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Cornelissen L, Donado C, Yu TW, Berde CB. Modified Sensory Testing in Non-verbal Patients Receiving Novel Intrathecal Therapies for Neurological Disorders. Front Neurol 2022; 13:664710. [PMID: 35222234 PMCID: PMC8866183 DOI: 10.3389/fneur.2022.664710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 01/14/2022] [Indexed: 11/24/2022] Open
Abstract
Several neurological disorders may be amenable to treatment with gene-targeting therapies such as antisense oligonucleotides (ASOs) or viral vector-based gene therapy. The US FDA has approved several of these treatments; many others are in clinical trials. Preclinical toxicity studies of ASO candidates have identified dose-dependent neurotoxicity patterns. These include degeneration of dorsal root ganglia, the cell bodies of peripheral sensory neurons. Quantitative sensory testing (QST) refers to a series of standardized mechanical and/or thermal measures that complement clinical neurologic examination in detecting sensory dysfunction. QST primarily relies on patient self-report or task performance (i.e., button-pushing). This brief report illustrates individualized pragmatic approaches to QST in non-verbal subjects receiving early phase investigational intrathecal drug therapies as a component of clinical trial safety protocols. Three children with neurodevelopmental disorders that include Neuronal Ceroid Lipofuscinosis Type 7, Ataxia-Telangiectasia, and Epilepsy of Infancy with Migrating Focal Seizures are presented. These case studies discuss individualized testing protocols, accounting for disease presentation, cognitive and motor function. We outline specific considerations for developing assessments for detecting changes in sensory processing in diverse patient groups and safety monitoring trials of early phase investigational intrathecal drug therapies. QST may complement information obtained from the standard neurologic examination, electrophysiologic studies, skin biopsies, and imaging. QST has limitations and challenges, especially in non-verbal subjects, as shown in the three cases discussed in this report. Future directions call for collaborative efforts to generate sensory datasets and share data registries in the pediatric neurology field.
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Affiliation(s)
- Laura Cornelissen
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
| | - Carolina Donado
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
| | - Timothy W Yu
- Divisions of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States.,Department of Paediatrics, Harvard Medical School, Boston, MA, United States
| | - Charles B Berde
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
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Sweeney D, Quinlan LR, Browne P, Counihan T, Rodriguez-Molinero A, ÓLaighin G. Applicability and tolerability of electrical stimulation applied to the upper and lower leg skin surface for cueing applications in Parkinson's disease. Med Eng Phys 2021; 87:73-81. [PMID: 33461676 DOI: 10.1016/j.medengphy.2020.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/16/2020] [Accepted: 11/14/2020] [Indexed: 11/29/2022]
Abstract
Due to possible sensory impairments in people with Parkinson's disease, several methodological aspects of electrical stimulation as a potential cueing method remain to be explored. This study aimed to investigate the applicability and tolerability of sensory and motor electrical stimulation in 10 people with Parkinson's disease. The study focused on assessing the electrical stimulation voltages and visual analogue scale discomfort scores at the electrical sensory, motor, discomfort, and pain thresholds. Results show that sensory electrical stimulation at the tibialis anterior, soleus, hamstrings, and quadriceps stimulation sites was applicable and tolerable for 6/10, 10/10, 9/10, and 10/10 participants, respectively. Furthermore, motor electrical stimulation at the tibialis anterior, soleus, hamstrings, and quadriceps stimulation sites were applicable and tolerable for 7/10, 7/10, 7/10, and 8/10 participants, respectively. Interestingly, the thresholds for the lower leg were higher than those of the upper leg. The data presented in this paper indicate that sensory and motor electrical stimulation is applicable and tolerable for cueing applications in people with Parkinson's disease. Sensory electrical stimulation was applicable and tolerable at the soleus and quadriceps sites. Motor electrical stimulation was not tolerable for two participants at any of the proposed stimulation sites. Therefore, future studies investigating motor electrical stimulation cueing, should apply it with caution in people with Parkinson's disease.
