|
1
|
Smid A, Dominguez-Vega ZT, van Laar T, Oterdoom DLM, Absalom AR, van Egmond ME, Drost G, van Dijk JMC. Objective clinical registration of tremor, bradykinesia, and rigidity during awake stereotactic neurosurgery: a scoping review. Neurosurg Rev 2024; 47:81. [PMID: 38355824 PMCID: PMC10866747 DOI: 10.1007/s10143-024-02312-4] [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: 12/06/2023] [Revised: 01/19/2024] [Accepted: 01/28/2024] [Indexed: 02/16/2024]
Abstract
Tremor, bradykinesia, and rigidity are incapacitating motor symptoms that can be suppressed with stereotactic neurosurgical treatment like deep brain stimulation (DBS) and ablative surgery (e.g., thalamotomy, pallidotomy). Traditionally, clinicians rely on clinical rating scales for intraoperative evaluation of these motor symptoms during awake stereotactic neurosurgery. However, these clinical scales have a relatively high inter-rater variability and rely on experienced raters. Therefore, objective registration (e.g., using movement sensors) is a reasonable extension for intraoperative assessment of tremor, bradykinesia, and rigidity. The main goal of this scoping review is to provide an overview of electronic motor measurements during awake stereotactic neurosurgery. The protocol was based on the PRISMA extension for scoping reviews. After a systematic database search (PubMed, Embase, and Web of Science), articles were screened for relevance. Hundred-and-three articles were subject to detailed screening. Key clinical and technical information was extracted. The inclusion criteria encompassed use of electronic motor measurements during stereotactic neurosurgery performed under local anesthesia. Twenty-three articles were included. These studies had various objectives, including correlating sensor-based outcome measures to clinical scores, identifying optimal DBS electrode positions, and translating clinical assessments to objective assessments. The studies were highly heterogeneous in device choice, sensor location, measurement protocol, design, outcome measures, and data analysis. This review shows that intraoperative quantification of motor symptoms is still limited by variable signal analysis techniques and lacking standardized measurement protocols. However, electronic motor measurements can complement visual evaluations and provide objective confirmation of correct placement of the DBS electrode and/or lesioning. On the long term, this might benefit patient outcomes and provide reliable outcome measures in scientific research.
Collapse
Affiliation(s)
- Annemarie Smid
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1 HPC AB71, 9713 GZ, Groningen, Netherlands.
| | - Zeus T Dominguez-Vega
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1 HPC AB71, 9713 GZ, Groningen, Netherlands
| | - Teus van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1 HPC AB71, 9713 GZ, Groningen, Netherlands
| | - D L Marinus Oterdoom
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1 HPC AB71, 9713 GZ, Groningen, Netherlands
| | - Anthony R Absalom
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1 HPC AB71, 9713 GZ, Groningen, Netherlands
| | - Martje E van Egmond
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1 HPC AB71, 9713 GZ, Groningen, Netherlands
| | - Gea Drost
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1 HPC AB71, 9713 GZ, Groningen, Netherlands
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1 HPC AB71, 9713 GZ, Groningen, Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1 HPC AB71, 9713 GZ, Groningen, Netherlands
| |
Collapse
|
|
2
|
Smid A, Oterdoom DLM, Pauwels RWJ, Tamasi K, Elting JWJ, Absalom AR, van Laar T, van Dijk JMC, Drost G. The Relevance of Intraoperative Clinical and Accelerometric Measurements for Thalamotomy Outcome. J Clin Med 2023; 12:5887. [PMID: 37762828 PMCID: PMC10532071 DOI: 10.3390/jcm12185887] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Thalamotomy alleviates medication-refractory tremors in patients with movement disorders such as Parkinson's Disease (PD), Essential tremor (ET), and Holmes tremor (HT). However, limited data are available on tremor intensity during different thalamotomy stages. Also, the predictive value of the intraoperative tremor status for treatment outcomes remains unclear. Therefore, we aimed to quantify tremor status during thalamotomy and postoperatively. Data were gathered between January 2020 and June 2023 during consecutive unilateral thalamotomy procedures in patients with PD (n = 13), ET (n = 8), and HT (n = 3). MDS-UPDRS scores and tri-axial accelerometry data were obtained during rest, postural, and intention tremor tests. Measurements were performed intraoperatively (1) before lesioning-probe insertion, (2) directly after lesioning-probe insertion, (3) during coagulation, (4) directly after coagulation, and (5) 4-6 months post-surgery. Accelerometric data were recorded continuously during the coagulation process. Outcome measures included MDS-UPDRS tremor scores and accelerometric parameters (peak frequency, tremor amplitude, and area under the curve of power (AUCP)). Tremor intensity was assessed for the insertion effect (1-2), during coagulation (3), post-coagulation effect (1-4), and postoperative effect (1-5). Following insertion and coagulation, tremor intensity improved significantly compared to baseline (p < 0.001). The insertion effect clearly correlated with the postoperative effect (ρ = 0.863, p < 0.001). Both tremor amplitude and AUCP declined gradually during coagulation. Peak frequency did not change significantly intraoperatively. In conclusion, the study data show that both the intraoperative insertion effect and the post-coagulation effect are good predictors for thalamotomy outcomes.
Collapse
Affiliation(s)
- Annemarie Smid
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (R.W.J.P.); (K.T.); (J.M.C.v.D.); (G.D.)
| | - D. L. Marinus Oterdoom
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (R.W.J.P.); (K.T.); (J.M.C.v.D.); (G.D.)
| | - Rik W. J. Pauwels
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (R.W.J.P.); (K.T.); (J.M.C.v.D.); (G.D.)
| | - Katalin Tamasi
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (R.W.J.P.); (K.T.); (J.M.C.v.D.); (G.D.)
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Jan Willem J. Elting
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.W.J.E.); (T.v.L.)
| | - Anthony R. Absalom
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Teus van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.W.J.E.); (T.v.L.)
| | - J. Marc C. van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (R.W.J.P.); (K.T.); (J.M.C.v.D.); (G.D.)
| | - Gea Drost
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (R.W.J.P.); (K.T.); (J.M.C.v.D.); (G.D.)
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.W.J.E.); (T.v.L.)
| |
Collapse
|