-learning-based video analysis software, DeepLabCut, to sensitively quantify kinematic aspects of grasping behavioral deficits in squirrel monkeys with C5-level spinal cord injuries. Three squirrel monkeys were trained to grasp sugar pellets from wells of varying depths before and after a left unilateral lesion of the cervical dorsal column. Using DeepLabCut, we identified post-lesion deficits in kinematic grasping behavior that included changes in digit orientation, increased variance in vertical and horizontal digit movement, and longer time to complete the task. While video-based analyses of grasping behavior demonstrated deficits in fine-scale digit function that persisted through at least 14 weeks post-injury, traditional end-point behavioral analyses showed a recovery of global hand function as evidenced by recovery of the proportion of successful retrievals by approximately 14 weeks post-injury. The combination of traditional end-point and video-based kinematic analyses provides a more comprehensive characterization of grasping behavior and highlights that global grasping performance may recover despite persistent fine-scale kinematic deficits in digit function. Machine-learning-based video analysis of kinematic digit function, in conjunction with traditional end-point behavioral analyses of grasping behavior, provide sensitive and specific indices for monitoring recovery of fine-grained hand sensorimotor behavior after spinal cord injury that can aid future studies that seek to develop targeted therapeutic interventions for improving behavioral outcomes.
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Affiliation(s)
- Daniela Hernandez Duque
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Institute of Surgery and Engineering (VISE), Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jordan M Racca
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Isaac V Manzanera Esteve
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, TN, USA; Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pai-Feng Yang
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John C Gore
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Li Min Chen
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
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9
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Wang Y, Yang J, Cai M, Liu X, Lu K, Lou Y, Li Z. Application of optimized convolutional neural networks for early aided diagnosis of essential tremor: Automatic handwriting recognition and feature analysis. Med Eng Phys 2023; 113:103962. [PMID: 36966002 DOI: 10.1016/j.medengphy.2023.103962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/05/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023]
Abstract
Essential tremor (ET) is one of the most common neurological disorders, and its mainly clinical symptoms, including patient hand's kinetic tremor, dystonia, ataxia, etc., would influence the daily life of patients inordinately. Current ET diagnosis highly replies on the clinical evaluation and neurological examination, so the objective measurement indicators are particularly important in the auxiliary diagnosis of ET. In this research, the Archimedes spiral line freehand sketching samples without template assistance is collected and the Convolutional Neural Network (CNN) model of optimized structure is adopted to fully analyze the tremor, spacing of turns, shape, etc. shown in the handwriting samples of patients with ET, including the following main process: characteristics extraction, model visualization and subregional relevance evaluation. Dropout is used as a regularization technique in the network structure. The test group consisted of 50 patients with confirmed ET and the control group consisted of 40 healthy individuals. The main research objectives of this paper comprise two points: on the one hand, to achieve effective automatic classification of patients with ET and healthy controls using a scheme combining deep learning and simple hand mapping for the purpose of primary disease screening; on the other hand, to design sub-regional automatic classification experiments to demonstrate that Archimedean spiral hand drawings of patients with ET do have distinct local features, and to lay the experimental foundation for future hand drawing-based automatic aid for the identification of a variety of neurodegenerative diseases. Our model's average accuracy rate in test set reaches 89.3%, and average AUC is 0.972, with favorable stability and generalization performance. Besides, subregional characteristics recognition proofs that the spiral line samples of most of the patients with ET show more category-related characteristics in the local area of upper right, which provides evidences and theory update for predecessors' medical research.
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Affiliation(s)
- Yanwen Wang
- Neurology Department, Zhejiang Hospital, Zhejiang 310013, China
| | - Jiayu Yang
- School of Electronics and Information, Hangzhou Dianzi University, Zhejiang 310018, China
| | - Miao Cai
- Neurology Department, Zhejiang Hospital, Zhejiang 310013, China
| | - Xiaoli Liu
- Neurology Department, Zhejiang Hospital, Zhejiang 310013, China
| | - Kang Lu
- School of Electronics and Information, Hangzhou Dianzi University, Zhejiang 310018, China
| | - Yue Lou
- Neurology Department, Zhejiang Hospital, Zhejiang 310013, China
| | - Zhu Li
- School of Electronics and Information, Hangzhou Dianzi University, Zhejiang 310018, China.
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10
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Bolton TAW, Van De Ville D, Régis J, Witjas T, Girard N, Levivier M, Tuleasca C. Exploring the heterogeneous morphometric data in essential tremor with probabilistic modelling. Neuroimage Clin 2023; 37:103283. [PMID: 36516728 PMCID: PMC9755240 DOI: 10.1016/j.nicl.2022.103283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/14/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
Essential tremor (ET) is a prevalent movement disorder characterized by marked clinical heterogeneity. Here, we explored the morphometric underpinnings of this cross-subject variability on a cohort of 34 patients with right-dominant drug-resistant ET and 29 matched healthy controls (HCs). For each brain region, group-wise morphometric data was modelled by a multivariate Gaussian to account for morphometric features' (co)variance. No group differences were found in terms of mean values, highlighting the limits of more basic group comparison approaches. Variance in surface area was higher in ET in the left lingual and caudal anterior cingulate cortices, while variance in mean curvature was lower in the right superior temporal cortex and pars triangularis, left supramarginal gyrus and bilateral paracentral gyrus. Heterogeneity further extended to the right putamen, for which a mixture of two Gaussians fitted the ET data better than a single one. Partial Least Squares analysis revealed the rich clinical relevance of the ET population's heterogeneity: first, increased head tremor and longer symptoms' duration were accompanied by broadly lower cortical gyrification. Second, more severe upper limb tremor and impairments in daily life activities characterized the patients whose morphometric profiles were more atypical compared to the average ET population, irrespective of the exact nature of the alterations. Our results provide candidate morphometric substrates for two different types of clinical variability in ET. They also demonstrate the importance of relying on analytical approaches that can efficiently handle multivariate data and enable to test more sophisticated hypotheses regarding its organization.
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Affiliation(s)
- Thomas A W Bolton
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; Department of Radiology, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland.
| | - Dimitri Van De Ville
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, 1202 Geneva, Switzerland; Department of Radiology and Medical Informatics, University of Geneva, 1202 Geneva, Switzerland
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, 13005 Marseille, France
| | - Tatiana Witjas
- Neurology Department, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, 13005 Marseille, France
| | - Nadine Girard
- Department of Diagnostic and Interventional Neuroradiology, Centre de Résonance Magnétique Biologique et Médicale, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, 13005 Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), 1015 Lausanne, Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), 1015 Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland
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11
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Upper Limb Function but Not Proprioception is Impaired in Essential Tremor: A Between-Groups Study and Causal Mediation Analysis. Tremor Other Hyperkinet Mov (N Y) 2023; 13:1. [PMID: 36644368 PMCID: PMC9818046 DOI: 10.5334/tohm.731] [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: 10/24/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023] Open
Abstract
Background Essential tremor (ET) is characterized by abnormal oscillatory muscle activity and cerebellar involvement, factors that can lead to proprioceptive deficits, especially in active tasks. The present study aimed to quantify the severity of proprioceptive deficits in people with ET and estimate how these contribute to functional impairments. Methods Upper limb sensory, proprioceptive and motor function was assessed inindividuals with ET (n = 20) and healthy individuals (n = 22). To measure proprioceptive ability, participants discriminated the width of grasped objects and the weight of objects liftedwith the wrist extensors. Causal mediation analysis was used to estimate the extentthat impairments in upper limb function in ET was mediated by proprioceptive ability. Results Participants with ET had impaired upper limb function in all outcomes, and had greater postural and kinetic tremor. There were no differences between groups in proprioceptive discrimination of width (between-group mean difference [95% CI]: 0.32 mm [-0.23 to 0.87 mm]) or weight (-1.12 g [-7.31 to 5.07 g]). Causal mediation analysis showed the effect of ET on upper limb function was not mediated by proprioceptive ability. Conclusions Upper limb function but not proprioception was impaired in ET. The effect of ET on motor function was not mediated by proprioception. These results indicate that the central nervous system of people with ET is able to accommodate mild to moderate tremor in active proprioceptive tasks that rely primarily on afferent signals from muscle spindles.
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12
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Antonazzo IC, Conti S, Rozza D, Fornari C, Eteve-Pitsaer C, Paris C, Gantzer L, Valentine D, Mantovani LG, Mazzaglia G. Time trends in the incidence of essential tremor: Evidences from UK and France primary care data. Front Neurol 2022; 13:987618. [PMID: 36203992 PMCID: PMC9531026 DOI: 10.3389/fneur.2022.987618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Although essential tremor (ET) is considered a common adult movement disorder, evidence on its incidence is still scant. This study aims at estimating ET incidence in two European countries, namely, the UK and France. Methods Incident cases of ET were identified within the Health Improvement Network (THIN®) database between 1st January 2014 and 31 December 2019. Yearly crude and standardized incidence rates (IR) were estimated across the study period for both countries. Poisson regression models were built to assess temporal trends in IRs and differences between sexes and age classes. Results In total, 4,970 and 4,905 incident cases of ET were identified in the UK and France, respectively. The yearly average crude IR (per 100,000 person-years) was 18.20 (95%CI: 15.09-21.32) in UK and 21.42 (17.83-25.00) in France, whereas standardized ones were 19.51 (18.97-20.01) and 19.50 (18.97-20.05). Regression analyses showed slightly increasing trends in both countries, higher incidence among males, and a significant increase with age. Yearly average IR increased from 3.96 (0.95-6.97) and 5.28 (1.12-9.44) in subjects aged <20 years to 49.27 (26.29-72.24) and 51.52 (30.19-72.86) in those aged >80 year in UK and France. Conclusions Standardized ET incidence was comparable in the UK and France, showing a slight increase in both countries, reporting a higher value among people aged 60 years and older. This study outlines the need to conduct future studies to estimate the burden of ET in terms of disease control and healthcare resource utilization.
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Affiliation(s)
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy,*Correspondence: Sara Conti
| | - Davide Rozza
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Carla Fornari
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | | | | | | | | | | | - Giampiero Mazzaglia
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
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13
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Ray A, Biswas DA. Association of Diet With Essential Tremor: A Narrative Review. Cureus 2022; 14:e29168. [PMID: 36258958 PMCID: PMC9567235 DOI: 10.7759/cureus.29168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/14/2022] [Indexed: 11/09/2022] Open
Abstract
Essential tremor is a neurological disorder categorized by the rhythmic shaking of the upper limbs, lower limbs, neck, or head. The etiology of essential tremor is believed to be genetic variations, environmental factors, lifestyle, etc. Poor lifestyle and diet are important factors contributing to the onset of various disorders. Environment and lifestyle play a significant part in the dietary habits of an individual. Some diet components may probably be associated with the etiopathogenesis or progression of the essential tremor. Dietary habits may be a key influence on the commencement of tremors in healthy individuals. Typically, the diet of essential tremor patients is not supervised. It may also intensify the tremors in essential tremor patients. Association of the diet with the essential tremor can shed light on the root of tremor aggravating aspect and aid in diet modification in essential tremor patients. The aim of the review is to establish a relation between the diet with etiopathogenesis and the progression of essential tremor. The review includes studies providing information about essential tremor and correlating essential tremor with diet, lifestyle, environment, and genetic factors. Studies that did not provide a link to the association of essential tremor were excluded. The interpretation of the research indicated that genetic variations might be triggered due to enzymatic changes triggered by dietary patterns. Dietary components showed ambiguous, weak, strong, or no association. Essential tremor may be influenced by diet. Further research must be carried out on essential tremor patients in the nutritional domain. Physicians may monitor the diet of the essential tremor patients and record the progress of the disorder on its basis to manage the patients with essential tremor and provide better services.
