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Synowiec A, Stark-Inbar A, Weinstein M, Ironi A, Mauskop A. One-Year Consistent Safety, Utilization, and Efficacy Assessment of Remote Electrical Neuromodulation (REN) for Migraine Treatment. Adv Ther 2024; 41:170-181. [PMID: 37855973 PMCID: PMC10796417 DOI: 10.1007/s12325-023-02697-6] [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: 08/13/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Migraine is a chronic neurological disorder causing severe pain and disability in more than a billion people worldwide. Ideal treatment should provide long-term efficacy with minimal side effects. Previous studies indicate that remote electrical neuromodulation (REN) is an efficacious and safe treatment option for the acute treatment of migraine in clinical practice. This study examined long-term safety, utilization, and efficacy of REN during 12 consecutive usage months. METHODS Data from patients with migraine across the USA using REN to treat their migraine attacks were electronically collected from the Nerivio® device. All patients who used REN during 12 consecutive months were included, and data were compared across months. Safety was assessed by the number and type of adverse events. Utilization was measured by the number of monthly treatments. Efficacy was evaluated as consistent change in headache pain intensity, functional disability, and disappearance of associated symptoms from baseline to 2 h post treatment. RESULTS Data were analyzed from 409 people living with migraine who treated with REN for 12 consecutive months, performing a total of 39,531 treatments. The incidence of device-related adverse events (dAEs) was 1.96% (8/409), including two negligible (0.49%), five mild (1.22%), one moderate (0.24%), and no severe events. All patients continued treatment with REN despite dAEs. One-year average monthly utilization was 8.05 treatments (SD 1.15). Month-to-month utilization did not change during 12 months of consecutive use [F(4.895, 1997.204) = 2.014, p = 0.075, repeated-measures ANOVA]. One-year average efficacy showed 74.1% of users reported consistent 2-h pain relief, and 26.0% reported consistent pain freedom. Month-to-month pain relief and pain freedom did not change during 12 months of consecutive use [F(11, 1069) = 0.55, p = 0.873 and F(11, 1295) = 0.69, p = 0.750 respectively; generalized linear mixed model analysis]. CONCLUSION REN is a safe and well-tolerated acute migraine treatment, with stable efficacy and utilization over 1 year, making it an advantageous non-drug option for the long-term management of this chronic disease. TRIAL REGISTRATION NUMBER NCT05760638.
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Affiliation(s)
| | | | | | - Alon Ironi
- Theranica Bio-Electronics, Netanya, Israel
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Monteith TS, Stark-Inbar A, Shmuely S, Harris D, Garas S, Ironi A, Kalika P, Irwin SL. Remote electrical neuromodulation (REN) wearable device for adolescents with migraine: a real-world study of high-frequency abortive treatment suggests preventive effects. Front Pain Res (Lausanne) 2023; 4:1247313. [PMID: 38028429 PMCID: PMC10657883 DOI: 10.3389/fpain.2023.1247313] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Migraine is a chronic neurological disease manifesting as attacks of disabling head pain and associated symptoms. Remote electrical neuromodulation (REN) is a non-pharmacological, prescribed, wearable device (Nerivio®). This device has been certified by the FDA for the acute and/or preventive treatment of migraine with or without aura in patients 12 years of age or older. The device is affixed to the user's arm during 45-min treatment sessions and is operated using a smartphone app. This study (NCT05769322) aims to evaluate whether frequent use of REN for the acute treatment of migraine in adolescents resulted in a reduction in monthly migraine treatment days (MMTD), as previously demonstrated in adults through a dedicated prevention clinical trial (NCT04828707). Methods The study included real-world prospective data from adolescent patients who used REN on at least 10 days every 28-day month, following the REN migraine prevention guideline of an every-other-day pattern. Additional requirements were at least three REN treatment days in each of the two subsequent months. The number of MMTD was used as a proxy measure for the number of monthly migraine days (MMD). The change in MMTD from the first month, taken as a "baseline," to each of the following months was used to evaluate the presence and size of potential migraine preventive benefits of REN in adolescents. Results A total of 83 adolescents were eligible for analysis. The users were 15.9 ± 1.3 years of age (mean ± SD), and 89% of them were female. The results demonstrated a substantial month-to-month reduction in the mean (±SD) number of REN treatment days from 12.6 (±3.2) MMTD in the first month to 9.0 (±4.8) MMTD in the second month (p < 0.001), and a further decrease to 7.4 (±4.2) MMTD in the third month (p < 0.001). This indicates an accumulative reduction of 5.2 (±4.8) mean REN MMTD from the first month to the third month of consecutive REN treatment. The users also reported consistent 2-h acute pain responses in at least 50% of their treated attacks, with 61.9% of the users reported experiencing pain relief, 24.5% reported pain freedom, 67.4% indicated relief in functional disability, and 41.3% reported complete freedom from functional disability. Conclusion The frequent use of REN among adolescents as an acute treatment for migraine attacks resulted in a decrease in the mean number of monthly treatment days in the subsequent months, suggesting that REN may have potential preventive benefits for migraine in this subpopulation.
