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Holcomb JM, Maldjian JA, Xi Y, O'Suilleabhain PE, Louis ED, Shah BR. ELectronic Archimedes spiral Neural Network (ELANN). Parkinsonism Relat Disord 2023; 115:105837. [PMID: 37683422 DOI: 10.1016/j.parkreldis.2023.105837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/11/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023]
Abstract
The Archimedes spiral is a clinical tool that aids in the diagnosis and monitoring of essential tremor. However, spiral ratings may vary based on experience and training of the rating physician. This study sought to generate an objective standard model for tremor evaluation using convolutional neural networks. One senior movement disorders neurologist (Neurologist 1) with over 30 years of clinical experience used the Bain and Findley Spirography Rating Scale to rate 1653 Archimedes spiral images from 46 essential tremor patients (mild to severe tremor) and 75 control subjects (no to mild tremor). Neurologist 1's labels were used as the reference standard to train the model. After training the model, a randomly selected subset of spiral testing data was re-evaluated by Neurologist 1, by a second senior movement disorders neurologist (Neurologist 2) with over 27 years of clinical experience, and by our model. Cohen's Weighted Kappa 95% confidence intervals were calculated from all rater comparisons to determine if our model performs with the same proficiency as two senior movement disorders neurologists. The Cohen's Weighted Kappa 95% confidence intervals for the agreement between the reference standard scores and Neurologist 1's rerated scores, for the agreement between the reference standard scores and Neurologist 2's scores, and for the agreement between the reference standard scores and our model's scores were 0.93-0.98, 0.86-0.94, and 0.89-0.96, respectively. With overlapping Cohen's Weighted Kappa 95% confidence intervals for all agreement comparisons, we demonstrate that our model evaluates spirals with the same proficiency as two senior movement disorders neurologists.
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Affiliation(s)
- James M Holcomb
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX, USA; Advanced Neuroscience Imaging Research Lab, Department of Radiology, UTSW Medical Center, Dallas, TX, USA
| | - Joseph A Maldjian
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX, USA; Advanced Neuroscience Imaging Research Lab, Department of Radiology, UTSW Medical Center, Dallas, TX, USA; O'Donnell Brain Institute, UTSW Medical Center, Dallas, TX, USA; Advanced Imaging Research Center, UTSW Medical Center, Dallas, TX, USA; Center for Alzheimer's and Neurodegenerative Diseases, UTSW Medical Center, Dallas, TX, USA
| | - Yin Xi
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX, USA; Advanced Neuroscience Imaging Research Lab, Department of Radiology, UTSW Medical Center, Dallas, TX, USA
| | | | - Elan D Louis
- Department of Neurology, UTSW Medical Center, Dallas, TX, USA
| | - Bhavya R Shah
- Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX, USA; Advanced Neuroscience Imaging Research Lab, Department of Radiology, UTSW Medical Center, Dallas, TX, USA; O'Donnell Brain Institute, UTSW Medical Center, Dallas, TX, USA; Department of Neurological Surgery, UTSW Medical Center, Dallas, TX, USA; Advanced Imaging Research Center, UTSW Medical Center, Dallas, TX, USA.
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Güler S, Caylan A, Turan FN, Dağdeviren N. The prevalence of essential tremor in Edirne and its counties accompanied comorbid conditions. Neurol Res 2019; 41:847-856. [PMID: 31238803 DOI: 10.1080/01616412.2019.1628409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: We aimed to determine the prevalence and risk factors of Essential Tremor (ET) in Edirne and its districts, located in Western Thrace, which is the most western part of Turkey. Methods: In this study, 3008 individuals who could communicate and agreed to participate in the study were evaluated. To obtain the data from the applicants in 30 Family Health Centres in Edirne and its districts, a face-to-face questionnaire that consisted of 37 questions was prepared by the researchers. The questionnaire included general information, questions to evaluate potential concomitant comorbid conditions and questions regarding the symptomatology used in ET diagnosis, as well as questions to evaluate ET severity, was examined with the spiral test. Patients were classified by using the Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) diagnostic and clinical evaluation scale. According to the diagnostic criteria for ET (used in participants who were examined and in those whose medical records were reviewed) were similar to those used in astudy conducted in Turkey. Results: Of 3008 individuals, 173 were diagnosed with ET according to the questionnaire results from Edirne and its districts, and the prevalence of ET was 5.8%. Approximately, 43.4% of the patients with ET were male, and 56.6% were female, which was not significantly different (p > 0.05). Participants with tremor related to alcohol withdrawal, hyperthyroidism, anxiety, depression other known causes of tremor were not considered to have ET. Thyroid disease was identified in 0.0% of the cases, and the control group was detected in 1.4%, which was not significantly different (p = 0.170). Psychiatric disease was identified in 0.0% of the cases, and the control group was detected in 1.3%, which was not significantly different (p = 0.271). Conclusions: ET prevalence studies will increase the awareness of the community and provide early diagnosis and treatment, as well as serve as a basis to reduce morbidity and improve the quality of life.
