1
|
Elble RJ, Ondo WG, Lyons KE, Qin M, Garafola S, Hersh B, Lieu T, Arkilo D, Chuang R, Bankole K, Pahwa R. A Randomized Phase 2 KINETIC Trial Evaluating SAGE-324/BIIB124 in Individuals with Essential Tremor. Mov Disord 2024; 39:733-738. [PMID: 38357797 DOI: 10.1002/mds.29731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND SAGE-324/BIIB124 is an investigational positive allosteric modulator of GABAA receptors. OBJECTIVE KINETIC (NCT04305275), a double-blind, randomized, placebo-controlled, phase 2 study, evaluated SAGE-324/BIIB124 in individuals with essential tremor (ET). METHODS Individuals aged 18 to 80 years were randomly assigned 1:1 to orally receive 60 mg of SAGE-324/BIIB124 or placebo once daily for 28 days. The primary endpoint was change from baseline in The Essential Tremor Rating Assessment Scale-Performance Subscale (TETRAS-PS) Item 4 (upper-limb tremor) at day 29 with SAGE-324/BIIB124 versus placebo. RESULTS Between May 2020 and February 2021, 69 U.S. participants were randomly assigned to receive SAGE-324/BIIB124 (n = 34) or placebo (n = 35). There was a significant reduction from baseline in TETRAS-PS Item 4 at day 29 with SAGE-324/BIIB124 versus placebo (least squares mean [standard error]: -2.31 [0.401] vs. -1.24 [0.349], P = 0.0491). The most common treatment-emergent adverse events included somnolence, dizziness, fatigue, and balance disorder. CONCLUSION These results support further development of SAGE-324/BIIB124 for potential ET treatment. © 2024 Sage Therapeutics, Inc and The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Rodger J Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - William G Ondo
- Department of Neurology, Houston Methodist Hospital, Houston, Texas, USA
| | - Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Min Qin
- Sage Therapeutics, Inc, Cambridge, Massachusetts, USA
| | | | | | | | | | | | - Kemi Bankole
- Sage Therapeutics, Inc, Cambridge, Massachusetts, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
2
|
Hernandez AB, Berry DS, Grill N, Hall TM, Burkes A, Ghanem A, Sharma VD, Louis ED. WHIGET and TETRAS Ratings of Action Tremor in Patients with Essential Tremor: Substantial Association and Agreement. Tremor Other Hyperkinet Mov (N Y) 2024; 14:14. [PMID: 38550904 PMCID: PMC10976980 DOI: 10.5334/tohm.874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024] Open
Abstract
Background Evaluating tremor severity is a critical component of diagnosing and clinically managing patients with essential tremor (ET). We examined the comparability of tremor severity ratings derived from two frequently used tremor rating scales: the Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) rating scale and the Tremor Research Group Essential Tremor Rating Scale (TETRAS). Methods A trained assistant administered and videotaped a neurological examination, including eight items assessing upper limb action tremor (arms outstretched, arms in the wingbeat position, finger-nose-finger maneuver, and drawing of Archimedes spirals). An experienced movement disorders neurologist reviewed the videos and assigned WHIGET and TETRAS ratings. We calculated associations between TETRAS and WHIGET ratings using Spearman rank order correlations. Subsequently, we collapsed these ratings into four tremor severity categories (absent, mild, moderate, severe) and then two broader tremor severity categories (absent/mild, moderate/severe). We calculated weighted Kappa coefficients to assess agreement between category assignments based on the TETRAS and the WHIGET. Results Spearman's r' s were significant for all items (p's ≤ 0.001, mean r = 0.89). Weighted Kappa's revealed substantial to near perfect agreement for all eight items (mean k = 0.86, range = 0.64 to 1.00). Conclusion Analyses revealed substantial strength of association and substantial to near perfect agreement between items rated with the WHIGET and TETRAS scales. These data indicated that ratings provided by each scale are highly comparable.
