Parkinsonian Tremor as Unstable Feedback in a Physiologically Consistent Control Framework

Parkinson's disease (PD) is characterized by decreased dopamine in the basal ganglia that causes excessive tonic inhibition of the thalamus. This excessive inhibition seems to explain inhibitory motor symptoms in PD, but the source of tremor remains unclear. This paper investigates how neural inhibition may change the closed-loop characteristics of the human motor control system to determine how this established pathophysiology could produce tremor. The rate-coding model of neural signals suggests increased inhibition decreases signal amplitude, which could create a mismatch between the closed-loop dynamics and the internal models that overcome proprioceptive feedback delays. This paper aims to identify a candidate model structure with decreased-amplitude-induced tremor in PD that also agrees with previously recorded movements of healthy and cerebellar patients. The optimal feedback control theory of human motor control forms the basis of the model. Key additional elements include gating of undesired movements via the basal ganglia-thalamus-motor cortex circuit and the treatment of the efferent copy of the control input as a measurement in the state estimator. Simulations confirm the model's ability to capture tremor in PD and also demonstrate how disease progression could affect tremor and other motor symptoms, providing insight into the existence of tremor and non-tremor phenotypes. Altogether, the physiological underpinnings of the model structure and the agreement of model predictions with clinical observations provides support for the hypothesis that unstable feedback produces parkinsonian tremor. Consequently, these results also support the associated framework for the neuroanatomy of human motor control.

Optimal Control Perspective on Parkinson's Disease: Increased Delay Between State Estimator and Controller Produces Tremor

Parkinson's disease produces tremor in a large subset of patients despite generally inhibiting movement. The pathophysiology of parkinsonian tremor is unclear, leading to uncertainty in how and why treatments reduce tremor with varying effectiveness. Models for parkinsonian tremor attempt to explain the underlying principles of tremor generation in the central nervous system, often focusing on neural activity of specific substructures. In contrast, control system approaches to modeling the human motor system provide qualitative results that help inform conclusions from clinical studies. This article uses an optimal control approach to investigate the hypothesis that an increased delay in the central nervous system-unaccounted by delay compensation mechanisms-produces parkinsonian tremor. This hypothesis is motivated by the excessive inhibition projected from the basal ganglia to the thalamus in Parkinson's disease. The thalamus relays signals from the cerebellum to the primary motor cortex: previous mapping of optimal control components indicates this prospective delay exists between the estimator (cerebellum) and controller (primary motor cortex). Simulations demonstrate realistic tremor in a neuromuscular model of the wrist. In addition, changes to effort sensitivity in the optimal controller may account for some clinical features of parkinsonian tremor, including the characteristics of re-emergent tremor and the time-varying amplitude and frequency of tremor. Contextualization of the optimal control model with physiological models and clinical observations provides insight into the potential role of the basal ganglia and cerebello-thalamo-cortical circuit and how treatments like dopaminergic medications and deep brain stimulation reduce tremor.

COMPARISON OF THEORIES OF REST TREMOR MECHANISM IN PARKINSON’S DISEASE: CENTRAL OSCILLATOR (SOURCE-TRIGGERED OSCILLATIONS) AND FEEDBACK-INDUCED INSTABILITY IN THE SENSORIMOTOR LOOP (SELF-SUSTAINED OSCILLATIONS)

Rest tremor is one of the most common and disabling symptoms of Parkinson’s disease (PD). The exact neural origin of rest tremor is still not clearly understood. Understanding the origin of rest tremor is important as it may aid in optimizing existing treatment strategies such as Deep Brain Stimulation or in developing new treatment strategies for rest tremor reduction. There are broadly two theories that are gaining prominence for rest tremor generation in PD. The first theory is the central oscillator theory that states that the rest tremor is triggered by an oscillatory source in the brain. The second theory is the feedback-induced instability theory that states that the rest tremor arises out of a feedback-induced instability in the sensorimotor loop. This paper analyzes validity of the two theories based on established clinical observations of Parkinsonian rest tremor by using representative simulation examples. Finally, based on our analysis, we propose two test-worthy experiments for further validation.

A Possible Explanation of How High-Frequency Deep Brain Stimulation Suppresses Low-Frequency Tremors in Parkinson's Disease

Parkinson's disease (PD) is a neurodegenerative disorder of the central nervous system and one of its key symptoms is rest tremor. Deep brain stimulation (DBS) effectively suppresses rest tremor in Parkinson's disease. Despite being a successful treatment option, its underlying principle and the mechanism by which it attenuates tremors is not yet fully understood. Since existing methods for tuning DBS parameters are largely trial and error, understanding how DBS works can help to reduce time and costs, and could also ultimately lead to better treatment strategies for PD. In this paper, we set out to analyze how a high-frequency stimulation applied through DBS can help reduce the low-frequency rest tremors observed in PD patients. We identify key elements in the sensorimotor loop (the feedback loop consisting of sensory feedbacks and motor responses) that play a role in the interaction of high-frequency DBS signal and the low-frequency tremor. Based on the analysis of these elements, we draw insights about the working of DBS and the role of frequency and the nature of stimulation. We verify these observations with numerical examples and a bench top experimental example.

SEPARATING PARKINSONIAN PATIENTS FROM NORMAL PERSONS USING HANDWRITING FEATURES

Parkinson's disease (PD) is a widespread progressive neural degenerative disease. Patients encounter problems in carrying out ordinary voluntary movements such as gaiting and writing. Effects of tremor, rigidity, and bradykinesia are seen in writing. Since the diagnosis of PD is based on the presence of cardinal symptoms, therefore voluntary movements like writing could be helpful as an indicator in this process. Handwriting analysis can be a suitable method to separate patients from normal individuals. We recorded handwriting data from 17 normal and 13 PD subjects, and then used mathematical analysis in order to extract proper features. At the end of the study, we used these selected features in a classifier. We achieved 93.89% accuracy in the test phase. Hence, this tool may be aid in the diagnosing of both PD and suspected PD individuals in the early stages of the disease.