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Affiliation(s)
- Sibel Güler
- Department of Neurology, Trakya University Faculty of Medicine , Edirne , Turkey
| | - Ayşe Caylan
- Department of Family Medicine, Trakya University Faculty of Medicine , Edirne , Turkey
| | - F Nesrin Turan
- Department of Biostatistics, Trakya University Faculty of Medicine , Edirne , Turkey
| | - Nezih Dağdeviren
- Department of Family Medicine, Trakya University Faculty of Medicine , Edirne , Turkey
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Louis ED, Hernandez N, Dyke JP, Ma RE, Dydak U. In Vivo Dentate Nucleus Gamma-aminobutyric Acid Concentration in Essential Tremor vs. Controls. THE CEREBELLUM 2019; 17:165-172. [PMID: 29039117 DOI: 10.1007/s12311-017-0891-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite its high prevalence, essential tremor (ET) is among the most poorly understood neurological diseases. The presence and extent of Purkinje cell (PC) loss in ET is the subject of controversy. PCs are a major storehouse of central nervous system gamma-aminobutyric acid (GABA), releasing GABA at the level of the dentate nucleus. It is therefore conceivable that cerebellar dentate nucleus GABA concentration could be an in vivo marker of PC number. We used in vivo 1H magnetic resonance spectroscopy (MRS) to quantify GABA concentrations in two cerebellar volumes of interest, left and right, which included the dentate nucleus, comparing 45 ET cases to 35 age-matched controls. 1H MRS was performed using a 3.0-T Siemens Tim Trio scanner. The MEGA-PRESS J-editing sequence was used for GABA detection in two cerebellar volumes of interest (left and right) that included the dentate nucleus. The two groups did not differ with respect to our primary outcome of GABA concentration (given in institutional units). For the right dentate nucleus, [GABA] in ET cases = 2.01 ± 0.45 and [GABA] in controls = 1.86 ± 0.53, p = 0.17. For the left dentate nucleus, [GABA] in ET cases = 1.68 ± 0.49 and [GABA] controls = 1.80 ± 0.53, p = 0.33. The controls had similar dentate nucleus [GABA] in the right vs. left dentate nucleus (p = 0.52); however, in ET cases, the value on the right was considerably higher than that on the left (p = 0.001). We did not detect a reduction in dentate nucleus GABA concentration in ET cases vs. CONTROLS One interpretation of the finding is that it does not support the existence of PC loss in ET; however, an alternative interpretation is the observed pattern could be due to the effects of terminal sprouting in ET (i.e., collateral sprouting from surviving PCs making up for the loss of GABA-ergic terminals from PC degeneration). Further research is needed.