Collapse
Affiliation(s)
| | - Diane S. Berry
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Natalie Grill
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Talía M. Hall
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Allison Burkes
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ali Ghanem
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vibhash D. Sharma
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elan D. Louis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
3
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
4
|
Cabral AM, Lora-Millán JS, Pereira AA, Rocon E, Andrade ADO. On the Effect of Vibrotactile Stimulation in Essential Tremor. Healthcare (Basel) 2024; 12:448. [PMID: 38391822 PMCID: PMC10888095 DOI: 10.3390/healthcare12040448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Background: Vibrotactile stimulation has been studied for tremor, but there is little evidence for Essential Tremor (ET). (2) Methods: This research employed a dataset from a previous study, with data collected from 18 individuals subjected to four vibratory stimuli. To characterise tremor changes before, during, and after stimuli, time and frequency domain features were estimated from the signals. Correlation and regression analyses verified the relationship between features and clinical tremor scores. (3) Results: Individuals responded differently to vibrotactile stimulation. The 250 Hz stimulus was the only one that reduced tremor amplitude after stimulation. Compared to the baseline, the 250 Hz and random frequency stimulation reduced tremor peak power. The clinical scores and amplitude-based features were highly correlated, yielding accurate regression models (mean squared error of 0.09). (4) Conclusions: The stimulation frequency of 250 Hz has the greatest potential to reduce tremors in ET. The accurate regression model and high correlation between estimated features and clinical scales suggest that prediction models can automatically evaluate and control stimulus-induced tremor. A limitation of this research is the relatively reduced sample size.
Collapse
Affiliation(s)
- Ariana Moura Cabral
- Centre for Innovation and Technology Assessment in Health, Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia 38400-902, Brazil
| | | | - Adriano Alves Pereira
- Centre for Innovation and Technology Assessment in Health, Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia 38400-902, Brazil
| | - Eduardo Rocon
- BioRobotics Group, Centre for Automation and Robotics (CAR), CSIC-UPM, 28500 Madrid, Spain
| | - Adriano de Oliveira Andrade
- Centre for Innovation and Technology Assessment in Health, Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia 38400-902, Brazil
| |
Collapse
|
5
|
Angelini L, Terranova R, Lazzeri G, van den Berg KRE, Dirkx MF, Paparella G. The role of laboratory investigations in the classification of tremors. Neurol Sci 2023; 44:4183-4192. [PMID: 37814130 PMCID: PMC10641063 DOI: 10.1007/s10072-023-07108-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Tremor is the most common movement disorder. Although clinical examination plays a significant role in evaluating patients with tremor, laboratory tests are useful to classify tremors according to the recent two-axis approach proposed by the International Parkinson and Movement Disorders Society. METHODS In the present review, we will discuss the usefulness and applicability of the various diagnostic methods in classifying and diagnosing tremors. We will evaluate a number of techniques, including laboratory and genetic tests, neurophysiology, and neuroimaging. The role of newly introduced innovative tremor assessment methods will also be discussed. RESULTS Neurophysiology plays a crucial role in tremor definition and classification, and it can be useful for the identification of specific tremor syndromes. Laboratory and genetic tests and neuroimaging may be of paramount importance in identifying specific etiologies. Highly promising innovative technologies are being developed for both clinical and research purposes. CONCLUSIONS Overall, laboratory investigations may support clinicians in the diagnostic process of tremor. Also, combining data from different techniques can help improve understanding of the pathophysiological bases underlying tremors and guide therapeutic management.
Collapse
Affiliation(s)
- Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy.
| | - Roberta Terranova
- Department of Medical, Surgical Sciences and Advanced Technologies "GF Ingrassia," University of Catania, Catania, Italy
| | - Giulia Lazzeri
- IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Kevin R E van den Berg
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Michiel F Dirkx
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
| |
Collapse
|
6
|
Kaburagi M, Maki F, Hino S, Nakano M, Yamaguchi T, Takasaki M, Iwamuro H, Iijima K, Sasanuma J, Watanabe K, Hasegawa Y, Yamano Y. Video Motion Analysis as a Quantitative Evaluation Tool for Essential Tremor during Magnetic Resonance-Guided Focused Ultrasound Thalamotomy. Neurol Int 2023; 15:1411-1422. [PMID: 38132970 PMCID: PMC10745303 DOI: 10.3390/neurolint15040091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
The Clinical Rating Scale for Tremor (CRST) is commonly used to evaluate essential tremor (ET) during focused ultrasound (FUS) thalamotomy. However, it faces challenges such as the ceiling effect and test-retest variability. This study explored the utility of videographic motion analysis as an evaluation index for ET. Forty-three patients with ET performed postural tremor and line-drawing tasks recorded on video, and the data were analyzed using motion analysis software. The test-retest and inter-rater reliability, correlations with the CRST and tremor scores, and pre/post-FUS treatment comparisons were analyzed. The video motion analysis showed excellent test-retest and inter-rater reliability. In the postural tremor tasks, video parameter amplitude significantly correlated with the CRST and tremor scores. Similarly, for the line-drawing task, video parameter amplitude showed significant correlations with CRST and tremor scores, effectively addressing the ceiling effect. Regarding post-FUS treatment improvements, changes in the CRST and tremor scores were significantly associated with changes in video parameter amplitude. In conclusion, quantitative analysis of the video motion of ET enables precise evaluation of kinematic characteristics and effectively resolves the ceiling effect and test-retest variability. The video motion analysis score accurately reflected the tremor severity and treatment effects, demonstrating its high clinical utility.