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Affiliation(s)
- Dean Sweeney
- Electrical and Electronic Engineering, School of Engineering, NUI Galway, University Road, Galway, Ireland; Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, NUI Galway, University Road, Galway, Ireland
| | - Leo R Quinlan
- Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, NUI Galway, University Road, Galway, Ireland; Physiology, School of Medicine, NUI Galway, University Road, Galway, Ireland
| | - Patrick Browne
- Neurology Department, University Hospital Galway, Newcastle, Galway, Ireland; School of Nursing and Midwifery, NUI Galway, University Road, Galway, Ireland
| | - Timothy Counihan
- Neurology Department, University Hospital Galway, Newcastle, Galway, Ireland; School of Medicine, NUI Galway, University Road, Galway, Ireland
| | - Alejandro Rodriguez-Molinero
- Electrical and Electronic Engineering, School of Engineering, NUI Galway, University Road, Galway, Ireland; Consorci Sanitari del Garraf, Clinical Research Unit, Vilanova I la Geltrú, Catalunya, Spain
| | - Gearóid ÓLaighin
- Electrical and Electronic Engineering, School of Engineering, NUI Galway, University Road, Galway, Ireland; Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, NUI Galway, University Road, Galway, Ireland
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Ozdemir RA, Perez MA. Afferent input and sensory function after human spinal cord injury. J Neurophysiol 2017; 119:134-144. [PMID: 28701541 DOI: 10.1152/jn.00354.2017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Spinal cord injury (SCI) often disrupts the integrity of afferent (sensory) axons projecting through the spinal cord dorsal columns to the brain. Examinations of ascending sensory tracts, therefore, are critical for monitoring the extent of SCI and recovery processes. In this review, we discuss the most common electrophysiological techniques used to assess transmission of afferent inputs to the primary motor cortex (i.e., afferent input-induced facilitation and inhibition) and the somatosensory cortex [i.e., somatosensory evoked potentials (SSEPs), dermatomal SSEPs, and electrical perceptual thresholds] following human SCI. We discuss how afferent input modulates corticospinal excitability by involving cortical and spinal mechanisms depending on the timing of the effects, which need to be considered separately for upper and lower limb muscles. We argue that the time of arrival of afferent input onto the sensory and motor cortex is critical to consider in plasticity-induced protocols in humans with SCI. We also discuss how current sensory exams have been used to detect differences between control and SCI participants but might be less optimal to characterize the level and severity of injury. There is a need to conduct some of these electrophysiological examinations during functionally relevant behaviors to understand the contribution of impaired afferent inputs to the control, or lack of control, of movement. Thus the effects of transmission of afferent inputs to the brain need to be considered on multiple functions following human SCI.
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Affiliation(s)
- Recep A Ozdemir
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami , Miami, Florida.,Bruce W. Carter Department of Veterans Affairs Medical Center , Miami, Florida
| | - Monica A Perez
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami , Miami, Florida.,Bruce W. Carter Department of Veterans Affairs Medical Center , Miami, Florida
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Macklin RA, Bae J, Orell M, Anderson KD, Ellaway PH, Perez MA. Time-Dependent Discrepancies between Assessments of Sensory Function after Incomplete Cervical Spinal Cord Injury. J Neurotrauma 2016; 34:1778-1786. [PMID: 27203696 DOI: 10.1089/neu.2016.4433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We recently demonstrated that the electrical perceptual threshold (EPT) examination reveals spared sensory function at lower spinal segments compared with the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination in humans with chronic incomplete cervical spinal cord injury (SCI). Here, we investigated whether discrepancies in sensory function detected by both sensory examinations change over time after SCI. Forty-five participants with acute (<1 year), chronic (≥1-10 years), and extended-chronic (>10 years) incomplete cervical SCI and 30 control subjects were tested on dermatomes C2-T4 bilaterally. EPT values were higher in subjects with acute (2.5 ± 0.8 mA), chronic (2.2 ± 0.7 mA), or extended-chronic (2.8 ± 1.1 mA) SCI compared with controls (1.0 ± 0.1 mA). The EPT examination detected sensory impairments in spinal segments above (2.3 ± 0.9) and below (4.2 ± 2.6) the level detected by the ISNCSCI sensory examination in participants with acute and chronic SCI, respectively. Notably, both examinations detected similar levels of spared sensory function in the extended-chronic phase of SCI (0.8 ± 0.5). A negative correlation was found between differences in EPT and ISNCSCI sensory levels and time post-injury. These observations indicate that discrepancies between EPT and ISNCSCI sensory scores are time-dependent, with the EPT revealing impaired sensory function above, below, or at the same spinal segment as the ISNCSCI examination. We propose that the EPT is a sensitive tool to assess changes in sensory function over time after incomplete cervical SCI.