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Affiliation(s)
- Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, LCI 710, 15 York Street, PO Box 208018, New Haven, CT, 06520-8018, USA. .,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA. .,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Nora Hernandez
- Department of Neurology, Yale School of Medicine, Yale University, LCI 710, 15 York Street, PO Box 208018, New Haven, CT, 06520-8018, USA
| | - Jonathan P Dyke
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Ruoyun E Ma
- School of Health Sciences, Purdue University, West Lafayette, IN, USA.,Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ulrike Dydak
- School of Health Sciences, Purdue University, West Lafayette, IN, USA.,Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
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Solé-Casals J, Anchustegui-Echearte I, Marti-Puig P, Calvo PM, Bergareche A, Sánchez-Méndez JI, Lopez-de-Ipina K. Discrete Cosine Transform for the Analysis of Essential Tremor. Front Physiol 2019; 9:1947. [PMID: 30705638 PMCID: PMC6345195 DOI: 10.3389/fphys.2018.01947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/22/2018] [Indexed: 01/18/2023] Open
Abstract
Essential tremor (ET) is the most common movement disorder. In fact, its prevalence is about 20 times higher than that of Parkinson's disease. In addition, studies have shown that a high percentage of cases, between 50 and 70%, are estimated to be of genetic origin. The gold standard test for diagnosis, monitoring and to differentiate between both pathologies is based on the drawing of the Archimedes' spiral. Our major challenge is to develop the simplest system able to correctly classify Archimedes' spirals, therefore we will exclusively use the information of the x and y coordinates. This is the minimum information provided by any digitizing device. We explore the use of features from drawings related to the Discrete Cosine Transform as part of a wider cross-study for the diagnosis of essential tremor held at Biodonostia. We compare the performance of these features against other classic and already analyzed ones. We outperform previous results using a very simple system and a reduced set of features. Because the system is simple, it will be possible to implement it in a portable device (microcontroller), which will receive the x and y coordinates and will issue the classification result. This can be done in real time, and therefore without needing any extra job from the medical team. In future works these new drawing-biomarkers will be integrated with the ones obtained in the previous Biodonostia study. Undoubtedly, the use of this technology and user-friendly tools based on indirect measures could provide remarkable social and economic benefits.
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Affiliation(s)
- Jordi Solé-Casals
- Data and Signal Processing Research Group, University of Vic-Central University of Catalonia, Barcelona, Spain
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Iker Anchustegui-Echearte
- Data and Signal Processing Research Group, University of Vic-Central University of Catalonia, Barcelona, Spain
- Seidor Labs, Tona, Spain
| | - Pere Marti-Puig
- Data and Signal Processing Research Group, University of Vic-Central University of Catalonia, Barcelona, Spain
| | - Pilar M. Calvo
- EleKin Research Group, System Engineering and Automation Department, University of the Basque Country UPV/EHU, Donostia, Spain
| | - Alberto Bergareche
- Neurodegenerative Disorders Area, Biodonostia Health Research Institute, San Sebastián, Spain
- Movement Disorders Unit, Department of Neurology, University Hospital Donostia, San Sebastián, Spain
- Biomedical Research Networking Centre Consortium for the area of Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - José Ignacio Sánchez-Méndez
- EleKin Research Group, System Engineering and Automation Department, University of the Basque Country UPV/EHU, Donostia, Spain
| | - Karmele Lopez-de-Ipina
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- EleKin Research Group, System Engineering and Automation Department, University of the Basque Country UPV/EHU, Donostia, Spain
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Chazen JL, Sarva H, Stieg PE, Min RJ, Ballon DJ, Pryor KO, Riegelhaupt PM, Kaplitt MG. Clinical improvement associated with targeted interruption of the cerebellothalamic tract following MR-guided focused ultrasound for essential tremor. J Neurosurg 2018; 129:315-323. [DOI: 10.3171/2017.4.jns162803] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe objective of this study was to evaluate the utility of diffusion tensor imaging (DTI) tractography–based targeting of the dentatorubrothalamic tract (DRT) for magnetic resonance–guided focused ultrasound (MRgFUS) thalamotomy in patients with essential tremor (ET) and correlate postprocedural tract disruption with clinical outcomes.METHODSFour patients received preprocedural and immediate postprocedural DTI in addition to traditional anatomical MRI sequences for MRgFUS thalamotomy. Optimal ablation sites were selected based on the patient-specific location of the DRT as demonstrated by DTI (direct targeting) and correlated with traditional atlas-based measurements for thalamic ventral intermediate nucleus (Vim) lesioning (indirect targeting). Fiber tracts were displayed three-dimensionally during the procedure and used in conjunction with clinical signs of tremor control for fine correction of the ablation site. Immediately following the conclusion of the procedure, the MRgFUS head frame was removed and patients were placed in a 32-channel MRI head coil for follow-up DTI and anatomical MRI sequences.RESULTSAll patients had excellent postoperative tremor control and successful pre- and postprocedural DTI fiber tracking of the corticospinal tract, medial lemniscus, and DRT. Immediate postprocedure DTI failed to track the DRT ipsilateral to the lesion site with a preserved contralateral DRT, coincident with substantial resolution of contralateral tremor.CONCLUSIONSDTI can reliably identify the optimal ablation target and demonstrates tract disruption on immediate postprocedural imaging. A clinical improvement of ET was observed immediately following the procedure, correlating with DRT disruption and suggesting that interruption of the DRT is a consequence of clinically successful MRgFUS thalamotomy. These findings may have utility for both MRgFUS procedure planning in surgically naive patients and retreatment of patients who have previously undergone unsuccessful thalamic Vim lesioning.