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14
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Shabani M, Naderi R. Phytohormone abscisic acid elicits positive effects on harmaline-induced cognitive and motor disturbances in a rat model of essential tremor. Brain Behav 2022; 12:e2564. [PMID: 35591769 PMCID: PMC9120731 DOI: 10.1002/brb3.2564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/13/2022] [Accepted: 01/28/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Essential tremor (ET) as a neurological disorder is accompanied by cognitive and motor disturbances. Despite the high incidence of ET, the drug treatment of ET remains unsatisfactory. Recently, abscisic acid (ABA) has been reported to have positive neurophysiological effects in mammals. Here, the effects of ABA on harmaline-induced motor and cognitive impairments were investigated in rats. METHODS Male Wistar rats weighing 120-140 g were divided into control, harmaline (30 mg/kg, ip), ABA vehicle (DMSO+normal saline), and ABA (10 μg/rat, icv, 30 min before harmaline injection) groups. Exploratory, balance and motor performance, anxiety, and cognitive function were assessed using footprint, open field, wire grip, rotarod, and shuttle box tests. RESULTS The results indicated that ABA (10 μg/rat) can improve harmaline-induced tremor in rats. The administration of ABA significantly increased time spent on wire grip and rotarod. In addition, ABA had a promising effect against the cognitive impairments induced by harmaline. CONCLUSION Taken together, ABA has positive effects on locomotor and cognitive impairments induced by tremor. However, further studies are required to determine the exact mechanisms of ABA on the ET.
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Affiliation(s)
- Mohammad Shabani
- Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Reyhaneh Naderi
- Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
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15
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Fenoy AJ, Schulz PE, Sanches M, Selvaraj S, Burrows CL, Asir B, Conner CR, Quevedo J, Soares JC. Deep brain stimulation of the "medial forebrain bundle": sustained efficacy of antidepressant effect over years. Mol Psychiatry 2022; 27:2546-2553. [PMID: 35288633 DOI: 10.1038/s41380-022-01504-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/11/2022] [Accepted: 02/22/2022] [Indexed: 12/15/2022]
Abstract
Deep brain stimulation (DBS) to the superolateral branch of the medial forebrain bundle (MFB) has emerged as a quite efficacious therapy for treatment resistant depression (TRD), leading to rapid antidepressant effects. In this study, we complete our assessment of our first 10 enrolled patients throughout one year post-implantation, showing sustained antidepressant effect up to 5 years. The primary outcome measure was a 50% reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) score, which was interpreted as a response. Deterministic fiber tracking was used to individually map the target area. An insertional effect was seen during the 4-week sham stimulation phase (29% mean MADRS reduction, p = 0.02). However, after 2 weeks of initiating stimulation, five patients met response criteria (47% mean MADRS reduction, p < 0.001). One patient withdrew from study participation at 6 weeks. Twelve weeks after initiating stimulation, six of nine remaining patients had a >50% decrease in MADRS scores relative to baseline (52% mean MADRS reduction, p = 0.001); these same six patients continued to meet response criteria at 52 weeks (63% overall mean MADRS reduction, p < 0.001). Four of five patients who achieved the 5-year time point analysis continued to be responders (81% mean MADRS reduction, p < 0.001). Evaluation of modulated fiber tracts reveals significant common prefrontal/orbitofrontal connectivity to the target region in all responders. Key points learned from this study that we can incorporate in future protocols to better elucidate the effect of this therapy are a longer blinded sham stimulation phase and use of scheduled discontinuation concomitant with functional imaging.
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Affiliation(s)
- Albert J Fenoy
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA. .,Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, (UT Health), Houston, TX, USA.
| | - Paul E Schulz
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA
| | - Marsal Sanches
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, (UT Health), Houston, TX, USA
| | - Sudhakar Selvaraj
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, (UT Health), Houston, TX, USA
| | - Christina L Burrows
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA
| | - Bashar Asir
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, (UT Health), Houston, TX, USA
| | - Christopher R Conner
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA
| | - Joao Quevedo
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, (UT Health), Houston, TX, USA
| | - Jair C Soares
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, (UT Health), Houston, TX, USA
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16
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Asif M, Mocanu ID, Abdullah U, Höhne W, Altmüller J, Makhdoom EUH, Thiele H, Baig SM, Nürnberg P, Graul-Neumann L, Hussain MS. A novel missense variant of SCN4A co-segregates with congenital essential tremor in a consanguineous Kurdish family. Am J Med Genet A 2021; 188:1251-1258. [PMID: 34913263 DOI: 10.1002/ajmg.a.62610] [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: 09/14/2021] [Revised: 11/10/2021] [Accepted: 11/30/2021] [Indexed: 11/09/2022]
Abstract
Essential tremor (ET) is a neurological disorder characterized by bilateral and symmetric postural, isometric, and kinetic tremors of forelimbs produced during voluntary movements. To date, only a single SCN4A variant has been suggested to cause ET. In continuation of the previous report on the association between SCN4A and ET in a family from Spain, we validated the pathogenicity of a novel SCN4A variant and its involvement in ET in a second family affected by this disease. We recruited a Kurdish family with four affected members manifesting congenital tremor. Using whole-exome sequencing, we identified a novel missense variant in SCN4A, NM_000334.4:c.4679C>T; p.(Pro1560Leu), thus corroborating SCN4A's role in ET. The residue is highly conserved across vertebrates and the substitution is predicted to be pathogenic by various in silico tools. Western blotting and immunocytochemistry performed in cells derived from one of the patients showed reduced immunoreactivity of SCN4A as compared to control cells. The study provides supportive evidence for the role of SCN4A in the etiology of ET and expands the phenotypic spectrum of channelopathies to this neurological disorder.
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Affiliation(s)
- Maria Asif
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Ionut Dragos Mocanu
- Center for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Uzma Abdullah
- University Institute of Biochemistry and Biotechnology (UIBB), PMAS-Arid Agriculture University, Rawalpindi, Pakistan
| | - Wolfgang Höhne
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Janine Altmüller
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Core Facility Genomics, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Ehtisham Ul Haq Makhdoom
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany.,Human Molecular Genetics Laboratory, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE) College, PIEAS, Faisalabad, Pakistan.,Neurochemicalbiology and Genetics Laboratory (NGL), Department of Physiology, Faculty of Life Sciences, Government College University, Faisalabad, Pakistan
| | - Holger Thiele
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Shahid Mahmood Baig
- Human Molecular Genetics Laboratory, Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE) College, PIEAS, Faisalabad, Pakistan.,Pakistan Science Foundation (PSF), Islamabad, Pakistan.,Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Luitgard Graul-Neumann
- Charité-Universitätsmedizin Berlin, Institut für Medizinische Genetik und Humangenetik, Berlin, Germany
| | - Muhammad Sajid Hussain
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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17
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Pietracupa S, Bologna M, Tommasin S, Berardelli A, Pantano P. The Contribution of Neuroimaging to the Understanding of Essential Tremor Pathophysiology: a Systematic Review. THE CEREBELLUM 2021; 21:1029-1051. [PMID: 34657271 DOI: 10.1007/s12311-021-01335-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 12/14/2022]
Abstract
Essential tremor (ET) is one of the most common movement disorders. Over the last 10 years, magnetic resonance imaging (MRI) has shed light on the structural and functional abnormalities possibly involved in ET pathophysiology. In this systematic review, we aimed to identify the cortical and subcortical structures involved and the role that different brain areas play in the pathophysiology of motor and non-motor ET features. We found that structural (grey and white matter) cerebellar damage and connectivity alterations between the cerebellum and various cortical areas play a role in both motor and non-motor symptoms of ET. In particular, many studies found an association between MRI findings and non-motor symptoms.
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Affiliation(s)
| | - Matteo Bologna
- IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, Italy.,Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Silvia Tommasin
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, Italy.,Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pantano
- IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, Italy.,Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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18
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Lora-Millan JS, Delgado-Oleas G, Benito-León J, Rocon E. A Review on Wearable Technologies for Tremor Suppression. Front Neurol 2021; 12:700600. [PMID: 34434161 PMCID: PMC8380769 DOI: 10.3389/fneur.2021.700600] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/28/2021] [Indexed: 12/29/2022] Open
Abstract
Tremor is defined as a rhythmic, involuntary oscillatory movement of a body part. Although everyone exhibits a certain degree of tremor, some pathologies lead to very disabling tremors. These pathological tremors constitute the most prevalent movement disorder, and they imply severe difficulties in performing activities of daily living. Although tremors are currently managed through pharmacotherapy or surgery, these treatments present significant associated drawbacks: drugs often induce side effects and show decreased effectiveness over years of use, while surgery is a hazardous procedure for a very low percentage of eligible patients. In this context, recent research demonstrated the feasibility of managing upper limb tremors through wearable technologies that suppress tremors by modifying limb biomechanics or applying counteracting forces. Furthermore, recent experiments with transcutaneous afferent stimulation showed significant tremor attenuation. In this regard, this article reviews the devices developed following these tremor management paradigms, such as robotic exoskeletons, soft robotic exoskeletons, and transcutaneous neurostimulators. These works are presented, and their effectiveness is discussed. The article also evaluates the different metrics used for the validation of these devices and the lack of a standard validation procedure that allows the comparison among them.
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Affiliation(s)
- Julio S. Lora-Millan
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
| | - Gabriel Delgado-Oleas
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
- Ingeniería Electrónica, Universidad del Azuay, Cuenca, Ecuador
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
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19
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Abe K, Horisawa S, Yamaguchi T, Hori H, Yamada K, Kondo K, Furukawa H, Kamada H, Kishima H, Oshino S, Mochizuki H, Kanemoto M, Hirabayashi H, Fukutome K, Ohnishi H, Igase K, Matsubara I, Ohnishi T, Sadamoto K, Taira T. Focused Ultrasound Thalamotomy for Refractory Essential Tremor: A Japanese Multicenter Single-Arm Study. Neurosurgery 2021; 88:751-757. [PMID: 33469648 DOI: 10.1093/neuros/nyaa536] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/10/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several feasibility studies and a randomized, controlled, multicenter trial have demonstrated the safety and efficacy of unilateral transcranial magnetic resonance-guided focused ultrasound (FUS) lesioning of the ventral intermediate thalamic nucleus in treating essential tremor. OBJECTIVE To evaluate the safety and efficacy of FUS thalamotomy in a Japanese patient cohort through a prospective, multicenter, single-arm confirmatory trial. METHODS A total of 35 patients with disabling refractory essential tremor underwent unilateral FUS thalamotomy and were followed up for 12 post-treatment months. Safety was measured as the incidence and severity of treatment-related adverse events. Efficacy was measured as the tremor severity and quality of life improvements using the Clinical Rating Scale for Tremor and Questionnaire for Essential Tremor. RESULTS The mean skull density ratio (SDR) was 0.47. There was a significant decrease in the mean postural tremor score of the treated hand from baseline to 12 mo by 56.4% (95% CI: 46.7%-66.1%; P < .001), which was maintained at last follow-up. Quality of life improved by 46.3% (mean overall Questionnaire for Essential Tremor score of 17.4 [95% CI: 12.1-22.7]) and there were no severe adverse events. The most frequent adverse event was gait disturbance and all events resolved. CONCLUSION Unilateral FUS thalamotomy allowed significant and sustained tremor relief and improved the quality of life with an outstanding safety profile. The observed safety and efficacy of FUS thalamotomy were comparable to those reported in a previous multicenter study with a low SDR, and inclusion of the low SDR group did not affect effectiveness.