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Affiliation(s)
| | | | - Sharon Shmuely
- Clinical Development Department, Theranica, Netanya, Israel
| | - Dagan Harris
- Clinical Development Department, Theranica, Netanya, Israel
| | - Sandy Garas
- Clinical Development Department, Theranica, Netanya, Israel
| | - Alon Ironi
- Clinical Development Department, Theranica, Netanya, Israel
| | - Paige Kalika
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Samantha L. Irwin
- Department of Neurology, UCSF Benioff Children’s Hospitals, San Francisco, CA, United States
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Blumenfeld AM, Rabany L, Ironi A, Stark-Inbar A, Harris D, Halker Singh RB, Harriott AM. Temporal analysis of remote electric neuromodulation for the prevention of migraine. Pain Manag 2023; 13:425-432. [PMID: 37615080 DOI: 10.2217/pmt-2023-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 08/25/2023] Open
Abstract
Aim: To evaluate the onset, magnitude and persistence of efficacy of remote electrical neuromodulation (REN) compared with placebo for the preventive treatment of migraine. Materials & methods: Analysis was conducted on data from a prospective, double-blind, placebo-controlled clinical trial, which assessed the efficacy of REN for the prevention of migraine. The number of monthly migraine days (MMD) per group was calculated in 2-week intervals and compared between the groups. Results: Differences between the active (N = 95) and placebo (N = 84) groups reached significance at 2 weeks: therapeutic gain 0.84 MMD; p = 0.036. 4 weeks gain 1.59 MMD; p = 0.025, 6 weeks gain 2.27 MMD; p < 0.001, 8 weeks gain 2.68 MMD; p < 0.001. Conclusion: REN provides rapid and consistent efficacy in preventive treatment of migraine.
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Affiliation(s)
- Andrew M Blumenfeld
- The Los Angeles Headache Center, Los Angeles, CA 90067, USA
- San Diego Headache Center, San Diego, CA 92111, USA
| | - Liron Rabany
- Theranica Bio-Electronics, Netnaya, 4250438, Israel
| | - Alon Ironi
- Theranica Bio-Electronics, Netnaya, 4250438, Israel
| | | | - Dagan Harris
- Theranica Bio-Electronics, Netnaya, 4250438, Israel
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Peretz A, Stark-Inbar A, Harris D, Tamir S, Shmuely S, Ironi A, Halpern A, Chuang L, Riggins N. Safety of remote electrical neuromodulation for acute migraine treatment in pregnant women: A retrospective controlled survey-study. Headache 2023. [PMID: 37335242 DOI: 10.1111/head.14586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Addie Peretz
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Shira Tamir
- Theranica Bio-Electronics LTD, Netanya, Israel
| | | | - Alon Ironi
- Theranica Bio-Electronics LTD, Netanya, Israel
| | - Audrey Halpern
- The Manhattan Center for Headache & Neurology, New York City, New York, USA
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Nuvance Health, Danbury, Connecticut, USA
- University of Vermont Larner's College of Medicine, Burlington, Vermont, USA
| | - Nina Riggins
- Department of Neurosciences, University of California San Diego, San Diego, California, USA
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Cowan R, Stark-Inbar A, Rabany L, Harris D, Vizel M, Ironi A, Vieira JR, Galen M, Treppendahl C. Clinical benefits and economic cost-savings of Remote Electrical Neuromodulation (REN) for migraine prevention. J Med Econ 2023; 26:656-664. [PMID: 37083448 DOI: 10.1080/13696998.2023.2205751] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