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Affiliation(s)
| | | | | | | | | | - Kane O. Pryor
- 4Anesthesia, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Paul M. Riegelhaupt
- 4Anesthesia, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
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Lopez-de-Ipina K, Solé-Casals J, Faúndez-Zanuy M, Calvo PM, Sesa E, Roure J, Martinez-de-Lizarduy U, Beitia B, Fernández E, Iradi J, Garcia-Melero J, Bergareche A. Automatic Analysis of Archimedes' Spiral for Characterization of Genetic Essential Tremor Based on Shannon's Entropy and Fractal Dimension. ENTROPY (BASEL, SWITZERLAND) 2018; 20:E531. [PMID: 33265620 PMCID: PMC7513055 DOI: 10.3390/e20070531] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 02/06/2023]
Abstract
Among neural disorders related to movement, essential tremor has the highest prevalence; in fact, it is twenty times more common than Parkinson's disease. The drawing of the Archimedes' spiral is the gold standard test to distinguish between both pathologies. The aim of this paper is to select non-linear biomarkers based on the analysis of digital drawings. It belongs to a larger cross study for early diagnosis of essential tremor that also includes genetic information. The proposed automatic analysis system consists in a hybrid solution: Machine Learning paradigms and automatic selection of features based on statistical tests using medical criteria. Moreover, the selected biomarkers comprise not only commonly used linear features (static and dynamic), but also other non-linear ones: Shannon entropy and Fractal Dimension. The results are hopeful, and the developed tool can easily be adapted to users; and taking into account social and economic points of view, it could be very helpful in real complex environments.
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Affiliation(s)
- Karmele Lopez-de-Ipina
- Systems Engineering and Automation Department, EleKin Research Group, University of the Basque Country UPV/EHU, 20018 Donostia, Spain
| | - Jordi Solé-Casals
- Data and Signal Processing Research Group, University of Vic—Central University of Catalonia, 08500 Barcelona, Spain
| | - Marcos Faúndez-Zanuy
- Escola Superior Politècnica Tecnocampus, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Pilar M. Calvo
- Systems Engineering and Automation Department, EleKin Research Group, University of the Basque Country UPV/EHU, 20018 Donostia, Spain
| | - Enric Sesa
- Escola Superior Politècnica Tecnocampus, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Josep Roure
- Escola Superior Politècnica Tecnocampus, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Unai Martinez-de-Lizarduy
- Department of Electronic Technology, EleKin Research Group, University of the Basque Country UPV/EHU, 20018 Donostia, Spain
| | - Blanca Beitia
- Department of Mathematics, EleKin Research Group, University of the Basque Country UPV/EHU, 1006 Gasteiz, Spain
| | - Elsa Fernández
- Systems Engineering and Automation Department, EleKin Research Group, University of the Basque Country UPV/EHU, 20018 Donostia, Spain
| | - Jon Iradi
- Department of Enterprises Organization, EleKin Research Group, University of the Basque Country UPV/EHU, 20018 Donostia, Spain
| | - Joseba Garcia-Melero
- Department of Mechanical Engineering, EleKin Research Group, University of the Basque Country UPV/EHU, 1006 Gasteiz, Spain
| | - Alberto Bergareche
- Department of Neuroscience, BioDonostia Health Institute, 20014 Donostia, Spain
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Louis ED, Meyers JH, Badejo OM, Cristal AD, Hickman R, Factor-Litvak P. Comparative Burden of Subclinical Tremor in a Cohort of Normal Individuals Stratified by Familial Risk for Essential Tremor. Neuroepidemiology 2018; 50:41-46. [PMID: 29339654 DOI: 10.1159/000486485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/22/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The burden of mild (i.e., subclinical) tremor within essential tremor (ET) families is not fully understood. We assessed the burden of mild tremor in a cohort of 287 adults, none of whom reported tremor or were diagnosed with ET. METHODS We recruited adults in 2 groups based on the familial risk for ET: 244 high-risk individuals (i.e., reporting one or more first-degree relative with ET) and 43 low-risk individuals (i.e., reporting no relatives with ET). Tremor was objectively assessed on 4 hand-drawn spirals (total spiral score = 0-12). Mild tremor was defined using 3 different cut points. RESULTS The prevalence rates of mild tremor among high-risk individuals ranged from 41.4 to 98.4% and were highly dependent on the cut point. Above a certain threshold (i.e., a total spiral score ≥5), 1-in-5 (i.e., 19.7%) high-risk individuals exhibited mild tremor, whereas no low-risk individuals did. High-risk individuals were 3.09-4.50 times more likely than low-risk individuals to exhibit mild tremor. CONCLUSION The burden of ET extends beyond the boundaries of the clinically defined disease, and partially expressed forms of ET are abundant in ET families. This fact greatly complicates gene-finding studies and epidemiological studies whose goal is to detect disease-linked associations.