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Affiliation(s)
- Keiichi Abe
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Shiro Horisawa
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Hiroki Hori
- Shinyurigaoka General Hospital, Kanagawa, Japan
| | - Kazumichi Yamada
- Division of Speech-Language-Hearing Therapy, Department of Rehabilitation, Faculty of Health Science, Kumamoto Health Science University, Chuo-ku, Japan
| | - Kimito Kondo
- Department of Neurology, Hokuto Hospital, Obihiro, Japan
| | | | - Hajime Kamada
- Department of Neurology, Hokuto Hospital, Obihiro, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoru Oshino
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Hidehiro Hirabayashi
- Department of Neurosurgery, National Hospital Organization Nara Medical Center, Nara, Japan
| | - Kenji Fukutome
- Department of Neurosurgery, Ohnishi Neurological Center, Hyogo, Japan
| | - Hideyuki Ohnishi
- Department of Neurosurgery, Ohnishi Neurological Center, Hyogo, Japan
| | - Keiji Igase
- Department of Neurosurgery, Washokai Sadamoto Hospital, Ehime, Japan
| | - Ichiro Matsubara
- Department of Neurosurgery, Washokai Sadamoto Hospital, Ehime, Japan
| | - Takanori Ohnishi
- Department of Neurosurgery, Washokai Sadamoto Hospital, Ehime, Japan
| | - Kazuhiko Sadamoto
- Department of Neurosurgery, Washokai Sadamoto Hospital, Ehime, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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20
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Song P, Zhang Y, Zha M, Yang Q, Ye X, Yi Q, Rudan I. The global prevalence of essential tremor, with emphasis on age and sex: A meta-analysis. J Glob Health 2021; 11:04028. [PMID: 33880180 PMCID: PMC8035980 DOI: 10.7189/jogh.11.04028] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Essential tremor (ET) is one of the most common neurological disorders that impairs quality of life and leads to disability and social handicap. It was estimated that approximate 0.9% of people worldwide were affected by ET. The last decade has seen new investigations on the epidemiology of ET, enabling us to provide an up-to-date estimation of ET prevalence, with emphasis on age and sex. Methods We searched PubMed, Medline, Embase and Global Health for studies that reported the prevalence of ET in the general population. Potential sources of heterogeneity were examined by age-adjusted meta-regression. The age- and sex-specific prevalence of ET was constructed with a multilevel mixed-effects meta-regression. Results A total of 29 articles were included in our systematic review and meta-analysis. The prevalence of ET increased dramatically with advancing age, where the prevalence estimate in people aged under 20 years was 0.04% (95% confidence interval [CI] = 0.00-0.29) and that in elderly aged 80 years and above was 2.87% (95% CI = 1.07-7.49). ET was consistently more common in males than in females. In 2020, the overall prevalence of ET in the general population was 0.32% (95% CI = 0.12-0.91), and the prevalence was higher in males (0.36%, 95% CI = 0.14-1.03) than in females (0.28%, 95% CI = 0.11-0.79). In 2020, the number of people affected by ET was 24.91million (95% CI = 9.51-70.92), among whom 56% were males. Conclusions This study provides an up-to-date estimation of ET prevalence in the general population throughout the whole life span, with emphasis on age and sex. The adoption of an internationally acknowledged diagnostic strategy is prompted in future epidemiological investigations. Protocol registration PROSPERO (CRD42020203979)
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Affiliation(s)
- Peige Song
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yan Zhang
- Faculty of Life Science and Medicine, Kings College London, London, UK
| | - Mingming Zha
- Medical School Southeast University, Nanjing, Jiangsu, China
| | - Qingwen Yang
- Medical School Southeast University, Nanjing, Jiangsu, China
| | - Xinxin Ye
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qian Yi
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Igor Rudan
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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21
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He S, Baig F, Mostofi A, Pogosyan A, Debarros J, Green AL, Aziz TZ, Pereira E, Brown P, Tan H. Closed-Loop Deep Brain Stimulation for Essential Tremor Based on Thalamic Local Field Potentials. Mov Disord 2021; 36:863-873. [PMID: 33547859 PMCID: PMC7610625 DOI: 10.1002/mds.28513] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/07/2020] [Accepted: 01/06/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND High-frequency thalamic stimulation is an effective therapy for essential tremor, which mainly affects voluntary movements and/or sustained postures. However, continuous stimulation may deliver unnecessary current to the brain due to the intermittent nature of the tremor. OBJECTIVE We proposed to close the loop of thalamic stimulation by detecting tremor-provoking movement states using local field potentials recorded from the same electrodes implanted for stimulation, so that the stimulation is only delivered when necessary. METHODS Eight patients with essential tremor participated in this study. Patient-specific support vector machine classifiers were first trained using data recorded while the patient performed tremor-provoking movements. Then, the trained models were applied in real-time to detect these movements and triggered the delivery of stimulation. RESULTS Using the proposed method, stimulation was switched on for 80.37 ± 7.06% of the time when tremor-evoking movements were present. In comparison, the stimulation was switched on for 12.71 ± 7.06% of the time when the patients were at rest and tremor-free. Compared with continuous stimulation, a similar amount of tremor suppression was achieved while only delivering 36.62 ± 13.49% of the energy used in continuous stimulation. CONCLUSIONS The results suggest that responsive thalamic stimulation for essential tremor based on tremor-provoking movement detection can be achieved without any requirement for external sensors or additional electrocorticography strips. Further research is required to investigate whether the decoding model is stable across time and generalizable to the variety of activities patients may engage with in everyday life. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Shenghong He
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Fahd Baig
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, Oxford, UK
| | - Abteen Mostofi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, Oxford, UK
| | - Alek Pogosyan
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jean Debarros
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alexander L Green
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Tipu Z Aziz
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Erlick Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, Oxford, UK
| | - Peter Brown
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Huiling Tan
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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22
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Lan H, Suo X, Li W, Li N, Li J, Peng J, Lei D, Sweeney JA, Kemp GJ, Peng R, Gong Q. Abnormalities of intrinsic brain activity in essential tremor: A meta-analysis of resting-state functional imaging. Hum Brain Mapp 2021; 42:3156-3167. [PMID: 33769638 PMCID: PMC8193520 DOI: 10.1002/hbm.25425] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 02/05/2023] Open
Abstract
Neuroimaging studies using a variety of techniques have demonstrated abnormal patterns of spontaneous brain activity in patients with essential tremor (ET). However, the findings are variable and inconsistent, hindering understanding of underlying neuropathology. We conducted a meta‐analysis of whole‐brain resting‐state functional neuroimaging studies in ET compared to healthy controls (HC), using anisotropic effect‐size seed‐based d mapping, to identify the most consistent brain activity alterations and their relation to clinical features. After systematic literature search, we included 13 studies reporting 14 comparisons, describing 286 ET patients and 254 HC. Subgroup analyses were conducted considering medication status, head tremor status, and methodological factors. Brain activity in ET is altered not only in the cerebellum and cerebral motor cortex, but also in nonmotor cortical regions including prefrontal cortex and insula. Most of the results remained unchanged in subgroup analyses of patients with head tremor, medication‐naive patients, studies with statistical threshold correction, and the large subgroup of studies using functional magnetic resonance imaging. These findings not only show consistent and robust abnormalities in specific brain regions but also provide new information on the biology of patient heterogeneity, and thus help to elucidate the pathophysiology of ET.
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Affiliation(s)
- Huan Lan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Xueling Suo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Wenbin Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Nannan Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Junying Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jiaxin Peng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Du Lei
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Rong Peng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
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23
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Li JY, Lu ZJ, Suo XL, Li NN, Lei D, Wang L, Peng JX, Duan LR, Xi J, Jiang Y, Gong QY, Peng R. Patterns of intrinsic brain activity in essential tremor with resting tremor and tremor-dominant Parkinson's disease. Brain Imaging Behav 2021; 14:2606-2617. [PMID: 31989422 DOI: 10.1007/s11682-019-00214-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The clinical pictures of essential tremor (ET) with resting tremor (rET) and tremor-dominant Parkinson's disease (tPD) are often quite mimic at the early stage, current approaches to the diagnosis and treatment therefore remain challenging. The regional homogeneity (ReHo) method under resting-state functional magnetic resonance imaging (rs-fMRI) would help exhibit the patterns in neural activity, which further contribute to differentiate these disorders and explore the relationship between symptoms and regional functional abnormalities. Sixty-eight Chinese participants were recruited, including 19 rET patients, 24 tPD patients and 25 age- and gender-matched healthy controls (HCs). All participants underwent clinical assessment and rs-fMRI with a ReHo method to investigate the alterations of neural activity, and the correlation between them. Differences were compared by two-sample t-test (corrected with AlphaSim, p < 0.05). Compared with HCs, patients' groups both displayed decreased ReHo in the default mode network (DMN), bilateral putamen and bilateral cerebellum. While tPD patients specifically exihibited decreased ReHo in the bilateral supplementary motor area (SMA) and precentral gyrus (M1). The correlation analysis revealed that ReHo in the bilateral putamen, right SMA and left cerebellum_crus I were negatively correlated with the UPDRS-III score, respectively, in tPD group. Our results indicated the rET patients may share part of the pathophysiological mechanism of tPD patients. In addition, we found disorder-specific involvement of the SMA and M1 in tPD. Such a distinction may lend itself to use as a potential biomarker for differentiating between these two diseases.
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Affiliation(s)
- Jun-Ying Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Zhong-Jiao Lu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Xue-Ling Suo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Nan-Nan Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Du Lei
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ling Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Jia-Xin Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Li-Ren Duan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Jing Xi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yi Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Qi-Yong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Rong Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China.
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24
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Objective detection of microtremors in netrin-G2 knockout mice. J Neurosci Methods 2021; 351:109074. [PMID: 33450333 DOI: 10.1016/j.jneumeth.2021.109074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Essential tremor is the most prevalent movement disorder and is thought to be caused by abnormalities in the cerebellar system; however, its underlying neural mechanism is poorly understood. In this study, we found that mice lacking netrin-G2, a cell adhesion molecule which is expressed in neural circuits related to the cerebellar system, exhibited a microtremor resembling an essential tremor. However, it was difficult to quantify microtremors in netrin-G2 KO mice. NEW METHOD We developed a new tremor detector which can quantify the intensity and frequency of a tremor. RESULTS Using this system, we were able to characterize both the microtremors in netrin-G2 KO mice and low-dose harmaline-induced tremors which, to date, had been difficult to detect. Alcohol and anti-tremor drugs, which are effective in decreasing the symptoms of essential tremor in patients, were examined in netrin-G2 KO mice. We found that some drugs lowered the tremor frequency, but had little effect on tremor intensity. Forced swim as a stress stimulus in netrin-G2 KO mice dramatically enhanced tremor symptoms. COMPARISON WITH EXISTING METHODS The detection performance even for tremors induced by low-dose harmaline was similar to that in previous studies or more sensitive than the others. CONCLUSIONS Microtremors in netrin-G2 KO mice are reliably and quantitatively detected by our new tremor detection system. We found different effects of medicines and factors between human essential tremors and microtremors in netrin-G2 KO mice, suggesting that the causations, mechanisms, and symptoms of tremors vary and are heterogeneous, and the objective analyses are required.