AIMS Assess the clinical benefits and associated direct and indirect cost-savings from Remote Electrical Neuromodulation (REN) for migraine prevention. METHODS REN, a prescribed, wearable, FDA-cleared neuromodulation-device for the acute and/or treatment of migraine, recently demonstrated efficacy for migraine prevention when used every-other-day, in a prospective, randomized, double-blind, placebo-controlled, multi-center study. Following baseline (4-weeks), subjects underwent treatment with REN (or placebo; 8-weeks), and electronically reported migraine symptoms and acute treatments daily. Therapeutic-gain was the between-groups difference (REN minus placebo) in change from baseline to the second month of intervention. Health-economics impact was derived as cost-savings associated with REN's clinical benefits. RESULTS Out of 248 subjects randomized (128 active, 120 placebo), 179 (95:84) qualified for modifiedintention-to-treat (mITT) analysis. Significant therapeutic gains favoring REN vs placebo were found (Tepper et al., 2023), including mean (±SD) reduction in number of acute medication days (3.4 ± 0.4 vs 1.2 ± 0.5; gain = 2.2; p = 0.001) and presenteeism days (2.7 ± 0.3 vs 1.1 ± 0.4; p = 0.001). Mean changes of provider visits (reduction of 0.09 ± 0.1 vs increase of 0.08 ± 0.2; p = 0.297), and reduction of absenteeism days (0.07 ± 0.1 vs 0.07 ± 0.2; p = 0.997) were not significant. Mean annual cost-saving for one patient using REN for migraine prevention estimated $10,000 (±$1,777) from reductions in these four clinical outcomes relative to baseline without REN treatment. Extrapolated to a hypothetical US commercial health-plan of one-million covered lives, assuming the national prevalence of migraine patients on preventive treatment, annual mean (±SE) cost-saving from using REN migraine prevention estimated $560.0 million (±$99.5 million) from reduction in direct and indirect metrics measured. LIMITATIONS Clinical and cost-savings benefits presented are conservative, assessed only from endpoints measured in the clinical trial. Moreover, some of the endpoints had only scarce or no occurrences during the study period. CONCLUSIONS Demonstrated significant and meaningful clinical, and cost-savings benefits for patients, health insurance systems, and employers, from utilizing REN for migraine prevention.
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Affiliation(s)
- R Cowan
- Division of Headache Medicine, Stanford University, Palo Alto, CA, USA
| | | | - L Rabany
- Theranica Bio-Electronics LTD., Netanya, Israel
| | - D Harris
- Theranica Bio-Electronics LTD., Netanya, Israel
| | - M Vizel
- Theranica Bio-Electronics LTD., Netanya, Israel
| | - A Ironi
- Theranica Bio-Electronics LTD., Netanya, Israel
| | - J R Vieira
- Nuvance Health Neuroscience Institute, Kingston, NY, USA
- Albert Einstein College of Medicine, Saul R. Korey Department of Neurology, Bronx, NY, USA
| | - M Galen
- Deaconess Research Institute, Newburgh, IN, USA
| | - C Treppendahl
- Headache Neurology Research Institute, Ridgeland, MS, USA
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Tepper SJ, Rabany L, Cowan RP, Smith TR, Grosberg BM, Torphy BD, Harris D, Vizel M, Ironi A, Stark-Inbar A, Blumenfeld AM. Remote electrical neuromodulation for migraine prevention: A double-blind, randomized, placebo-controlled clinical trial. Headache 2023; 63:377-389. [PMID: 36704988 DOI: 10.1111/head.14469] [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: 10/09/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To assess the clinical efficacy of remote electrical neuromodulation (REN), used every other day, for the prevention of migraine. BACKGROUND Preventive treatment is key to managing migraine, but it is often underutilized. REN, a non-pharmacological acute treatment for migraine, was evaluated as a method of