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Affiliation(s)
- Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut, USA.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - James H Meyers
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Olufunmilayo M Badejo
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Ashley D Cristal
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Ruby Hickman
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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Effect of Primidone on Dentate Nucleus γ-Aminobutyric Acid Concentration in Patients With Essential Tremor. Clin Neuropharmacol 2016; 39:24-8. [PMID: 26757316 DOI: 10.1097/wnf.0000000000000127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES It is not known whether current use of the medication primidone affects brain γ-aminobutyric acid (GABA) concentrations. This is an important potential confound in studies of the pathophysiology of essential tremor (ET), one of the most common neurological diseases. We compared GABA concentrations in the dentate nucleus in 6 ET patients taking primidone versus 26 ET patients not taking primidone. METHODS (1)H magnetic resonance spectroscopy was performed using a 3.0-T Siemens Tim Trio scanner. The MEGA-PRESS J-editing sequence was used for GABA detection in 2 cerebellar volumes of interest (left and right) that included the dentate nucleus. RESULTS The right dentate GABA concentration was similar in the 2 groups (2.21 ± 0.46 [on primidone] vs 1.93 ± 0.39 [not on primidone], P = 0.15), as was the left dentate GABA concentration (1.61 ± 0.35 [on primidone] vs 1.67 ± 0.34 [not on primidone], P = 0.72). The daily primidone dose was not associated with either right or left dentate GABA concentrations (P = 0.89 and 0.76, respectively). CONCLUSIONS We did not find a difference in dentate GABA concentrations between 6 ET patients taking daily primidone and 26 ET patients not taking primidone. Furthermore, there was no association between daily primidone dose and dentate GABA concentration. These data suggest that it is not necessary to exclude ET patients on primidone from magnetic resonance spectroscopy studies of dentate GABA concentration, and if assessment of these concentrations was to be developed as a biomarker for ET, primidone usage would not confound interpretation of the results.
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Morgan S, Louis ED. Re-Emergent Tremor of Parkinson's Disease Masquerading as Essential Tremor. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:370. [PMID: 27352396 PMCID: PMC4790196 DOI: 10.7916/d8ng4qdb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/09/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND The re-emergent tremor of Parkinson's disease (PD) is generally recognized as a postural tremor. PHENOMENOLOGY SHOWN A PD patient with a re-emergent tremor occurring during a task (spiral drawing), which on the surface produced a tremor that resembled that of essential tremor (ET). EDUCATIONAL VALUE Researchers and clinicians should be aware of features of this re-emergent tremor to help distinguish it from that of ET.
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Affiliation(s)
- Sarah Morgan
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
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Koirala N, Muthuraman M, Anjum T, Chaitanya CV, Helmolt VF, Mideksa KG, Lange K, Schmidt G, Schneider S, Deuschl G. Differentiating tremor patients using spiral analyses. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:6227-30. [PMID: 26737715 DOI: 10.1109/embc.2015.7319815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Essential tremor follows an autosomal dominant type of inheritance in the majority of patients, yet its genetic basis has not been identified. The age of onset in this tremor is bimodal, one in young age and another when they are old. The old onset is referred to as senile tremor in this study. The precise pathology is still not completely understood for both these tremors. We wanted to develop an easy diagnostic tool to differentiate these two tremors clinically. In this study, the spirals were asked to be drawn by 30 patients, 15 from each group. The spirals were recorded digitally from each hand, with and without the spiral template, using a Wacom intuos version 4 tablets. The aim of the study was to look at the easy diagnostic measures from these spirals to distinguish the two cohorts of patients. The first measure was to use the well-known clinical scores like the number of complete circles without the template, width, height, axis, and degree of severity. The second measure was to estimate the peak frequency and the peak amplitude for the position, velocity, and acceleration data, in the frequency domain. The well-known clinical scores, most of them, did not show any significant difference between the two patient cohorts except the degree of severity which showed significant difference. The peak frequency and the peak amplitude in most of the data were not significantly different between the two cohorts of patients, only the peak amplitude from the acceleration data showed significant difference. Thus, we could use these two parameters to differentiate between the two tremors patient groups, which would be an easy clinical diagnostic tool without the need for any complicated analyses.