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25
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Gallagher VT, Obolsky MA, Soble JR. "Benign" tremor? A serial case report of 2.5 year progression from mild cognitive impairment to amnestic dementia following deep brain stimulator placement for essential tremor. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:1280-1287. [PMID: 33232620 DOI: 10.1080/23279095.2020.1848837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Essential tremor (ET) is a prevalent neurological disorder with associated neuropsychological sequalae. Although cognitive deficits associated with ET are traditionally conceptualized as attention, processing speed, and executive impairments attributed to underlying frontal-subcortical dysfunction, emerging literature highlights the elevated frequency of progressive amnestic memory impairments in patients with ET. This case study centers around a 75-year-old woman with a 15-year history of ET who underwent deep brain stimulation (DBS) as well as three neuropsychological evaluations, one pre-surgically and two post-surgically at one and two-years post successful DBS surgery. Neuropsychological evaluation results revealed circumscribed mild and variable memory deficits pre-surgically and one-year post-surgically, However, two-years post-DBS, reliable change indices revealed significant declines in verbal/visual memory, consistent with an amnestic presentation, in addition to executive functions, aspects of higher-level language abilities, and overall IQ. This case study adds to a growing literature identifying a subset of ET patients with a neurodegenerative cognitive trajectory characterized by progressive, amnestic memory impairment. The case also highlights the importance of serial monitoring of cognition beyond the pre-surgical DBS workup to monitor for clinically significant decline(s).
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Affiliation(s)
- Virginia T Gallagher
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Maximillian A Obolsky
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Psychology, Roosevelt University, Chicago, IL, USA
| | - Jason R Soble
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
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26
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Ibrahim MF, Beevis JC, Empson RM. Essential Tremor - A Cerebellar Driven Disorder? Neuroscience 2020; 462:262-273. [PMID: 33212218 DOI: 10.1016/j.neuroscience.2020.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 10/23/2020] [Accepted: 11/01/2020] [Indexed: 02/07/2023]
Abstract
Abnormal tremors are the most common of all movement disorders. In this review we focus on the role of the cerebellum in Essential Tremor, a highly debilitating but poorly treated movement disorder. We propose a variety of mechanisms driving abnormal burst firing of deep cerebellar nuclei neurons as a key initiator of tremorgenesis in Essential Tremor. Targetting these mechanisms may generate more effective treatments for Essential Tremor.
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Affiliation(s)
- Mohamed Fasil Ibrahim
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin 9016, New Zealand.
| | - Jessica C Beevis
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin 9016, New Zealand
| | - Ruth M Empson
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin 9016, New Zealand
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27
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Sailani MR, Jahanbani F, Abbott CW, Lee H, Zia A, Rego S, Winkelmann J, Hopfner F, Khan TN, Katsanis N, Müller SH, Berg D, Lyman KM, Mychajliw C, Deuschl G, Bernstein JA, Kuhlenbäumer G, Snyder MP. Candidate variants in TUB are associated with familial tremor. PLoS Genet 2020; 16:e1009010. [PMID: 32956375 PMCID: PMC7529431 DOI: 10.1371/journal.pgen.1009010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 10/01/2020] [Accepted: 07/24/2020] [Indexed: 11/19/2022] Open
Abstract
Essential tremor (ET) is the most common adult-onset movement disorder. In the present study, we performed whole exome sequencing of a large ET-affected family (10 affected and 6 un-affected family members) and identified a TUB p.V431I variant (rs75594955) segregating in a manner consistent with autosomal-dominant inheritance. Subsequent targeted re-sequencing of TUB in 820 unrelated individuals with sporadic ET and 630 controls revealed significant enrichment of rare nonsynonymous TUB variants (e.g. rs75594955: p.V431I, rs1241709665: p.Ile20Phe, rs55648406: p.Arg49Gln) in the ET cohort (SKAT-O test p-value = 6.20e-08). TUB encodes a transcription factor predominantly expressed in neuronal cells and has been previously implicated in obesity. ChIP-seq analyses of the TUB transcription factor across different regions of the mouse brain revealed that TUB regulates the pathways responsible for neurotransmitter production as well thyroid hormone signaling. Together, these results support the association of rare variants in TUB with ET. Essential tremor (ET) is the most common adult-onset movement disorder and in most affected families it appears to be inherited in an autosomal dominant pattern. The causes of essential tremor are unknown. Although many genetic studies in affected families and sporadic cases of ET have shown that genes may play a role, it has proven quite challenging to identify the specific genetic variants involved. Here, we use state-of-the-art technologies to identify the role of genetic variants on ET through exome sequencing of a large affected ET family and subsequent validation in a large population of cases and controls. We show that rare nonsynonymous variants of the TUB gene are significantly enriched in ET cases versus healthy controls. Further studies of biological pathways regulated by TUB in the mouse brain reveal key pathways related to ET. Our work expands our knowledge of the genetic basis of ET.
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Affiliation(s)
- M. Reza Sailani
- Department of Genetics, Stanford University, Stanford, CA, United States of America
| | - Fereshteh Jahanbani
- Department of Genetics, Stanford University, Stanford, CA, United States of America
| | - Charles W. Abbott
- Department of Genetics, Stanford University, Stanford, CA, United States of America
| | - Hayan Lee
- Department of Genetics, Stanford University, Stanford, CA, United States of America
| | - Amin Zia
- Department of Genetics, Stanford University, Stanford, CA, United States of America
| | - Shannon Rego
- Department of Genetics, Stanford University, Stanford, CA, United States of America
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany; Institute of Human Genetics, Technical University, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Franziska Hopfner
- Department of Neurology, Kiel University, Germany
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Tahir N. Khan
- Center for Human Disease Modeling, Duke University, United States of America
| | - Nicholas Katsanis
- Center for Human Disease Modeling, Duke University, United States of America
- Advanced Center for Translational and Genetic Medicine, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | | | - Daniela Berg
- Department of Neurology, Kiel University, Germany
- Department of Neurology, Universitätsklinikum Tübingen, Germany
| | - Katherine M. Lyman
- Department of Genetics, Stanford University, Stanford, CA, United States of America
| | - Christian Mychajliw
- University Hospital Tübingen, Department of Psychiatry and Psychotherapy, Tübingen, Germany
| | | | - Jonathan A. Bernstein
- Department of Pediatrics, Stanford University, Stanford, CA, United States of America
| | | | - Michael P. Snyder
- Department of Genetics, Stanford University, Stanford, CA, United States of America
- * E-mail: (GK); (MPS)
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Moon S, Song HJ, Sharma VD, Lyons KE, Pahwa R, Akinwuntan AE, Devos H. Classification of Parkinson's disease and essential tremor based on balance and gait characteristics from wearable motion sensors via machine learning techniques: a data-driven approach. J Neuroeng Rehabil 2020; 17:125. [PMID: 32917244 PMCID: PMC7488406 DOI: 10.1186/s12984-020-00756-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) and essential tremor (ET) are movement disorders that can have similar clinical characteristics including tremor and gait difficulty. These disorders can be misdiagnosed leading to delay in appropriate treatment. The aim of the study was to determine whether balance and gait variables obtained with wearable inertial motion sensors can be utilized to differentiate between PD and ET using machine learning. Additionally, we compared classification performances of several machine learning models. METHODS This retrospective study included balance and gait variables collected during the instrumented stand and walk test from people with PD (n = 524) and with ET (n = 43). Performance of several machine learning techniques including neural networks, support vector machine, k-nearest neighbor, decision tree, random forest, and gradient boosting, were compared with a dummy model or logistic regression using F1-scores. RESULTS Machine learning models classified PD and ET based on balance and gait characteristics better than the dummy model (F1-score = 0.48) or logistic regression (F1-score = 0.53). The highest F1-score was 0.61 of neural network, followed by 0.59 of gradient boosting, 0.56 of random forest, 0.55 of support vector machine, 0.53 of decision tree, and 0.49 of k-nearest neighbor. CONCLUSIONS This study demonstrated the utility of machine learning models to classify different movement disorders based on balance and gait characteristics collected from wearable sensors. Future studies using a well-balanced data set are needed to confirm the potential clinical utility of machine learning models to discern between PD and ET.
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Affiliation(s)
- Sanghee Moon
- Department of Physical Therapy, Ithaca College, Ithaca, NY, USA.
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Hyun-Je Song
- Department of Information Technology, Jeonbuk National University, Jeonju, South Korea
| | - Vibhash D Sharma
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Abiodun E Akinwuntan
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
- Office of the Dean, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
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29
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Gana S, Valente EM. Movement Disorders in Genetic Pediatric Ataxias. Mov Disord Clin Pract 2020; 7:383-393. [PMID: 32373654 DOI: 10.1002/mdc3.12937] [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: 11/19/2019] [Revised: 02/24/2020] [Accepted: 03/08/2020] [Indexed: 11/06/2022] Open
Abstract
Background Genetic pediatric ataxias are heterogeneous rare disorders, mainly inherited as autosomal-recessive traits. Most forms are progressive and lack effective treatment, with relevant socioeconomical impact. Albeit ataxia represents the main clinical feature, the phenotype can be more complex, with additional neurological and nonneurological signs being described in several forms. Methods and Results In this review, we provide an overview of the occurrence and spectrum of movement disorders in the most relevant forms of childhood-onset genetic ataxias. All types of hypokinetic and hyperkinetic movement disorders of variable severity have been reported. Movement disorders occasionally represent the symptom of onset, predating ataxia even of a few years and therefore challenging an early diagnosis. Their pathogenesis still remains poorly defined, as it is not yet clear whether movement disorders may directly relate to the cerebellar pathology or result from an extracerebellar dysfunction, including the basal ganglia. Conclusion Recognition of the complete movement disorder phenotype in genetic pediatric ataxias has important implications for diagnosis, management, and genetic counseling.
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Affiliation(s)
| | - Enza Maria Valente
- IRCCS Mondino Foundation Pavia Italy.,Department of Molecular Medicine University of Pavia Pavia Italy
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30
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Pouratian N, Baltuch G, Elias WJ, Gross R. American Society for Stereotactic and Functional Neurosurgery Position Statement on Magnetic Resonance-Guided Focused Ultrasound for the Management of Essential Tremor. Neurosurgery 2019; 87:E126-E129. [DOI: 10.1093/neuros/nyz510] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/19/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Magnetic resonance-guided focused ultrasound thalamotomy is a novel tool in the neurosurgical armamentarium for management of essential tremor (ET). Given the recent introduction of this technology, the American Society of Stereotactic and Functional Neurosurgery (ASSFN), which acts as the joint section representing the field of stereotactic and functional neurosurgery on behalf of the Congress of Neurological Surgeons and the American Association of Neurological Surgeons, provides here the expert consensus opinion on evidence-based best practices for the use and implementation of this treatment modality. Indications for treatment are outlined, including confirmed diagnosis of ET, failure to respond to first-line therapies, disabling appendicular tremor, and unilateral treatment are detailed, based on current evidence. Contraindications to therapy are also detailed. Finally, the evidence and authority on which the ASSFN bases this consensus position statement is detailed.