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Affiliation(s)
- Richard A Macklin
- 1 Department of Neurological Surgery, University of Miami , The Miami Project to Cure Paralysis, Miami, Florida
| | - Jihye Bae
- 1 Department of Neurological Surgery, University of Miami , The Miami Project to Cure Paralysis, Miami, Florida
| | - Melanie Orell
- 1 Department of Neurological Surgery, University of Miami , The Miami Project to Cure Paralysis, Miami, Florida
| | - Kim D Anderson
- 1 Department of Neurological Surgery, University of Miami , The Miami Project to Cure Paralysis, Miami, Florida
| | - Peter H Ellaway
- 2 Division of Brain Sciences, Imperial College , London, United Kingdom
| | - Monica A Perez
- 1 Department of Neurological Surgery, University of Miami , The Miami Project to Cure Paralysis, Miami, Florida
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Discrepancies between clinical assessments of sensory function and electrical perceptual thresholds after incomplete chronic cervical spinal cord injury. Spinal Cord 2015; 54:16-23. [PMID: 26123212 PMCID: PMC5558198 DOI: 10.1038/sc.2015.104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/11/2015] [Accepted: 05/19/2015] [Indexed: 12/03/2022]
Abstract
Study Design Prospective experimental. Objectives To compare sensory function as revealed by light touch and pin prick tests of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the electrical perceptual threshold (EPT) exams in individuals with chronic incomplete cervical spinal cord injury (SCI). Setting Pittsburgh, United States. Methods EPT was tested using cutaneous electrical stimulation (0.5 ms pulse width, 3 Hz) in 32 healthy controls and in 17 participants with SCI over key points on dermatomes C2 to T4 on each side of the body. Light touch and pin prick ISNCSCI scores were tested at the same key dermatomes in SCI participants. Results In controls, EPT values were higher in older males (1.26±0.2 mA, mean±s.d.) compared with younger males (1.0±0.2 mA) and older females (0.9±0.2 mA), regardless of the dermatome and side tested. Fifteen out of seventeen SCI participants showed that the level of sensory impairment detected by the EPT was below the level detected by the ISNCSCI (mean=4.5±2.4, range 1–9). The frequency distribution of EPTs was similar to older male controls in dermatomes above but not below the ISNCSCI sensory level. The difference between EPT and ISNCSCI sensory level was negatively correlated with the time post injury. Conclusions The results show that, in the chronic stage of cervical SCI, the EPT reveals spared sensory function at lower (~5) spinal segments than the ISNCSCI sensory exam. It is hence found that the EPT is a sensitive tool to assess recovery of sensory function after chronic SCI.