migraine prevention in patients with episodic and chronic migraine. METHODS We conducted a prospective, randomized, double-blind, placebo-controlled, multi-center trial, with 1:1 ratio. The study consisted of a 4-week baseline observation phase, and an 8-week double-blind intervention phase in which participants used either REN or a placebo stimulation every other day. Throughout the study, participants reported their symptoms daily, via an electronic diary. RESULTS Two hundred forty-eight participants were randomized (128 active, 120 placebo), of which 179 qualified for the modified intention-to-treat (mITT) analysis (95 active; 84 placebo). REN was superior to placebo in the primary endpoint, change in mean number of migraine days per month from baseline, with mean reduction of 4.0 ± SD of 4.0 days (1.3 ± 4.0 in placebo, therapeutic gain = 2.7 [confidence interval -3.9 to -1.5], p < 0.001). The significance was maintained when analyzing the episodic (-3.2 ± 3.4 vs. -1.0 ± 3.6, p = 0.003) and chronic (-4.7 ± 4.4 vs. -1.6 ± 4.4, p = 0.001) migraine subgroups separately. REN was also superior to placebo in reduction of moderate/severe headache days (3.8 ± 3.9 vs. 2.2 ± 3.6, p = 0.005), reduction of headache days of all severities (4.5 ± 4.1 vs. 1.8 ± 4.6, p < 0.001), percentage of patients achieving 50% reduction in moderate/severe headache days (51.6% [49/95] vs. 35.7% [30/84], p = 0.033), and reduction in days of acute medication intake (3.5 ± 4.1 vs. 1.4 ± 4.3, p = 0.001). Similar results were obtained in the ITT analysis. No serious device-related adverse events were reported in any group. CONCLUSION Applied every other day, REN is effective and safe for the prevention of migraine.
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Affiliation(s)
- Stewart J Tepper
- The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | - Robert P Cowan
- Division of Headache Medicine, Stanford University, Palo Alto, California, USA
| | | | | | - Bradley D Torphy
- Chicago Headache Center and Research Institute, Chicago, Illinois, USA
| | | | - Maya Vizel
- Theranica Bio-Electronics Ltd., Netanya, Israel
| | - Alon Ironi
- Theranica Bio-Electronics Ltd., Netanya, Israel
| | | | - Andrew M Blumenfeld
- The Los Angeles Headache Center, Los Angeles, California, USA
- San Diego Headache Center, San Diego, California, USA
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Grosberg B, Rabany L, Vizel M, Ironi A, Harris D, Stark-Inbar A, Smith TR. Effectiveness comparison of remote electrical neuromodulation and standard-care medications for acute treatment of chronic migraine: a post-hoc analysis. Pain Manag 2022; 12:837-844. [PMID: 36097974 DOI: 10.2217/pmt-2022-0053] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: The current study compared the effectiveness of remote electrical neuromodulation (REN) to that of standard-care medications for acute treatments of migraine, using a within-subjects design. Materials & methods: Post-hoc within-subject analysis was performed on data from 78 adult chronic migraine patients who participated in a clinical trial with REN, on four end points: single-treatment pain relief, single-treatment pain freedom, consistency of pain relief and consistency of pain freedom. Results: No statistical differences were found between REN and the tested medications, in any of the effectiveness outcomes: single-treatment pain relief p = 0.056, single-treatment pain freedom p = 0.532, consistency of pain relief p = 0.369, consistency of pain freedom p = 1.00. Conclusion: The results suggest that REN may provide an effective non-pharmacological alternative for standard care abortive medications in individuals impacted by chronic migraine.