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Affiliation(s)
- Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, California
| | - Gordon Baltuch
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - W Jeff Elias
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert Gross
- Department of Neurosurgery, Emory University, Atlanta, Georgia
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31
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Maas RPPWM, Helmich RCG, van de Warrenburg BPC. The role of the cerebellum in degenerative ataxias and essential tremor: Insights from noninvasive modulation of cerebellar activity. Mov Disord 2019; 35:215-227. [PMID: 31820832 PMCID: PMC7027854 DOI: 10.1002/mds.27919] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/19/2019] [Accepted: 10/23/2019] [Indexed: 12/20/2022] Open
Abstract
Over the last three decades, measuring and modulating cerebellar activity and its connectivity with other brain regions has become an emerging research topic in clinical neuroscience. The most important connection is the cerebellothalamocortical pathway, which can be functionally interrogated using a paired‐pulse transcranial magnetic stimulation paradigm. Cerebellar brain inhibition reflects the magnitude of suppression of motor cortex excitability after stimulating the contralateral cerebellar hemisphere and therefore represents a neurophysiological marker of the integrity of the efferent cerebellar tract. Observations that cerebellar noninvasive stimulation techniques enhanced performance of certain motor and cognitive tasks in healthy individuals have inspired attempts to modulate cerebellar activity and connectivity in patients with cerebellar diseases in order to achieve clinical benefit. We here comprehensively explore the therapeutic potential of these techniques in two movement disorders characterized by prominent cerebellar involvement, namely the degenerative ataxias and essential tremor. The article aims to illustrate the (patho)physiological insights obtained from these studies and how these translate into clinical practice, where possible by addressing the association with cerebellar brain inhibition. Finally, possible explanations for some discordant interstudy findings, shortcomings in our current understanding, and recommendations for future research will be provided. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Roderick P P W M Maas
- Department of Neurology & Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rick C G Helmich
- Department of Neurology & Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bart P C van de Warrenburg
- Department of Neurology & Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
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32
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Zsigmond P, Ljunggren SA, Ghafouri B. Proteomic Analysis of the Cerebrospinal Fluid in Patients With Essential Tremor Before and After Deep Brain Stimulation Surgery: A Pilot Study. Neuromodulation 2019; 23:502-508. [PMID: 31755628 DOI: 10.1111/ner.13075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/09/2019] [Accepted: 10/18/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Electrical neuromodulation by deep brain stimulation (DBS) is a well-established method for treatment of severe essential tremor (ET). The mechanism behind the tremor relieving effect remains largely unknown. Our aim of this study was to evaluate alterations in proteomics pre- and post-DBS in patients diagnosed with severe ET. MATERIALS AND METHODS Ten right-handed ET patients were included in this study. Cerebrospinal fluid (CSF) was obtained by lumbar puncture preoperatively (N = 10) and six months postoperatively (N = 7). The samples were analyzed by high sensitive liquid chromatography tandem mass spectrometry. RESULTS Twenty-two proteins were statistically significantly altered in the CSF of ET patients before and after DBS treatment. Downregulated proteins were involved in regulatory processes of protein activation, complement activation, humoral immune response as well as acute inflammatory response. The upregulated proteins were involved in pathways for cell secretion, adhesion as well as response to axon injury. CONCLUSIONS DBS in ET patients effects the neurochemical environment in the CSF. These findings further elucidate the mechanisms of DBS and may lead to new biomarkers for evaluating the effect of DBS treatment.
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Affiliation(s)
- Peter Zsigmond
- Department of Clinical and Experimental Medicine and department of Neurosurgery, Linköping University, Linköping, Sweden
| | - Stefan A Ljunggren
- Occupational and Environmental Medicine Center, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Bijar Ghafouri
- Pain and Rehabilitation Center, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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33
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Mechanical vibration does not systematically reduce the tremor in essential tremor patients. Sci Rep 2019; 9:16476. [PMID: 31712728 PMCID: PMC6848159 DOI: 10.1038/s41598-019-52988-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/25/2019] [Indexed: 02/07/2023] Open
Abstract
Essential tremor (ET) is a major cause of disability and is not effectively managed in half of the patients. We investigated whether mechanical vibration could reduce tremor in ET by selectively recruiting afferent pathways. We used piezoelectric actuators to deliver vibratory stimuli to the hand and forearm during long trials (4 min), while we monitored the tremor using inertial sensors. We analyzed the effect of four stimulation strategies, including different constant and variable vibration frequencies, in 18 ET patients. Although there was not a clear homogeneous response to vibration across patients and strategies, in most cases (50–72%) mechanical vibration was associated with an increase in the amplitude of their tremor. In contrast, the tremor was reduced in 5–22% of the patients, depending on the strategy. However, these results are hard to interpret given the intrinsic variability of the tremor: during equally long trials without vibration, the tremor changed significantly in 67% of the patients (increased in 45%; decreased in 22%). We conclude that mechanical vibration of the limb does not have a systematic effect on tremor in ET. Moreover, the observed intrinsic variability of the tremor should be taken into account when designing future experiments to assess tremor in ET and how it responds to any intervention.
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34
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Martuscello RT, Kerridge CA, Chatterjee D, Hartstone WG, Kuo SH, Sims PA, Louis ED, Faust PL. Gene expression analysis of the cerebellar cortex in essential tremor. Neurosci Lett 2019; 721:134540. [PMID: 31707044 DOI: 10.1016/j.neulet.2019.134540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/28/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023]
Abstract
Essential tremor (ET) is one of the most common neurological diseases, with a central feature of an 8-12 Hz kinetic tremor. While previous postmortem studies have identified a cluster of morphological changes in the ET cerebellum centered in/around the Purkinje cell (PC) population, including a loss of PCs in some studies, the underlying molecular mechanisms for these changes are not clear. As genomic studies of ET patients have yet to identify major genetic contributors and animal models that fully recapitulate the human disease do not yet exist, the study of human tissue is currently the most applicable method to gain a mechanistic insight into ET disease pathogenesis. To begin exploration of an underlying molecular source of ET disease pathogenesis, we have performed the first transcriptomic analysis by direct sequencing of RNA from frozen cerebellar cortex tissue in 33 ET patients compared to 21 normal controls. Principal component analysis showed a heterogenous distribution of the expression data in ET patients that only partially overlapped with control patients. Differential expression analysis identified 231 differentially expressed gene transcripts ('top gene hits'), a subset of which has defined expression profiles in the cerebellum across neuronal and glial cell types but a largely unknown relationship to cerebellar function and/or ET pathogenesis. Gene set enrichment analysis (GSEA) identified dysregulated pathways of interest and stratified dysregulation among ET cases. By GSEA and mining curated databases, we compiled major categories of dysregulated processes and clustered string networks of known interacting proteins. Here we demonstrate that these 'top gene hits' contribute to regulation of four main biological processes, which are 1) axon guidance, 2) microtubule motor activity, 3) endoplasmic reticulum (ER) to Golgi transport and 4) calcium signaling/synaptic transmission. The results of our transcriptomic analysis suggest there is a range of different processes involved among ET cases, and draws attention to a particular set of genes and regulatory pathways that provide an initial platform to further explore the underlying biology of ET.
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Affiliation(s)
- Regina T Martuscello
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, 630 W 168th Street, P&S 15-405, New York, NY, USA; College of Physicians and Surgeons, Columbia University Medical Center and the New York Presbyterian Hospital, 630 W 168th Street, New York, NY, USA.
| | - Chloë A Kerridge
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, 630 W 168th Street, P&S 15-405, New York, NY, USA; College of Physicians and Surgeons, Columbia University Medical Center and the New York Presbyterian Hospital, 630 W 168th Street, New York, NY, USA.
| | - Debotri Chatterjee
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, 630 W 168th Street, P&S 15-405, New York, NY, USA; College of Physicians and Surgeons, Columbia University Medical Center and the New York Presbyterian Hospital, 630 W 168th Street, New York, NY, USA.
| | - Whitney G Hartstone
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, 630 W 168th Street, P&S 15-405, New York, NY, USA; College of Physicians and Surgeons, Columbia University Medical Center and the New York Presbyterian Hospital, 630 W 168th Street, New York, NY, USA.
| | - Sheng-Han Kuo
- College of Physicians and Surgeons, Columbia University Medical Center and the New York Presbyterian Hospital, 630 W 168th Street, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, 630 W 168th Street, BB302, New York, NY, USA.
| | - Peter A Sims
- Department of Neurology, College of Physicians and Surgeons, Columbia University, 630 W 168th Street, BB302, New York, NY, USA; Department of Systems Biology, Columbia University Medical Center, 3960 Broadway, RM208, New York, NY, USA; Sulzberger Columbia Genome Center, Columbia University Medical Center, 1150 St. Nicholas Ave., New York, NY, USA; Department of Biochemistry & Molecular Biophysics, Columbia University Medical Center, 701 W 168th Street, New York, NY, USA.
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, 15 York Street, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, 15 York Street, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, 15 York Street, New Haven, CT, USA.
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, 630 W 168th Street, P&S 15-405, New York, NY, USA; College of Physicians and Surgeons, Columbia University Medical Center and the New York Presbyterian Hospital, 630 W 168th Street, New York, NY, USA.
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Pineda-Pardo JA, Urso D, Martínez-Fernández R, Rodríguez-Rojas R, del-Alamo M, Millar Vernetti P, Máñez-Miró JU, Hernández-Fernández F, de Luis-Pastor E, Vela-Desojo L, Obeso JA. Transcranial Magnetic Resonance-Guided Focused Ultrasound Thalamotomy in Essential Tremor: A Comprehensive Lesion Characterization. Neurosurgery 2019; 87:256-265. [DOI: 10.1093/neuros/nyz395] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/21/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) thalamotomy is a novel and effective treatment for controlling tremor in essential tremor patients.
OBJECTIVE
To provide a comprehensive characterization of the radiological, topographical, and volumetric aspects of the tcMRgFUS thalamic lesion, and to quantify how they relate to the clinical outcomes.
METHODS
In this study, clinical and radiological data from forty patients with medically-refractory essential tremor treated with unilateral tcMRgFUS thalamotomy were retrospectively analyzed. Treatment efficacy was assessed with Clinical Rating Scale for Tremor (CRST). Lesions were manually segmented on T1, T2, and susceptibility-weighted images, and 3-dimensional topographical analysis was then carried out. Statistical comparisons were performed using nonparametric statistics.
RESULTS
The greatest clinical improvement was correlated with a more inferior and posterior lesion, a bigger lesion volume, and percentage of the ventral intermediate nucleus covered by the lesion; whereas, the largest lesions accounted for the occurrence of gait imbalance. Furthermore, the volume of the lesion was significantly predicted by the number of sonications surpassing 52°C.