Collapse
Affiliation(s)
- Mayumi Kaburagi
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan; (M.K.); (F.M.); (Y.H.)
- Department of Neurology, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan
| | - Futaba Maki
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan; (M.K.); (F.M.); (Y.H.)
- Department of Neurology, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan
| | - Sakae Hino
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan; (M.K.); (F.M.); (Y.H.)
- Department of Neurology, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan
| | - Masayuki Nakano
- Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan; (M.N.)
| | - Toshio Yamaguchi
- Research Institute for Diagnostic Radiology, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan
- International Academia for Focused Ultrasound Therapy, Kanagawa 215-0023, Japan
| | - Masahito Takasaki
- Department of Anesthesiology, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan
| | - Hirokazu Iwamuro
- Department of Neurosurgery, Juntendo University, Tokyo 113-8421, Japan
| | - Ken Iijima
- Department of Diagnostic Radiology, Saitama Sekishinkai Hospital, Saitama 350-1305, Japan
| | - Jinichi Sasanuma
- Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan; (M.N.)
| | - Kazuo Watanabe
- Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan; (M.N.)
| | - Yasuhiro Hasegawa
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan; (M.K.); (F.M.); (Y.H.)
- Department of Neurology, Shin-Yurigaoka General Hospital, Kanagawa 215-0026, Japan
| | - Yoshihisa Yamano
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan; (M.K.); (F.M.); (Y.H.)
| |
Collapse
|
7
|
van der Linden C, Berger T, Brandt GA, Strelow JN, Jergas H, Baldermann JC, Visser-Vandewalle V, Fink GR, Barbe MT, Petry-Schmelzer JN, Dembek TA. Accelerometric Classification of Resting and Postural Tremor Amplitude. Sensors (Basel) 2023; 23:8621. [PMID: 37896714 PMCID: PMC10611060 DOI: 10.3390/s23208621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
Clinical rating scales for tremors have significant limitations due to low resolution, high rater dependency, and lack of applicability in outpatient settings. Reliable, quantitative approaches for assessing tremor severity are warranted, especially evaluating treatment effects, e.g., of deep brain stimulation (DBS). We aimed to investigate how different accelerometry metrics can objectively classify tremor amplitude of Essential Tremor (ET) and tremor in Parkinson's Disease (PD). We assessed 860 resting and postural tremor trials in 16 patients with ET and 25 patients with PD under different DBS settings. Clinical ratings were compared to different metrics, based on either spectral components in the tremorband or pure acceleration, derived from simultaneous triaxial accelerometry captured at the index finger and wrist. Nonlinear regression was applied to a training dataset to determine the relationship between accelerometry and clinical ratings, which was then evaluated in a holdout dataset. All of the investigated accelerometry metrics could predict clinical tremor ratings with a high concordance (>70%) and substantial interrater reliability (Cohen's weighted Kappa > 0.7) in out-of-sample data. Finger-worn accelerometry performed slightly better than wrist-worn accelerometry. We conclude that triaxial accelerometry reliably quantifies resting and postural tremor amplitude in ET and PD patients. A full release of our dataset and software allows for implementation, development, training, and validation of novel methods.
Collapse
Affiliation(s)
- Christina van der Linden
- Department of Neurology, University Hospital Cologne and Faculty of Medicine, University of Cologne, 50937 Cologne, Germany; (C.v.d.L.); (J.N.P.-S.)
| | - Thea Berger
- Department of Neurology, University Hospital Cologne and Faculty of Medicine, University of Cologne, 50937 Cologne, Germany; (C.v.d.L.); (J.N.P.-S.)
| | - Gregor A. Brandt
- Department of Neurology, University Hospital Cologne and Faculty of Medicine, University of Cologne, 50937 Cologne, Germany; (C.v.d.L.); (J.N.P.-S.)
| | - Joshua N. Strelow
- Department of Neurology, University Hospital Cologne and Faculty of Medicine, University of Cologne, 50937 Cologne, Germany; (C.v.d.L.); (J.N.P.-S.)