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Affiliation(s)
- Brian Grosberg
- Hartford Hospital, 65 Memorial Rd #508, West Hartford, CT 06107, USA
| | - Liron Rabany
- Theranica Bio-Electronics, Ha'Omanut St. 4, Netanya, 4250438, Israel
| | - Maya Vizel
- Theranica Bio-Electronics, Ha'Omanut St. 4, Netanya, 4250438, Israel
| | - Alon Ironi
- Theranica Bio-Electronics, Ha'Omanut St. 4, Netanya, 4250438, Israel
| | - Dagan Harris
- Theranica Bio-Electronics, Ha'Omanut St. 4, Netanya, 4250438, Israel
| | - Alit Stark-Inbar
- Theranica Bio-Electronics, Ha'Omanut St. 4, Netanya, 4250438, Israel
| | - Timothy R Smith
- StudyMetrix Research, LLC 3862 Mexico Rd, St. Peters, MO 63303, USA
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Nierenburg H, Stark-Inbar A. Nerivio ® remote electrical neuromodulation for acute treatment of chronic migraine. Pain Manag 2021; 12:267-281. [PMID: 34538078 DOI: 10.2217/pmt-2021-0038] [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] [Indexed: 11/21/2022] Open
Abstract
Nerivio® (by Theranica Bio-Electronics Ltd, Tel Aviv, Israel) is a wireless, wearable, noninvasive, battery-operated, remote electrical neuromodulation device controlled by a smartphone application. It is US FDA authorized for the acute treatment of migraine with or without aura in people 12 years and older in the US, and European Conformity (CE) marked for the same indication in the EU. The American Headache Society Consensus Statement recommends Nerivio as a tier 2 treatment for migraines. This review summarizes a series of five independent clinical trials and two real-world evidence studies that established safety, tolerability and efficacy of Nerivio in treating migraine attacks. It further provides up-to-date practical information on device usability. Based on findings of this review, Nerivio offers a safe and effective nonpharmacological alternative for acute treatment in patients with chronic (and nonchronic) migraine.
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McVige JW, Stark-Inbar A. Remote Electrical Neuromodulation for the Acute Treatment of Episodic and Chronic Migraine. Neurology 2021. [DOI: 10.17925/usn.2021.17.1.6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Motolese F, Magliozzi A, Puttini F, Rossi M, Capone F, Karlinski K, Stark-Inbar A, Yekutieli Z, Di Lazzaro V, Marano M. Parkinson's Disease Remote Patient Monitoring During the COVID-19 Lockdown. Front Neurol 2020; 11:567413. [PMID: 33117262 PMCID: PMC7575750 DOI: 10.3389/fneur.2020.567413] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [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: 05/29/2020] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the feasibility of a smartphone remote patient monitoring approach in a real-life Parkinson's disease (PD) cohort during the Italian COVID-19 lockdown. Methods: Fifty-four non-demented PD patients who were supposed to attend the outpatient March clinic were recruited for a prospective study. All patients had a known UPDRS-III and a modified Hoehn and Yahr (H&Y) score and were provided with a smartphone application capable of providing indicators of gait, tapping, tremor, memory and executive functions. Different questionnaires exploring non-motor symptoms and quality of life were administered through phone-calls. Patients were asked to run the app at least twice per week (i.e., full compliance). Subjects were phone-checked weekly throughout a 3-week period for compliance and final satisfaction questionnaires. Results: Forty-five patients (83.3%) ran the app at least once; Twenty-nine (53.7%) subjects were half-compliant, while 16 (29.6%) were fully compliant. Adherence was hindered by technical issues or digital illiteracy (38.7%), demotivation (24%) and health-related issues (7.4%). Ten patients (18.5%) underwent PD therapy changes. The main factors related to lack of compliance included loss of interest, sadness, anxiety, the absence of a caregiver, the presence of falls and higher H&Y. Gait, tapping, tremor and cognitive application outcomes were correlated to disease duration, UPDRS-III and H&Y. Discussion: The majority of patients were compliant and satisfied by the provided monitoring program. Some of the application outcomes were statistically correlated to clinical parameters, but further validation is required. Our pilot study suggested that the available technologies could be readily implemented even with the current population's technical and intellectual resources.