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Louis ED, Factor-Litvak P. Screening for and Estimating the Prevalence of Essential Tremor: A Random-Digit Dialing-Based Study in the New York Metropolitan Area. Neuroepidemiology 2015; 46:51-6. [PMID: 26673312 DOI: 10.1159/000442576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/16/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND There are nearly no published screening instruments for essential tremor (ET). This is a remarkable fact, given its high prevalence. Here, we assess the validity of a screening questionnaire and hand-drawn spirals and also estimate the prevalence of ET in a community sample. METHODS Four hundred nineteen study subjects living in a geographically defined area in the New York metropolitan area were contacted using a random digit telephone dialing scheme. Seven tremor screening questions were administered and each subject drew 2 spirals. A movement disorders neurologist assigned ET diagnoses based on neurological examination. RESULTS The spirals were a more sensitive test than the screening questions (73.7 vs. 26.3%); specificities of the 2 tests were similar (95.5 vs. 96.8%). The combination of both tests was not superior to the use of spirals alone. The positive predictive value of the spiral test was 43.8%. The crude prevalence of ET, 19 of 419 (4.53%, 95% CI 2.92-6.97), increased with age (p = 0.049). CONCLUSIONS A screening spiral was more sensitive than a screening questionnaire for ET and was moderately sensitive. Nearly one-half of subjects who screened positive had ET; therefore, when screening a population, one can expect the number of true positives and false positives to be roughly equivalent.
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Affiliation(s)
- Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Conn., USA
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13
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Fang W, Chen H, Wang H, Zhang H, Puneet M, Liu M, Lv F, Luo T, Cheng O, Wang X, Lu X. Essential tremor is associated with disruption of functional connectivity in the ventral intermediate Nucleus--Motor Cortex--Cerebellum circuit. Hum Brain Mapp 2015; 37:165-78. [PMID: 26467643 DOI: 10.1002/hbm.23024] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 09/05/2015] [Accepted: 09/28/2015] [Indexed: 01/09/2023] Open
Abstract
The clinical benefits of targeting the ventral intermediate nucleus (VIM) for the treatment of tremors in essential tremor (ET) patients suggest that the VIM is a key hub in the network of tremor generation and propagation and that the VIM can be considered as a seed region to study the tremor network. However, little is known about the central tremor network in ET patients. Twenty-six ET patients and 26 matched healthy controls (HCs) were included in this study. After considering structural and head-motion factors and establishing the accuracy of our seed region, a VIM seed-based functional connectivity (FC) analysis of resting-state functional magnetic resonance imaging (RS-fMRI) data was performed to characterize the VIM FC network in ET patients. We found that ET patients and HCs shared a similar VIM FC network that was generally consistent with the VIM anatomical connectivity network inferred from normal nonhuman primates and healthy humans. Compared with HCs, ET patients displayed VIM-related FC changes, primarily within the VIM-motor cortex (MC)-cerebellum (CBLM) circuit, which included decreased FC in the CBLM and increased FC in the MC. Importantly, tremor severity correlated with these FC changes. These findings provide the first evidence that the pathological tremors observed in ET patients might be based on a physiologically pre-existing VIM - MC - CBLM network and that disruption of FC in this physiological network is associated with ET. Further, these findings demonstrate a potential approach for elucidating the neural network mechanisms underlying this disease.
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Affiliation(s)
- Weidong Fang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huiyue Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hansheng Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Han Zhang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China
| | - Munankami Puneet
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mengqi Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tianyou Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Oumei Cheng
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuefeng Wang
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiurong Lu
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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