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, 50937 Cologne, Germany
| | - Hannah Jergas
- Department of Neurology, University Hospital Cologne and Faculty of Medicine, University of Cologne, 50937 Cologne, Germany; (C.v.d.L.); (J.N.P.-S.)
| | - Juan Carlos Baldermann
- Department of Neurology, University Hospital Cologne and Faculty of Medicine, University of Cologne, 50937 Cologne, Germany; (C.v.d.L.); (J.N.P.-S.)
- Department of Psychiatry and Psychotherapy, University Hospital Cologne and Faculty of Medicine, University of Cologne, 50937 Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, 50937 Cologne, Germany
| | - Gereon R. Fink
- Department of Neurology, University Hospital Cologne and Faculty of Medicine, University of Cologne, 50937 Cologne, Germany; (C.v.d.L.); (J.N.P.-S.)
- Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, 52428 Jülich, Germany
| | - Michael T. Barbe
- Department of Neurology, University Hospital Cologne and Faculty of Medicine, University of Cologne, 50937 Cologne, Germany; (C.v.d.L.); (J.N.P.-S.)
| | - Jan Niklas Petry-Schmelzer
- Department of Neurology, University Hospital Cologne and Faculty of Medicine, University of Cologne, 50937 Cologne, Germany; (C.v.d.L.); (J.N.P.-S.)
| | - Till A. Dembek
- Department of Neurology, University Hospital Cologne and Faculty of Medicine, University of Cologne, 50937 Cologne, Germany; (C.v.d.L.); (J.N.P.-S.)
| |
Collapse
|
8
|
Smid A, Pauwels RWJ, Elting JWJ, Everlo CSJ, van Dijk JMC, Oterdoom DLM, van Laar T, Tamasi K, van der Stouwe AMM, Drost G. A Novel Accelerometry Method to Perioperatively Quantify Essential Tremor Based on Fahn-Tolosa-Marin Criteria. J Clin Med 2023; 12:4235. [PMID: 37445270 DOI: 10.3390/jcm12134235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
The disease status, progression, and treatment effect of essential tremor (ET) patients are currently assessed with clinical scores, such as the Fahn-Tolosa-Marin Clinical Rating Scale for Tremor (FTM). The use of objective and rater-independent monitoring of tremors may improve clinical care for patients with ET. Therefore, the focus of this study is to develop an objective accelerometry-based method to quantify ET, based on FTM criteria. Thirteen patients with ET and thirteen matched healthy participants underwent FTM tests to rate tremor severity, paired with tri-axial accelerometric measurements at the index fingers. Analogue FTM assessments were performed by four independent raters based on video recordings. Quantitative measures were derived from the accelerometric data, e.g., the area under the curve of power in the 4-8 Hz frequency band (AUCP) and maximal tremor amplitude. As such, accelerometric tremor scores were computed, using thresholds based on healthy measurements and FTM criteria. Agreement between accelerometric and clinical FTM scores was analyzed with Cohen's kappa coefficient. It was assessed whether there was a relationship between mean FTM scores and the natural logarithm (ln) of the accelerometric outcome measures using linear regression. The agreement between accelerometric and FTM scores was substantial for resting and intention tremor tests (≥72.7%). However, the agreement between accelerometric postural tremor data and clinical FTM ratings (κ = 0.459) was low, although their logarithmic (ln) relationship was substantial (R2 ≥ 0.724). Accelerometric test-retest reliability was good to excellent (ICC ≥ 0.753). This pilot study shows that tremors can be quantified with accelerometry, using healthy thresholds and FTM criteria. The test-retest reliability of the accelerometric tremor scoring algorithm indicates that our low-cost accelerometry-based approach is a promising one. The proposed easy-to-use technology could diminish the rater dependency of FTM scores and enable physicians to monitor ET patients more objectively in clinical, intraoperative, and home settings.