CONCLUSION
Here we provide a comprehensive characterization of the thalamic tcMRgFUS lesion including radiological and topographical analysis. Our results indicate that the location and volume of the lesion were significantly associated with the clinical outcome and that mid-temperatures may be responsible for the lesion size. This could serve ultimately to improve targeting and judgment and to optimize clinical outcome of tcMRgFUS thalamotomy.
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Affiliation(s)
- José Angel Pineda-Pardo
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
| | - Daniele Urso
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Raul Martínez-Fernández
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
| | - Rafael Rodríguez-Rojas
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
| | - Marta del-Alamo
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
| | | | - Jorge U Máñez-Miró
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
| | - Frida Hernández-Fernández
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Nursing
| | | | - Lydia Vela-Desojo
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
| | - José A Obeso
- CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases, Instituto Carlos III, Madrid, Spain
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Puttaraksa G, Muceli S, Gallego JÁ, Holobar A, Charles SK, Pons JL, Farina D. Voluntary and tremorogenic inputs to motor neuron pools of agonist/antagonist muscles in essential tremor patients. J Neurophysiol 2019; 122:2043-2053. [PMID: 31509467 PMCID: PMC6998026 DOI: 10.1152/jn.00407.2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pathological tremor is an oscillation of body parts at 3–10 Hz, determined by the output of spinal motor neurons (MNs), which receive synaptic inputs from supraspinal centers and muscle afferents. The behavior of spinal MNs during tremor is not well understood, especially in relation to the activation of the multiple muscles involved. Recent studies on patients with essential tremor have shown that antagonist MN pools receive shared input at the tremor frequency. In this study, we investigated the synaptic inputs related to tremor and voluntary movement, and their coordination across antagonist muscles. We analyzed the spike trains of motor units (MUs) identified from high-density surface electromyography from the forearm extensor and flexor muscles in 15 patients with essential tremor during postural tremor. The shared synaptic input was quantified by coherence and phase difference analysis of the spike trains. All pairs of spike trains in each muscle showed coherence peaks at the voluntary drive frequency (1–3 Hz, 0.2 ± 0.2, mean ± SD) and tremor frequency (3–10 Hz, 0.6 ± 0.3) and were synchronized with small phase differences (3.3 ± 25.2° and 3.9 ± 22.0° for the voluntary drive and tremor frequencies, respectively). The coherence between MN spike trains of antagonist muscle groups at the tremor frequency was significantly smaller than intramuscular coherence. We predominantly observed in-phase activation of MUs between agonist/antagonist muscles at the voluntary frequency band (0.6 ± 48.8°) and out-of-phase activation at the tremor frequency band (126.9 ± 75.6°). Thus MNs innervating agonist/antagonist muscles concurrently receive synaptic inputs with different phase shifts in the voluntary and tremor frequency bands. NEW & NOTEWORTHY Although the mechanical characteristics of tremor have been widely studied, the activation of the affected muscles is still poorly understood. We analyzed the behavior of motor units of pairs of antagonistic wrist muscle groups in patients with essential tremor and studied their activity at voluntary movement- and tremor-related frequencies. We found that the phase relation between inputs to antagonistic muscles is different at the voluntary and tremor frequency bands.
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Affiliation(s)
| | - Silvia Muceli
- Department of Bioengineering, Imperial College London, London, United Kingdom.,Division of Signal Processing and Biomedical Engineering, Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Juan Álvaro Gallego
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics, Spanish National Research Council, Arganda del Rey, Spain
| | - Ales Holobar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Steven K Charles
- Department of Mechanical Engineering and Neuroscience Center, Brigham Young University, Provo, Utah
| | - Jose L Pons
- Legs & Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, Illinois.,Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering and Department of Mechanical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois.,Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, United Kingdom
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Tuleasca C, Régis J, Najdenovska E, Witjas T, Girard N, Bolton T, Delaire F, Vincent M, Faouzi M, Thiran JP, Bach Cuadra M, Levivier M, Van de Ville D. Pretherapeutic resting-state fMRI profiles are associated with MR signature volumes after stereotactic radiosurgical thalamotomy for essential tremor. J Neurosurg 2019; 129:63-71. [PMID: 30544321 DOI: 10.3171/2018.7.gks18752] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/24/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEssential tremor (ET) is the most common movement disorder. Drug-resistant ET can benefit from standard stereotactic deep brain stimulation or radiofrequency thalamotomy or, alternatively, minimally invasive techniques, including stereotactic radiosurgery (SRS) and high-intensity focused ultrasound, at the level of the ventral intermediate nucleus (Vim). The aim of the present study was to evaluate potential correlations between pretherapeutic interconnectivity (IC), as depicted on resting-state functional MRI (rs-fMRI), and MR signature volume at 1 year after Vim SRS for tremor, to be able to potentially identify hypo- and hyperresponders based only on pretherapeutic neuroimaging data.METHODSSeventeen consecutive patients with ET were included, who benefitted from left unilateral SRS thalamotomy (SRS-T) between September 2014 and August 2015. Standard tremor assessment and rs-fMRI were acquired pretherapeutically and 1 year after SRS-T. A healthy control group was also included (n = 12). Group-level independent component analysis (ICA; only n = 17 for pretherapeutic rs-fMRI) was applied. The mean MR signature volume was 0.125 ml (median 0.063 ml, range 0.002-0.600 ml). The authors correlated baseline IC with 1-year MR signatures within all networks. A 2-sample t-test at the level of each component was first performed in two groups: group 1 (n = 8, volume < 0.063 ml) and group 2 (n = 9, volume ≥ 0.063 ml). These groups did not statistically differ by age, duration of symptoms, baseline ADL score, ADL point decrease at 1 year, time to tremor arrest, or baseline tremor score on the treated hand (TSTH; p > 0.05). An ANOVA was then performed on each component, using individual subject-level maps and continuous values of 1-year MR signatures, correlated with pretherapeutic IC.RESULTSUsing 2-sample t-tests, two networks were found to be statistically significant: network 3, including the brainstem, motor cerebellum, bilateral thalamus, and left supplementary motor area (SMA) (pFWE = 0.004, cluster size = 94), interconnected with the red nucleus (MNI -2, -22, -32); and network 9, including the brainstem, posterior insula, bilateral thalamus, and left SMA (pFWE = 0.002, cluster size = 106), interconnected with the left SMA (MNI 24, -28, 44). Higher pretherapeutic IC was associated with higher MR volumes, in a network including the anterior default-mode network and bilateral thalamus (ANOVA, pFWE = 0.004, cluster size = 73), interconnected with cerebellar lobule V (MNI -12, -70, -22). Moreover, in the same network, radiological hyporesponders presented with negative IC values.CONCLUSIONSThese findings have clinical implications for predicting MR signature volumes after SRS-T. Here, using pretherapeutic MRI and data processing without prior hypothesis, the authors showed that pretherapeutic network interconnectivity strength predicts 1-year MR signature volumes following SRS-T.
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Affiliation(s)
- Constantin Tuleasca
- 1Neurosurgery Service and Gamma Knife Center.,4Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Jean Régis
- 5Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, and
| | - Elena Najdenovska
- 2Medical Image Analysis Laboratory (MIAL) and Department of Radiology, Centre d'Imagerie BioMédicale (CIBM), and
| | | | - Nadine Girard
- 7AMU, CRMBM UMR CNRS 7339, Faculté de Médecine et APHM, Hôpital Timone, Department of Diagnostic and Interventional Neuroradiology, Marseille, France
| | - Thomas Bolton
- 8Medical Image Processing Laboratory, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland
| | - Francois Delaire
- 5Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, and
| | - Marion Vincent
- 5Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, and
| | - Mohamed Faouzi
- 9Institute of Social and Preventive Medicine, Lausanne, Switzerland; and
| | - Jean-Philippe Thiran
- 3Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland.,4Faculty of Biology and Medicine, University of Lausanne, Switzerland.,10Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Meritxell Bach Cuadra
- 2Medical Image Analysis Laboratory (MIAL) and Department of Radiology, Centre d'Imagerie BioMédicale (CIBM), and.,3Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland
| | - Marc Levivier
- 1Neurosurgery Service and Gamma Knife Center.,4Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Dimitri Van de Ville
- 8Medical Image Processing Laboratory, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland.,11University of Geneva, Faculty of Medicine, Geneva, Switzerland
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Khedr EM, El Fawal B, Abdelwarith A, Nasreldein A, Rothwell JC, Saber M. TMS excitability study in essential tremor: Absence of gabaergic changes assessed by silent period recordings. Neurophysiol Clin 2019; 49:309-315. [DOI: 10.1016/j.neucli.2019.05.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 10/26/2022] Open
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Kim CY, Luo L, Yu Q, Mirallave A, Saunders-Pullman R, Lipton RB, Louis ED, Pullman SL. Repeated Spiral Drawings in Essential Tremor: a Possible Limb-Based Measure of Motor Learning. THE CEREBELLUM 2019; 18:178-187. [PMID: 30206795 DOI: 10.1007/s12311-018-0974-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To investigate changes in tremor severity over repeated spiral drawings to assess whether learning deficits can be evaluated directly in a limb in essential tremor (ET). A motor learning deficit in ET, possibly mediated by cerebellar pathways, has been established in eye-blink conditioning studies, but not paradigms measuring from an affected, tremulous limb. Computerized spiral analysis captures multiple characteristics of Archimedean spirals and quantifies performance through calculated indices. Sequential spiral drawing has recently been suggested to demonstrate improvement across trials among ET subjects. One hundred and sixty-one ET and 80 age-matched control subjects drew 10 consecutive spirals on a digitizing tablet. Degree of severity (DoS), a weighted, computational score of spiral execution that takes into account spiral shape and line smoothness, previously validated against a clinical rating scale, was calculated in both groups. Tremor amplitude (Ampl), an independent index of tremor size, measured in centimeters, was also calculated. Changes in DoS and Ampl across trials were assessed using linear regression with slope evaluations. Both groups demonstrated improvement in DoS across trials, but with less improvement in the ET group compared to controls. Ampl demonstrated a tendency to worsen across trials in ET subjects. ET subjects demonstrated less improvement than controls when drawing sequential spirals, suggesting a possible motor learning deficit in ET, here captured in an affected limb. DoS improved independently of Ampl, showing that DoS and Ampl are separable motor physiologic components in ET that may be independently mediated.