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Affiliation(s)
- Francesco Motolese
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Alessandro Magliozzi
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Fiorella Puttini
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Mariagrazia Rossi
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Fioravante Capone
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | | | | | | | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Marano
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
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Tchelet K, Stark-Inbar A, Yekutieli Z. Pilot Study of the EncephaLog Smartphone Application for Gait Analysis. Sensors (Basel) 2019; 19:s19235179. [PMID: 31779224 PMCID: PMC6929058 DOI: 10.3390/s19235179] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 12/30/2022]
Abstract
Gait disorders and falls are common in elders and in many clinical conditions, yet they are typically infrequently and subjectively evaluated, limiting prevention and intervention. Completion-time of the Timed-Up-and-Go (TUG) test is a well-accepted clinical biomarker for rating mobility and prediction of falls risk. Using smartphones’ integral accelerometers and gyroscopes, we already demonstrated that TUG completion-time can be accurately measured via a smartphone app. Here we present an extended app, EncephaLogTM, which provides gait analysis in much more detail, offering 9 additional gait biomarkers on top of the TUG completion-time. In this pilot, four healthy adults participated in a total of 32 TUG tests; simultaneously recorded by EncephaLog and motion sensor devices used in movement labs: motion capture cameras (MCC), pressure mat; and/or wearable sensors. Results show high agreement between EncephaLog biomarkers and those measured by the other devices. These preliminary results suggest that EncephaLog can provide an accurate, yet simpler, instrumented TUG (iTUG) platform than existing alternatives, offering a solution for clinics that cannot afford the cost or space required for a dedicated motion lab and for monitoring patients at their homes. Further research on a larger study population with pathologies is required to assess full validity.
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Labruna L, Stark-Inbar A, Breska A, Dabit M, Vanderschelden B, Nitsche MA, Ivry RB. Individual differences in TMS sensitivity influence the efficacy of tDCS in facilitating sensorimotor adaptation. Brain Stimul 2019; 12:992-1000. [PMID: 30930208 DOI: 10.1016/j.brs.2019.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 07/05/2018] [Revised: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) can enhance cognitive function in healthy individuals, with promising applications as a therapeutic intervention. Despite this potential, variability in the efficacy of tDCS has been a considerable concern. OBJECTIVE /Hypothesis: Given that tDCS is always applied at a set intensity, we examined whether individual differences in sensitivity to brain stimulation might be one variable that modulates the efficacy of tDCS in a motor learning task. METHODS In the first part of the experiment, single-pulse transcranial magnetic stimulation (TMS) over primary motor cortex (M1) was used to determine each participant's resting motor threshold (rMT). This measure was used as a proxy of individual sensitivity to brain stimulation. In an experimental group of 28 participants, 2 mA tDCS was then applied during a motor learning task with the anodal electrode positioned over left M1. Another 14 participants received sham stimulation. RESULTS M1-Anodal tDCS facilitated learning relative to participants who received sham stimulation. Of primary interest was a within-group analysis of the experimental group, showing that the rate of learning was positively correlated with rMT: Participants who were more sensitive to brain stimulation as operationalized by our TMS proxy (low rMT), showed faster adaptation. CONCLUSIONS Methodologically, the results indicate that TMS sensitivity can predict tDCS efficacy in a behavioral task, providing insight into one source of variability that may contribute to replication problems with tDCS. Theoretically, the results provide further evidence of a role of sensorimotor cortex in adaptation, with the boost from tDCS observed during acquisition.
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Affiliation(s)
- L Labruna
- Department of Psychology, University of California, 94704, Berkeley, CA, USA; Helen Wills Neuroscience Institute, University of California, 94704, Berkeley, CA, USA.
| | - A Stark-Inbar
- Department of Psychology, University of California, 94704, Berkeley, CA, USA; Helen Wills Neuroscience Institute, University of California, 94704, Berkeley, CA, USA
| | - A Breska
- Department of Psychology, University of California, 94704, Berkeley, CA, USA; Helen Wills Neuroscience Institute, University of California, 94704, Berkeley, CA, USA
| | - M Dabit
- Department of Psychology, University of California, 94704, Berkeley, CA, USA
| | - B Vanderschelden
- Department of Psychology, University of California, 94704, Berkeley, CA, USA
| | - M A Nitsche
- Leibniz Research Center for Working Environment and Human Factors, 44139, Dortmund, Germany
| | - R B Ivry
- Department of Psychology, University of California, 94704, Berkeley, CA, USA; Helen Wills Neuroscience Institute, University of California, 94704, Berkeley, CA, USA