Collapse
Affiliation(s)
- Annemarie Smid
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Rik W J Pauwels
- Department of Neurosurgery, 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
| | - Cheryl S J Everlo
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - D L Marinus Oterdoom
- Department of Neurosurgery, 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
| | - Katalin Tamasi
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - A M Madelein van der Stouwe
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Gea Drost
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| |
Collapse
|
9
|
Smid A, Elting JWJ, van Dijk JMC, Otten B, Oterdoom DLM, Tamasi K, Heida T, van Laar T, Drost G. Intraoperative Quantification of MDS-UPDRS Tremor Measurements Using 3D Accelerometry: A Pilot Study. J Clin Med 2022; 11:jcm11092275. [PMID: 35566401 PMCID: PMC9104023 DOI: 10.3390/jcm11092275] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 02/05/2023] Open
Abstract
The most frequently used method for evaluating tremor in Parkinson’s disease (PD) is currently the internationally standardized Movement Disorder Society—Unified PD Rating Scale (MDS-UPDRS). However, the MDS-UPDRS is associated with limitations, such as its inherent subjectivity and reliance on experienced raters. Objective motor measurements using accelerometry may overcome the shortcomings of visually scored scales. Therefore, the current study focuses on translating the MDS-UPDRS tremor tests into an objective scoring method using 3D accelerometry. An algorithm to measure and classify tremor according to MDS-UPDRS criteria is proposed. For this study, 28 PD patients undergoing neurosurgical treatment and 26 healthy control subjects were included. Both groups underwent MDS-UPDRS tests to rate tremor severity, while accelerometric measurements were performed at the index fingers. All measurements were performed in an off-medication state. Quantitative measures were calculated from the 3D acceleration data, such as tremor amplitude and area-under-the-curve of power in the 4−6 Hz range. Agreement between MDS-UPDRS tremor scores and objective accelerometric scores was investigated. The trends were consistent with the logarithmic relationship between tremor amplitude and MDS-UPDRS score reported in previous studies. The accelerometric scores showed a substantial concordance (>69.6%) with the MDS-UPDRS ratings. However, accelerometric kinetic tremor measures poorly associated with the given MDS-UPDRS scores (R2 < 0.3), mainly due to the noise between 4 and 6 Hz found in the healthy controls. This study shows that MDS-UDPRS tremor tests can be translated to objective accelerometric measurements. However, discrepancies were found between accelerometric kinetic tremor measures and MDS-UDPRS ratings. This technology has the potential to reduce rater dependency of MDS-UPDRS measurements and allow more objective intraoperative monitoring of tremor.
Collapse
Affiliation(s)
- Annemarie Smid
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.M.C.v.D.); (D.L.M.O.); (K.T.); (G.D.)
- Correspondence:
| | - 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.)
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - J. Marc C. van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.M.C.v.D.); (D.L.M.O.); (K.T.); (G.D.)
| | - Bert Otten
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - D. L. Marinus Oterdoom
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.M.C.v.D.); (D.L.M.O.); (K.T.); (G.D.)
| | - Katalin Tamasi
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.M.C.v.D.); (D.L.M.O.); (K.T.); (G.D.)
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Tjitske Heida
- Department of Biomedical Signals and Systems, Faculty EEMCS, TechMed Centre, University of Twente, Drienerlolaan 5, 7522 NB Enschede, 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.)
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Gea Drost
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (J.M.C.v.D.); (D.L.M.O.); (K.T.); (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
|
10
|
Al-aboosi AF, Fink R. Novel Device Used to Monitor Hand Tremors during Nocturnal Hypoglycemic Events. Inventions 2022; 7:32. [DOI: 10.3390/inventions7020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Diabetes is one of the lifelong diseases that require systematic medical care to avoid life-menacing ramifications. Uncontrolled diabetes can cause severe damage to most internal body organs, probably leading to death. Particularly, nocturnal hypoglycemic that occur usually at night during sleep. Severe cases of these events can lead to seizures, fainting, loss of consciousness, and death. The current medical devices lack to give the warning to reduce the risk of acquiring nocturnal hypoglycemic events because they use only for glucose monitoring during waking times. Consequently, the main goal of this work is to design and implement a new wearable device to detect and monitor tremors, which occur when a user has hypoglycemia (low blood sugar). The device can detect a frequency range of 4–12 Hz by using the accelerometer of Arduino Nano 33 BLE. It can send a signal to the phone application (app) via Bluetooth Low Energy (BLE). Once the phone receives a signal, the phone application can activate an alarm system to wake up the patient, call three selected contacts number, and universal emergency number. In case of the user is unresponsive, the app can provide the patient’s location, name, and date of birth to the emergency contacts numbers and universal emergency number. Additionally, the device cost is economically feasible and competitive compared to other medical devices.
Collapse
|
11
|
Truong D, Shaikh A, Hallett M. Editorial: Tremors. J Neurol Sci 2022; 435:120189. [DOI: 10.1016/j.jns.2022.120189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
|