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Affiliation(s)
- Christine Y Kim
- Department of Neurology, Clinical Motor Physiology Laboratory, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Lan Luo
- Department of Neurology, Clinical Motor Physiology Laboratory, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Qiping Yu
- Department of Neurology, Clinical Motor Physiology Laboratory, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Ana Mirallave
- Department of Neurology, Clinical Motor Physiology Laboratory, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - 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
| | - Seth L Pullman
- Department of Neurology, Clinical Motor Physiology Laboratory, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
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Archer DB, Coombes SA, Chu WT, Woo Chung J, Burciu RG, Okun MS, Wagle Shukla A, Vaillancourt DE. Reply: Visually-sensitive networks in essential tremor: evidence from structural and functional imaging. Brain 2019; 141:e48. [PMID: 29659746 DOI: 10.1093/brain/awy096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Derek B Archer
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Stephen A Coombes
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Winston T Chu
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA.,Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Jae Woo Chung
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Roxana G Burciu
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology and Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology and Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA
| | - David E Vaillancourt
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA.,Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.,Department of Neurology and Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA
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41
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Güler S, Caylan A, Turan FN, Dağdeviren N. The prevalence of essential tremor in Edirne and its counties accompanied comorbid conditions. Neurol Res 2019; 41:847-856. [PMID: 31238803 DOI: 10.1080/01616412.2019.1628409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: We aimed to determine the prevalence and risk factors of Essential Tremor (ET) in Edirne and its districts, located in Western Thrace, which is the most western part of Turkey. Methods: In this study, 3008 individuals who could communicate and agreed to participate in the study were evaluated. To obtain the data from the applicants in 30 Family Health Centres in Edirne and its districts, a face-to-face questionnaire that consisted of 37 questions was prepared by the researchers. The questionnaire included general information, questions to evaluate potential concomitant comorbid conditions and questions regarding the symptomatology used in ET diagnosis, as well as questions to evaluate ET severity, was examined with the spiral test. Patients were classified by using the Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) diagnostic and clinical evaluation scale. According to the diagnostic criteria for ET (used in participants who were examined and in those whose medical records were reviewed) were similar to those used in astudy conducted in Turkey. Results: Of 3008 individuals, 173 were diagnosed with ET according to the questionnaire results from Edirne and its districts, and the prevalence of ET was 5.8%. Approximately, 43.4% of the patients with ET were male, and 56.6% were female, which was not significantly different (p > 0.05). Participants with tremor related to alcohol withdrawal, hyperthyroidism, anxiety, depression other known causes of tremor were not considered to have ET. Thyroid disease was identified in 0.0% of the cases, and the control group was detected in 1.4%, which was not significantly different (p = 0.170). Psychiatric disease was identified in 0.0% of the cases, and the control group was detected in 1.3%, which was not significantly different (p = 0.271). Conclusions: ET prevalence studies will increase the awareness of the community and provide early diagnosis and treatment, as well as serve as a basis to reduce morbidity and improve the quality of life.
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Affiliation(s)
- Sibel Güler
- Department of Neurology, Trakya University Faculty of Medicine , Edirne , Turkey
| | - Ayşe Caylan
- Department of Family Medicine, Trakya University Faculty of Medicine , Edirne , Turkey
| | - F Nesrin Turan
- Department of Biostatistics, Trakya University Faculty of Medicine , Edirne , Turkey
| | - Nezih Dağdeviren
- Department of Family Medicine, Trakya University Faculty of Medicine , Edirne , Turkey
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ALLEN BRENDONC, CHARLES STEVENK. EFFECT OF GYROSCOPE PARAMETERS ON GYROSCOPIC TREMOR SUPPRESSION IN A SINGLE DEGREE OF FREEDOM. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419500246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although tremor is one of the most common movement disorders, there are few effective tremor-suppressing options available to patients. Gyrostabilization is a potential option, but we do not currently know how to optimize gyrostabilization for tremor suppression. To address this gap, we present a systematic investigation of how gyrostabilizer parameters affect tremor suppression in a single degree of freedom (DOF). A simple model with a single DOF at the wrist and a gyroscope mounted on the back of the hand was used to focus on the most basic effects. We simulated the frequency response of the system (hand + gyroscope) to a tremorogenic input torque at the wrist. Varying system parameters one at a time, we determined the effect of individual parameters on the system’s frequency response. To minimize the bandwidth without adding significant inertia, the inertia and spin speed of the flywheel should be as high as design constraints allow, whereas the distance from the wrist joint axis to the gyroscope and the precession stiffness and damping should be kept as low as possible. The results demonstrate the potential of gyroscopic tremor suppression and can serve as foundation for further investigations of gyroscopic tremor suppression in the upper limb.
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Affiliation(s)
- BRENDON C. ALLEN
- Mechanical Engineering, Brigham Young University, 350 EB, Provo, UT 84602, USA
| | - STEVEN K. CHARLES
- Mechanical Engineering and Neuroscience, Brigham Young University, 350 EB, Provo, UT 84602, USA
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Archer DB, Coombes SA, Chu WT, Chung JW, Burciu RG, Okun MS, Wagle Shukla A, Vaillancourt DE. A widespread visually-sensitive functional network relates to symptoms in essential tremor. Brain 2019; 141:472-485. [PMID: 29293948 DOI: 10.1093/brain/awx338] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/21/2017] [Indexed: 12/17/2022] Open
Abstract
Essential tremor is a neurological syndrome of heterogeneous pathology and aetiology that is characterized by tremor primarily in the upper extremities. This tremor is commonly hypothesized to be driven by a single or multiple neural oscillator(s) within the cerebello-thalamo-cortical pathway. Several studies have found an association of blood-oxygen level-dependent (BOLD) signal in the cerebello-thalamo-cortical pathway with essential tremor, but there is behavioural evidence that also points to the possibility that the severity of tremor could be influenced by visual feedback. Here, we directly manipulated visual feedback during a functional MRI grip force task in patients with essential tremor and control participants, and hypothesized that an increase in visual feedback would exacerbate tremor in the 4-12 Hz range in essential tremor patients. Further, we hypothesized that this exacerbation of tremor would be associated with dysfunctional changes in BOLD signal and entropy within, and beyond, the cerebello-thalamo-cortical pathway. We found that increases in visual feedback increased tremor in the 4-12 Hz range in essential tremor patients, and this increase in tremor was associated with abnormal changes in BOLD amplitude and entropy in regions within the cerebello-thalamo-motor cortical pathway, and extended to visual and parietal areas. To determine if the tremor severity was associated with single or multiple brain region(s), we conducted a birectional stepwise multiple regression analysis, and found that a widespread functional network extending beyond the cerebello-thalamo-motor cortical pathway was associated with changes in tremor severity measured during the imaging protocol. Further, this same network was associated with clinical tremor severity measured with the Fahn, Tolosa, Marin Tremor Rating Scale, suggesting this network is clinically relevant. Since increased visual feedback also reduced force error, this network was evaluated in relation to force error but the model was not significant, indicating it is associated with force tremor but not force error. This study therefore provides new evidence that a widespread functional network is associated with the severity of tremor in patients with essential tremor measured simultaneously at the hand during functional imaging, and is also associated with the clinical severity of tremor. These findings support the idea that the severity of tremor is exacerbated by increased visual feedback, suggesting that designers of new computing technologies should consider using lower visual feedback levels to reduce tremor in essential tremor.
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Affiliation(s)
- Derek B Archer
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Stephen A Coombes
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Winston T Chu
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA.,Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Jae Woo Chung
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Roxana G Burciu
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology and Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology and Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA
| | - David E Vaillancourt
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA.,Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.,Department of Neurology and Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA
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Pietracupa S, Bologna M, Bharti K, Pasqua G, Tommasin S, Elifani F, Paparella G, Petsas N, Grillea G, Berardelli A, Pantano P. White matter rather than gray matter damage characterizes essential tremor. Eur Radiol 2019; 29:6634-6642. [PMID: 31139970 DOI: 10.1007/s00330-019-06267-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/09/2019] [Accepted: 05/06/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We investigated changes in gray matter (GM) and white matter (WM) in the whole brain, including both cortical and subcortical structures, and their relationship with tremor severity, psychiatric symptoms, and cognitive impairment in patients affected by essential tremor (ET). METHODS We studied 19 ET patients and 15 healthy subjects (HS). All the subjects underwent a 3-T MRI study based on 3D-T1 and diffusion tensor images. For the GM analysis, cortical thickness was assessed by using the Computational Anatomy Tool, basal ganglia and thalamus volumes by using the FMRIB software library, and cerebellum lobular volumes by using the spatial unbiased atlas template. For the WM assessment, we performed a voxel-wise analysis by means of tract-based spatial statistics. Patients' tremor severity and psychiatric and cognitive disorders were evaluated by means of standard clinical scales. Neuroimaging data were correlated with clinical scores. RESULTS We found significantly smaller right and left thalamic volumes in ET patients than in HS, which correlated with cognitive scores. We did not observe any significant differences either in cortical thickness or in cerebellar lobular volumes between patients and HS. WM abnormalities were detected in most hemisphere bundles, particularly in the corticospinal tract, cerebellar peduncles, and corpus callosum. The WM abnormalities significantly correlated with tremor severity, cognitive profile, and depression. CONCLUSION Our study indicates that ET is characterized by several GM and WM changes of both infra- and supratentorial brain structures. The results may help to better understand mechanisms underlying tremor severity and psychiatric and cognitive impairment in ET. KEY POINTS • We performed a comprehensive evaluation of gray and white matter in the same sample of patients with essential tremor using recently developed data analysis methods. • Essential tremor is characterized by widespread gray and white matter changes in both infra- and supratentorial brain structures. The results may help to better understand motor and non-motor symptoms in patients with essential tremor.
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Affiliation(s)
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Komal Bharti
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Gabriele Pasqua
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | | | | | | | | | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Patrizia Pantano
- IRCCS Neuromed, Pozzilli (IS), Italy. .,Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
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Tuleasca C, Bolton TAW, Régis J, Najdenovska E, Witjas T, Girard N, Delaire F, Vincent M, Faouzi M, Thiran JP, Bach Cuadra M, Levivier M, Van De Ville D. Normalization of aberrant pretherapeutic dynamic functional connectivity of extrastriate visual system in patients who underwent thalamotomy with stereotactic radiosurgery for essential tremor: a resting-state functional MRI study. J Neurosurg 2019; 132:1792-1801. [PMID: 31075777 DOI: 10.3171/2019.2.jns183454] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The tremor circuitry has commonly been hypothesized to be driven by one or multiple pacemakers within the cerebello-thalamo-cortical pathway, including the cerebellum, contralateral motor thalamus, and primary motor cortex. However, previous studies, using multiple methodologies, have advocated that tremor could be influenced by changes within the right extrastriate cortex, at both the structural and functional level. The purpose of this work was to evaluate the role of the extrastriate cortex in tremor generation and further arrest after left unilateral stereotactic radiosurgery thalamotomy (SRS-T). METHODS The authors considered 12 healthy controls (HCs, group 1); 15 patients with essential tremor (ET, right-sided, drug-resistant; group 2) before left unilateral SRS-T; and the same 15 patients (group 3) 1 year after the intervention, to account for delayed effects. Blood oxygenation level-dependent functional MRI during resting state was used to characterize the dynamic interactions of the right extrastriate cortex, comparing HC subjects against patients with ET before and 1 year after SRS-T. In particular, the authors applied coactivation pattern analysis to extract recurring whole-brain spatial patterns of brain activity over time. RESULTS The authors found 3 different sets of coactivating regions within the right extrastriate cortex in HCs and patients with pretherapeutic ET, reminiscent of the "cerebello-visuo-motor," "thalamo-visuo-motor" (including the targeted thalamus), and "basal ganglia and extrastriate" networks. The occurrence of the first pattern was decreased in pretherapeutic ET compared to HCs, whereas the other two patterns showed increased occurrences. This suggests a misbalance between the more prominent cerebellar circuitry and the thalamo-visuo-motor and basal ganglia networks. Multiple regression analysis showed that pretherapeutic standard tremor scores negatively correlated with the increased occurrence of the thalamo-visuo-motor network, suggesting a compensatory pathophysiological trait. Clinical improvement after SRS-T was related to changes in occurrences of the basal ganglia and extrastriate cortex circuitry, which returned to HC values after the intervention, suggesting that the dynamics of the extrastriate cortex had a role in tremor generation and further arrest after the intervention. CONCLUSIONS The data in this study point to a broader implication of the visual system in tremor generation, and not only through visual feedback, given its connections to the dorsal visual stream pathway and the cerebello-thalamo-cortical circuitry, with which its dynamic balance seems to be a crucial feature for reduced tremor. Furthermore, SRS-T seems to bring abnormal pretherapeutic connectivity of the extrastriate cortex to levels comparable to those of HC subjects.
