A low-cost solution for quantification of movement during DBS surgery

Objective clinical registration of tremor, bradykinesia, and rigidity during awake stereotactic neurosurgery: a scoping review

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.

Diagnosis and Treatment of Tremor in Parkinson's Disease Using Mechanical Devices

BACKGROUND

Parkinsonian tremors are sometimes confused with essential tremors or other conditions. Recently, researchers conducted several studies on tremor evaluation using wearable sensors and devices, which may support accurate diagnosis. Mechanical devices are also commonly used to treat tremors and have been actively researched and developed. Here, we aimed to review recent progress and the efficacy of the devices related to Parkinsonian tremors.

METHODS

The PubMed and Scopus databases were searched for articles. We searched for "Parkinson disease" and "tremor" and "device".

RESULTS

Eighty-six articles were selected by our systematic approach. Many studies demonstrated that the diagnosis and evaluation of tremors in patients with PD can be done accurately by machine learning algorithms. Mechanical devices for tremor suppression include deep brain stimulation (DBS), electrical muscle stimulation, and orthosis. In recent years, adaptive DBS and optimization of stimulation parameters have been studied to further improve treatment efficacy.

CONCLUSIONS

Due to developments using state-of-the-art techniques, effectiveness in diagnosing and evaluating tremor and suppressing it using these devices is satisfactorily high in many studies. However, other than DBS, no devices are in practical use. To acquire high-level evidence, large-scale studies and randomized controlled trials are needed for these devices.

Quantification of Parkinson's Disease Motor Symptoms: A Wireless Motion Sensing Approach

Parkinson's Disease (PD) is a neurodegenerative disease characterized by its hallmark motor symptoms of bradykinesia and tremor. Numerous studies have suggested novel quantification methods of its symptoms. However, there lacks the means to accurately assess improvements in an intraoperative setting during deep brain stimulation (DBS) electrode implantation. This study introduces a methodology to quantify selected PD motor symptoms in such a restrictive environment using a wireless Leap Motion sensor. The result suggests that utilizing the Leap Motion sensor intraoperatively is feasible for quantifying motor parameters for bradykinesia and resting tremor of a PD patient.

Stimulation maps: visualization of results of quantitative intraoperative testing for deep brain stimulation surgery

Deep brain stimulation (DBS) is an established therapy for movement disorders such as essential tremor (ET). Positioning of the DBS lead in the patient's brain is crucial for effective treatment. Extensive evaluations of improvement and adverse effects of stimulation at different positions for various current amplitudes are performed intraoperatively. However, to choose the optimal position of the lead, the information has to be "mentally" visualized and analyzed. This paper introduces a new technique called "stimulation maps," which summarizes and visualizes the high amount of relevant data with the aim to assist in identifying the optimal DBS lead position. It combines three methods: outlines of the relevant anatomical structures, quantitative symptom evaluation, and patient-specific electric field simulations. Through this combination, each voxel in the stimulation region is assigned one value of symptom improvement, resulting in the division of stimulation region into areas with different improvement levels. This technique was applied retrospectively to five ET patients in the University Hospital in Clermont-Ferrand, France. Apart from identifying the optimal implant position, the resultant nine maps show that the highest improvement region is frequently in the posterior subthalamic area. The results demonstrate the utility of the stimulation maps in identifying the optimal implant position. Graphical abstract.

Validation of a Low-Cost Electromyography (EMG) System via a Commercial and Accurate EMG Device: Pilot Study

Electromyography (EMG) devices are well-suited for measuring the behaviour of muscles during an exercise or a task, and are widely used in many different research areas. Their disadvantage is that commercial systems are expensive. We designed a low-cost EMG system with enough accuracy and reliability to be used in a wide range of possible ways. The present article focuses on the validation of the low-cost system we designed, which is compared with a commercially available, accurate device. The evaluation was done by means of a set of experiments, in which volunteers performed isometric and dynamic exercises while EMG signals from the rectus femoris muscle were registered by both the proposed low-cost system and a commercial system simultaneously. Analysis and assessment of three indicators to estimate the similarity between both signals were developed. These indicated a very good result, with spearman’s correlation averaging above 0.60, the energy ratio close to the 80% and the linear correlation coefficient approximating 100%. The agreement between both systems (custom and commercial) is excellent, although there are also some limitations, such as the delay of the signal (<1 s) and noise due to the hardware and assembly in the proposed system.