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The Sir Ludwig Guttmann Lecture 2012: the contribution of Stoke Mandeville Hospital to spinal cord injuries. Spinal Cord 2012; 50:790-6. [DOI: 10.1038/sc.2012.109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Reliability of the electrical perceptual threshold and Semmes-Weinstein monofilament tests of cutaneous sensibility. Spinal Cord 2012; 51:120-5. [PMID: 22945746 DOI: 10.1038/sc.2012.96] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Prospective experimental. OBJECTIVES To compare the reliability and repeatability of the electrical perceptual threshold (EPT) and Semmes-Weinstein monofilament (SWM) tests for cutaneous sensibility. EPT and SWM tests have potential as quantitative and sensitive adjuncts to the American Spinal Injuries Association (ASIA) Impairment Scale (AIS) assessment of spinal cord injury (SCI). SETTING London, UK. METHODS EPT and SWM tests were carried out on 40 neurologically healthy individuals (20 male). One examiner carried out all the tests. Each individual was examined for EPT and SWM sensitivity at ASIA key points on four dermatomes (C4, T1, T6, L4) on both sides of the body. The tests were repeated after an interval of approximately 1 week. Intra-rater reliability was determined using intra-class correlation coefficients (ICC). Repeatability was determined using the method of Bland and Altman. RESULTS There were no significant differences in the mean values of EPT or SWM between assessments for any dermatome. Significant difference in mean values for both EPT and SWM were observed between some dermatomes. ICC ranged from 0.67 to 0.81 for the EPT and from 0.46 to 0.61 for the SWM. Higher ICC for the EPT compared with the SWM was again revealed when male and female subjects were assessed separately. Correlation between EPT and SWM was weak or (largely) absent. CONCLUSION EPT has better reliability than SWM in healthy subjects. However, as both tests have the potential to add sensitivity and resolution to the AIS assessment, a further comparison of their repeatability in SCI is warranted.
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van Hedel HJA, Kumru H, Röhrich F, Galen S. Changes in Electrical Perception Threshold Within the First 6 Months After Traumatic Spinal Cord Injury. Neurorehabil Neural Repair 2011; 26:497-506. [DOI: 10.1177/1545968311423669] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective. To assess the reliability of the electrical perception threshold (EPT) in healthy participants and its responsiveness in patients for 6 months after traumatic spinal cord injury (SCI). Methods. The reliability of EPT measures was assessed in 15 healthy volunteers (from C3 to S2). EPT measures were assessed in 37 patients at 1, 3, and 6 months after SCI. EPT was determined in dermatomes at, above, and below the neurological level of lesion. Reliability was quantified with an intraclass correlation coefficient (ICC) and responsiveness with the standardized response mean (SRM). Dermatomes were classified as having normal or pathological sensory perception, based on both light touch (LT) and EPT testing. The percentage of agreement between LT and EPT classifications was determined. Results. The ICCs varied considerably between dermatomes (0.00 ≤ ICC ≤ 0.86). Overall, EPTs changed little within the first 6 months after SCI, resulting in small SRM values. Agreement between classifications according to EPT or LT testing varied from 30% to 100%. The least agreement was observed in the first segment below the lesion. Conclusion. Future studies must note that the reliability of EPT differs between dermatomes in healthy participants. Furthermore, at and below the level of the lesion, spontaneous recovery of sensory perception is poor within the first 6 months after SCI. Based on subgroup analyses, if a translational trial aims to improve sensory perception around the level of the lesion, sensory-incomplete tetraplegic patients could be included. These patients show poor spontaneous recovery, and the EPT may detect subtle changes in perception.
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Affiliation(s)
- Hubertus J. A. van Hedel
- Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study for Human Spinal Cord Injury (EM-SCI)
- University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
| | - Hatice Kumru
- European Multicenter Study for Human Spinal Cord Injury (EM-SCI)
- Institut Universitari adscrit a la Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Frank Röhrich
- European Multicenter Study for Human Spinal Cord Injury (EM-SCI)
- Berufsgenossenschaftliche Kliniken Bergmannstrost Zentrum für Rückenmarkverletzte und Klinik für Orthopädie, Halle, Germany
| | - Sujay Galen
- European Multicenter Study for Human Spinal Cord Injury (EM-SCI)
- University of Strathclyde, Glasgow, UK
- Southern General Hospital, Glasgow, UK
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