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Stark-Inbar A, Dayan E. Preferential encoding of movement amplitude and speed in the primary motor cortex and cerebellum. Hum Brain Mapp 2017; 38:5970-5986. [PMID: 28885740 DOI: 10.1002/hbm.23802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 08/02/2016] [Revised: 07/04/2017] [Accepted: 08/27/2017] [Indexed: 11/06/2022] Open
Abstract
Voluntary movements require control of multiple kinematic parameters, a task carried out by a distributed brain architecture. However, it remains unclear whether regions along the motor system encode single, or rather a mixture of, kinematic parameters during action execution. Here, rapid event-related functional magnetic resonance imaging was used to differentiate brain activity along the motor system during the encoding of movement amplitude, duration, and speed. We present cumulative evidence supporting preferential encoding of kinematic parameters along the motor system, based on blood-oxygenation-level dependent signal recorded in a well-controlled single-joint wrist-flexion task. Whereas activity in the left primary motor cortex (M1) showed preferential encoding of movement amplitude, the anterior lobe of the right cerebellum (primarily lobule V) showed preferential encoding of movement speed. Conversely, activity in the left supplementary motor area (SMA), basal ganglia (putamen), and anterior intraparietal sulcus was not preferentially modulated by any specific parameter. We found no preference in peak activation for duration encoding in any of the tested regions. Electromyographic data was mainly modulated by movement amplitude, restricting the distinction between amplitude and muscle force encoding. Together, these results suggest that during single-joint movements, distinct kinematic parameters are controlled by largely distinct brain-regions that work together to produce and control precise movements. Hum Brain Mapp 38:5970-5986, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Alit Stark-Inbar
- Department of Psychology, University of California, Berkeley, California
| | - Eran Dayan
- Department of Radiology, Biomedical Research Imaging Center and Neuroscience Curriculum, University of North Carolina at Chapel Hill, North Carolina
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Nahum M, Van Vleet TM, Sohal VS, Mirzabekov JJ, Rao VR, Wallace DL, Lee MB, Dawes H, Stark-Inbar A, Jordan JT, Biagianti B, Merzenich M, Chang EF. Immediate Mood Scaler: Tracking Symptoms of Depression and Anxiety Using a Novel Mobile Mood Scale. JMIR Mhealth Uhealth 2017; 5:e44. [PMID: 28404542 PMCID: PMC5406620 DOI: 10.2196/mhealth.6544] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/24/2016] [Accepted: 02/11/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Mood disorders are dynamic disorders characterized by multimodal symptoms. Clinical assessment of symptoms is currently limited to relatively sparse, routine clinic visits, requiring retrospective recollection of symptoms present in the weeks preceding the visit. Novel advances in mobile tools now support ecological momentary assessment of mood, conducted frequently using mobile devices, outside the clinical setting. Such mood assessment may help circumvent problems associated with infrequent reporting and better characterize the dynamic presentation of mood symptoms, informing the delivery of novel treatment options. OBJECTIVES The aim of our study was to validate the Immediate Mood Scaler (IMS), a newly developed, iPad-deliverable 22-item self-report tool designed to capture current mood states. METHODS A total of 110 individuals completed standardized questionnaires (Patient Health Questionnaire, 9-item [PHQ-9]; generalized anxiety disorder, 7-Item [GAD-7]; and rumination scale) and IMS at baseline. Of the total, 56 completed at least one additional session of IMS, and 17 completed one additional administration of PHQ-9 and GAD-7. We conducted exploratory Principal Axis Factor Analysis to assess dimensionality of IMS, and computed zero-order correlations to investigate associations between IMS and standardized scales. Linear Mixed Model (LMM) was used to assess IMS stability across time and to test predictability of PHQ-9 and GAD-7 score by IMS. RESULTS Strong correlations were found between standard mood scales and the IMS at baseline (r=.57-.59, P<.001). A factor analysis revealed a 12-item IMS ("IMS-12") with two factors: a "depression" factor and an "anxiety" factor. IMS-12 depression subscale was more strongly correlated with PHQ-9 than with GAD-7 (z=1.88, P=.03), but the reverse pattern was not found for IMS-12 anxiety subscale. IMS-12 showed less stability over time compared with PHQ-9 and GAD-7 (.65 vs .91), potentially reflecting more sensitivity to mood dynamics. In addition, IMS-12 ratings indicated that individuals with mild to moderate depression had greater mood fluctuations compared with individuals with severe depression (.42 vs .79; P=.04). Finally, IMS-12 significantly contributed to the prediction of subsequent PHQ-9 (beta=1.03, P=.02) and GAD-7 scores (beta =.93, P=.01). CONCLUSIONS Collectively, these data suggest that the 12-item IMS (IMS-12) is a valid tool to assess momentary mood symptoms related to anxiety and depression. Although IMS-12 shows good correlation with standardized scales, it further captures mood fluctuations better and significantly adds to the prediction of the scales. Results are discussed in the context of providing continuous symptom quantification that may inform novel treatment options and support personalized treatment plans.