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Affiliation(s)
- Constantin Tuleasca
- 1Service de Neurochirurgie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Centre Hospitalier Universitaire de Bicêtre, Paris.,2Faculté de Médecine, Sorbonne Université, Paris, France.,3Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne.,4Medical Image Analysis Laboratory and Department of Radiology-Center of Biomedical Imaging, Centre Hospitalier Universitaire Vaudois, Lausanne.,5Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne.,6Faculty of Biology and Medicine University of Lausanne
| | - Thomas A W Bolton
- 7Medical Image Processing Laboratory, École Polytechnique Fédérale de Lausanne, Switzerland.,8Department of Radiology and Medical Informatics, University of Geneva, Switzerland
| | - Jean Régis
- 9Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, CHU Timone, Marseille
| | - Elena Najdenovska
- 4Medical Image Analysis Laboratory and Department of Radiology-Center of Biomedical Imaging, Centre Hospitalier Universitaire Vaudois, Lausanne
| | | | - Nadine Girard
- 11Department of Diagnostic and Interventional Neuroradiology, Centre de Résonance Magnétique Biologique et Médicale, Unité Mixte de Recherche, Centre National de la Recherche Scientifique, Faculté de Médecine et Assistance Publique-Hôpitaux de Marseille, Hôpital Timone, Marseille, France
| | - Francois Delaire
- 9Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, CHU Timone, Marseille
| | - Marion Vincent
- 9Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, CHU Timone, Marseille
| | - Mohamed Faouzi
- 12Institute of Social and Preventive Medicine, Lausanne; and
| | - Jean-Philippe Thiran
- 5Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne.,13Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Meritxell Bach Cuadra
- 4Medical Image Analysis Laboratory and Department of Radiology-Center of Biomedical Imaging, Centre Hospitalier Universitaire Vaudois, Lausanne.,5Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne
| | - Marc Levivier
- 3Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne.,6Faculty of Biology and Medicine University of Lausanne
| | - Dimitri Van De Ville
- 7Medical Image Processing Laboratory, École Polytechnique Fédérale de Lausanne, Switzerland.,8Department of Radiology and Medical Informatics, University of Geneva, Switzerland
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Salsone M, Arabia G, Manfredini L, Quattrone A, Chiriaco C, Vescio B, Sturniolo M, Morelli M, Nistico' R, Novellino F, Gambardella A, Quattrone A. REM-Sleep Behavior Disorder in Patients With Essential Tremor: What Is Its Clinical Significance? Front Neurol 2019; 10:315. [PMID: 31068885 PMCID: PMC6491751 DOI: 10.3389/fneur.2019.00315] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/12/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: REM sleep behavior disorder (RBD) is an important risk factor for the dementia development and for the deterioration of autonomic functions in patients with Parkinson's Disease. RBD has also been reported in patients with Essential Tremor (ET). However, its clinical significance in ET remains still unknown. We aimed to investigate clinical, neuropsychological and cardiac autonomic scintigraphic differences between ET patients with and without RBD. Methods: To assess RBD symptoms, RBD Single-Question has been administered in a cohort of 55 patients with a clinical diagnosis of ET. Patients with clinical RBD underwent polysomnography (PSG) confirmation. All patients completed a battery of neuropsychological assessment of memory, executive function, attention, language, and visuospatial function. Cardiac MIBG scintigraphy was performed in order to measure the cardiac autonomic innervation. Results: Ten ET patients (18%) had a PSG-confirmed RBD (ETRBD+). Compared to ET patients without RBD (ETRBD−), significantly reduced scores on memory domain tests such as Rey auditory verbal learning test immediate recall (p = 0.015) and Rey auditory verbal learning test delayed recall (p = 0.004) and phonemic fluency test (p = 0.028) were present in ETRBD+. By contrast, no other significant clinical difference has emerged from the comparison between two ET groups. Similarly, ETRBD+ patients have cardiac MIBG tracer uptake in the normal value range as occurred in those with ETRBD−. Conclusions: This study improves the knowledge on clinical significance of RBD symptoms in ET patients. Our preliminary findings demonstrate that presence of RBD in ET is associated with neurocognitive impairment, but not with cardiac autonomic dysfunction. Further longitudinal studies are needed to investigate whether ET patients with RBD will develop a frank dementia over the time.
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Affiliation(s)
- Maria Salsone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Gennarina Arabia
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Lucia Manfredini
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Andrea Quattrone
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Carmelina Chiriaco
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | | | - Miriam Sturniolo
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Maurizio Morelli
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Rita Nistico'
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Fabiana Novellino
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | | | - Aldo Quattrone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.,Neuroscience Center, University Magna Graecia, Catanzaro, Italy
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Altinel Y, Alkhalfan F, Qiao N, Velimirovic M. Outcomes in Lesion Surgery versus Deep Brain Stimulation in Patients with Tremor: A Systematic Review and Meta-Analysis. World Neurosurg 2019; 123:443-452.e8. [DOI: 10.1016/j.wneu.2018.11.175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 12/21/2022]
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48
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Pahwa R, Dhall R, Ostrem J, Gwinn R, Lyons K, Ro S, Dietiker C, Luthra N, Chidester P, Hamner S, Ross E, Delp S. An Acute Randomized Controlled Trial of Noninvasive Peripheral Nerve Stimulation in Essential Tremor. Neuromodulation 2019; 22:537-545. [PMID: 30701655 PMCID: PMC6766922 DOI: 10.1111/ner.12930] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/28/2018] [Accepted: 12/12/2018] [Indexed: 11/30/2022]
Abstract
Objective To evaluate the safety and effectiveness of a wrist‐worn peripheral nerve stimulation device in patients with essential tremor (ET) in a single in‐office session. Methods This was a randomized controlled study of 77 ET patients who received either treatment stimulation (N = 40) or sham stimulation (N = 37) on the wrist of the hand with more severe tremor. Tremor was evaluated before and immediately after the end of a single 40‐minute stimulation session. The primary endpoint compared spiral drawing in the stimulated hand using the Tremor Research Group Essential Tremor Rating Assessment Scale (TETRAS) Archimedes spiral scores in treatment and sham groups. Additional endpoints included TETRAS upper limb tremor scores, subject‐rated tasks from the Bain and Findley activities of daily living (ADL) scale before and after stimulation as well as clinical global impression‐improvement (CGI‐I) rating after stimulation. Results Subjects who received peripheral nerve stimulation did not show significantly larger improvement in the Archimedes spiral task compared to sham but did show significantly greater improvement in upper limb TETRAS tremor scores (p = 0.017) compared to sham. Subject‐rated improvements in ADLs were significantly greater with treatment (49% reduction) than with sham (27% reduction; p = 0.001). A greater percentage of ET patients (88%) reported improvement in the stimulation group as compared to the sham group (62%) according to CGI‐I ratings (p = 0.019). No significant adverse events were reported; 3% of subjects experienced mild adverse events. Conclusions Peripheral nerve stimulation in ET may provide a safe, well‐tolerated, and effective treatment for transient relief of hand tremor symptoms.
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Affiliation(s)
- Rajesh Pahwa
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Rohit Dhall
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jill Ostrem
- University of California San Francisco, San Francisco, CA, USA
| | - Ryder Gwinn
- Swedish Medical Center Seattle, Seattle, WA, USA
| | - Kelly Lyons
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Susie Ro
- Swedish Medical Center Seattle, Seattle, WA, USA
| | | | - Nijee Luthra
- University of California San Francisco, San Francisco, CA, USA
| | | | | | - Erika Ross
- Cala Health, Inc., Burlingame, CA, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Scott Delp
- Department of Bioengineering, Stanford University, Stanford, CA, USA
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49
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Botulinum toxin for the treatment of tremor. Parkinsonism Relat Disord 2019; 63:31-41. [PMID: 30709779 DOI: 10.1016/j.parkreldis.2019.01.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 11/23/2022]
Abstract
Tremor is a key clinical feature of several common neurological disorders. Adequate management of tremor has been an unmet need in clinical practice. Most of the anti-tremor medications have limited efficacy and are associated with undesirable adverse effects, especially in elderly patients. Several studies have reported good outcomes with the use of botulinum neurotoxin (BoNT) for the treatment of tremor. This article aims to systematically review these studies and to highlight the role of BoNT in the management of tremor. A PubMed search was performed in August 2018 to identify articles pertinent to this review. Majority of the studies that have assessed the efficacy of BoNT in tremor, enrolled patients with essential tremor (ET), Parkinson's disease (PD), and dystonic tremor. Results of these studies suggest clinically meaningful improvement in hand tremor in both ET and PD and vocal tremor in ET after BoNT therapy. Additionally, BoNT has been reported to be efficacious in alleviating head and palatal tremor, tremor in multiple sclerosis, and proximal positional tremor. It is apparent that BoNT injections tailored to the needs of individual patients yield better efficacy and lower adverse effects compared to fixed-muscle-fixed-dose approach. BoNT individualized approach adds to the armamentarium for patients who have medically refractory tremors or those who are unable to tolerate the anti-tremor medications. The studies are limited and mostly open-label; thus, randomized placebo-controlled studies are needed to prove the efficacy of BoNT in various tremor conditions.
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50
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Chiang VL, Chao ST, Tuleasca C, Foote MC, Lee CC, Mathieu D, Soliman H, Sahgal A. Proceedings of the 2018 next-generation Gamma Knife research meeting. J Neurosurg 2018; 129:5-9. [PMID: 30544302 DOI: 10.3171/2018.7.gks181206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022]
Abstract
In order to determine what areas of research are a clinical priority, a small group of young Gamma Knife investigators was invited to attend a workshop discussion at the 19th International Leksell Gamma Knife Society Meeting. Two areas of interest and the need for future radiosurgical research involving multiple institutions were identified by the young investigators working group: 1) the development of additional imaging sequences to guide the understanding, treatment, and outcome tracking of diseases such as tremor, radiation necrosis, and AVM; and 2) trials to clarify the role of hypofractionation versus single-fraction radiosurgery in the treatment of large lesions such as brain metastases, postoperative cavities, and meningiomas.
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Affiliation(s)
- Veronica L Chiang
- 1Department of Neurosurgery, Yale University, New Haven, Connecticut
| | - Samuel T Chao
- 2Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Constantin Tuleasca
- 3Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV); Faculty of Biology and Medicine (FBM), University of Lausanne; and Signal Processing Laboratory (EPFL), Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Matthew C Foote
- 4Department of Radiation Oncology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Cheng-Chia Lee
- 5Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and School of Medicine, National Yan-Min University, Taipei, Taiwan
| | - David Mathieu
- 6Department of Neurosurgery, Department of Surgery, Université de Sherbrooke, Quebec, Canada; and
| | - Hany Soliman
- 7Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Arjun Sahgal
- 7Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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