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Affiliation(s)
- Mor Nahum
- School of OT, Faculty of Medicine, Hebrew University, Jerusalem, Israel.,Posit Science Corporation, San Francisco, CA, United States
| | | | - Vikaas S Sohal
- Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Julie J Mirzabekov
- UC Berkeley- UCSF Joint Medical Program, University of California, Berkeley, CA, United States.,School of Medicine, University of California, San Francisco, CA, United States
| | - Vikram R Rao
- Department of Neurology, University of California, San Francisco, CA, United States
| | - Deanna L Wallace
- Department of Neurosurgery, University of California, San Francisco, CA, United States
| | - Morgan B Lee
- Department of Neurosurgery, University of California, San Francisco, CA, United States
| | - Heather Dawes
- Department of Neurosurgery, University of California, San Francisco, CA, United States
| | - Alit Stark-Inbar
- Posit Science Corporation, San Francisco, CA, United States.,Department of Psychology, University of California, Berkeley, CA, United States
| | - Joshua Thomas Jordan
- California School of Professional Psychology, Alliant International University, San Francisco, CA, United States
| | - Bruno Biagianti
- Posit Science Corporation, San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, CA, United States
| | | | - Edward F Chang
- Department of Neurosurgery, University of California, San Francisco, CA, United States
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Stark-Inbar A, Raza M, Taylor JA, Ivry RB. Individual differences in implicit motor learning: task specificity in sensorimotor adaptation and sequence learning. J Neurophysiol 2016; 117:412-428. [PMID: 27832611 DOI: 10.1152/jn.01141.2015] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [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: 12/22/2015] [Accepted: 10/30/2016] [Indexed: 11/22/2022] Open
Abstract
In standard taxonomies, motor skills are typically treated as representative of implicit or procedural memory. We examined two emblematic tasks of implicit motor learning, sensorimotor adaptation and sequence learning, asking whether individual differences in learning are correlated between these tasks, as well as how individual differences within each task are related to different performance variables. As a prerequisite, it was essential to establish the reliability of learning measures for each task. Participants were tested twice on a visuomotor adaptation task and on a sequence learning task, either the serial reaction time task or the alternating reaction time task. Learning was evident in all tasks at the group level and reliable at the individual level in visuomotor adaptation and the alternating reaction time task but not in the serial reaction time task. Performance variability was predictive of learning in both domains, yet the relationship was in the opposite direction for adaptation and sequence learning. For the former, faster learning was associated with lower variability, consistent with models of sensorimotor adaptation in which learning rates are sensitive to noise. For the latter, greater learning was associated with higher variability and slower reaction times, factors that may facilitate the spread of activation required to form predictive, sequential associations. Interestingly, learning measures of the different tasks were not correlated. Together, these results oppose a shared process for implicit learning in sensorimotor adaptation and sequence learning and provide insight into the factors that account for individual differences in learning within each task domain. NEW & NOTEWORTHY We investigated individual differences in the ability to implicitly learn motor skills. As a prerequisite, we assessed whether individual differences were reliable across test sessions. We found that two commonly used tasks of implicit learning, visuomotor adaptation and the alternating serial reaction time task, exhibited good test-retest reliability in measures of learning and performance. However, the learning measures did not correlate between the two tasks, arguing against a shared process for implicit motor learning.
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Affiliation(s)
- Alit Stark-Inbar
- Department of Psychology, University of California, Berkeley, California;
| | - Meher Raza
- Department of Psychology, University of California, Berkeley, California
| | - Jordan A Taylor
- Department of Psychology, Princeton University, Princeton, New Jersey
| | - Richard B Ivry
- Department of Psychology, University of California, Berkeley, California.,Helen Wills Neuroscience Institute, University of California, Berkeley, California; and
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