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Rajan R, Vishnu VY, Latorre A, Bhatia KP. Reply to: Pregabalin Responsive Tongue and Arm Tremor after Guillain Barré Syndrome. Mov Disord Clin Pract 2023; 10:1707-1708. [PMID: 37982120 PMCID: PMC10654821 DOI: 10.1002/mdc3.13891] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 11/21/2023] Open
Affiliation(s)
- Roopa Rajan
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Anna Latorre
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London (UCL) Institute of NeurologyLondonUnited Kingdom
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London (UCL) Institute of NeurologyLondonUnited Kingdom
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Rajan R, Anandapadmanabhan R, Vishnoi A, Vishnu VY, Latorre A, Agarwal H, Ghosh T, Mangat N, Biswas D, Gupta A, Radhakrishnan DM, Singh MB, Bhatia R, Srivastava A, Srivastava MVP, Bhatia KP. Neuropathic Tremor in Guillain-Barré Syndrome. Mov Disord Clin Pract 2023; 10:1333-1340. [PMID: 37772292 PMCID: PMC10525049 DOI: 10.1002/mdc3.13807] [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: 12/06/2022] [Revised: 05/12/2023] [Accepted: 05/24/2023] [Indexed: 09/30/2023] Open
Abstract
Background Neuropathic Tremor (NT) is a postural/kinetic tremor of the upper extremity, often encountered in patients with chronic neuropathies such as paraprotein-associated and hereditary neuropathies. Objectives To describe the clinical and electrophysiological features of NT in a previously underrecognized setting- during recovery from Guillain-Barré Syndrome (GBS). Methods Patients with a documented diagnosis of GBS in the past, presenting with tremor were identified from review of clinical records. Participants underwent structured, videotaped neurological examination, and electrophysiological analysis using tri-axial accelerometry-surface electromyography. Tremor severity was assessed using the Fahn-Tolosa-Marin Tremor Rating Scale. Results We describe the clinical and electrophysiological features of 5 patients with GBS associated NT. Our cohort had a fine, fast, and slightly jerky postural tremor of frequency ranging from 8 to 10 Hz. Dystonic posturing and overflow movements were noted in 4/5 patients. Tremor appeared 3 months-5 years after the onset of GBS, when patients had regained near normal muscle strength and deep tendon jerks were well elicitable. Electrophysiological analysis of tremor strongly suggested the presence of a central oscillator in all patients. Conclusion NT is not limited to chronic inflammatory or hereditary neuropathies and may occur in the recovery phase of GBS. The tremor is characterized by a high frequency, jerky postural tremor with dystonic posturing. Electrophysiological evaluation suggests the presence of a central oscillator, hypothetically the cerebellum driven by impaired sensorimotor feedback.
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Affiliation(s)
- Roopa Rajan
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Aayushi Vishnoi
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Anna Latorre
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London (UCL) Institute of NeurologyLondonUnited Kingdom
| | - Harsh Agarwal
- All Indian Institute of Medical SciencesNew DelhiIndia
| | | | - Navtej Mangat
- All Indian Institute of Medical SciencesNew DelhiIndia
| | - Deblina Biswas
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Anu Gupta
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Mamta Bhushan Singh
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Rohit Bhatia
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Achal Srivastava
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London (UCL) Institute of NeurologyLondonUnited Kingdom
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di Biase L, Pecoraro PM, Pecoraro G, Caminiti ML, Di Lazzaro V. Markerless Radio Frequency Indoor Monitoring for Telemedicine: Gait Analysis, Indoor Positioning, Fall Detection, Tremor Analysis, Vital Signs and Sleep Monitoring. Sensors (Basel) 2022; 22:8486. [PMID: 36366187 PMCID: PMC9656920 DOI: 10.3390/s22218486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/20/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Quantitative indoor monitoring, in a low-invasive and accurate way, is still an unmet need in clinical practice. Indoor environments are more challenging than outdoor environments, and are where patients experience difficulty in performing activities of daily living (ADLs). In line with the recent trends of telemedicine, there is an ongoing positive impulse in moving medical assistance and management from hospitals to home settings. Different technologies have been proposed for indoor monitoring over the past decades, with different degrees of invasiveness, complexity, and capabilities in full-body monitoring. The major classes of devices proposed are inertial-based sensors (IMU), vision-based devices, and geomagnetic and radiofrequency (RF) based sensors. In recent years, among all available technologies, there has been an increasing interest in using RF-based technology because it can provide a more accurate and reliable method of tracking patients' movements compared to other methods, such as camera-based systems or wearable sensors. Indeed, RF technology compared to the other two techniques has higher compliance, low energy consumption, does not need to be worn, is less susceptible to noise, is not affected by lighting or other physical obstacles, has a high temporal resolution without a limited angle of view, and fewer privacy issues. The aim of the present narrative review was to describe the potential applications of RF-based indoor monitoring techniques and highlight their differences compared to other monitoring technologies.
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Affiliation(s)
- Lazzaro di Biase
- Research Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
- Operative Research Unit of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Brain Innovations Lab, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Pasquale Maria Pecoraro
- Research Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
- Operative Research Unit of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Giovanni Pecoraro
- Department of Electronics Engineering, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Maria Letizia Caminiti
- Research Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
- Operative Research Unit of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Vincenzo Di Lazzaro
- Research Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
- Operative Research Unit of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
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Piepjohn P, Bald C, Kuhlenbäumer G, Becktepe JS, Deuschl G, Schmidt G. Real-time classification of movement patterns of tremor patients. BIOMED ENG-BIOMED TE 2022; 67:119-130. [PMID: 35218686 DOI: 10.1515/bmt-2021-0140] [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: 05/06/2021] [Accepted: 01/27/2022] [Indexed: 11/15/2022]
Abstract
The process of diagnosing tremor patients often leads to misdiagnoses. Therefore, existing technical methods for analysing tremor are needed to more effectively distinguish between different diseases. For this purpose, a system has been developed that classifies measured tremor signals in real time. To achieve this, the hand tremor of 561 subjects has been measured in different hand positions. Acceleration and surface electromyography are recorded during the examination. For this study, data from subjects with Parkinson's Disease, Essential Tremor, and physiological tremor are considered. In a first signal analysis feature extraction is performed, and the resulting features are examined for their discriminative value. In a second step, three classification models based on different pattern recognition techniques are developed to classify the subjects with respect to their tremor type. With a trained decision tree, the three tremor types can be classified with a relative diagnostic accuracy of 83.14%. A neural network achieves 84.24% and the combination of both classifiers yields a relative diagnostic accuracy of 85.76%. The approach is promising and involving more features of the recorded time series will improve the discriminative value.
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Affiliation(s)
- Patricia Piepjohn
- Faculty of Engineering, Institute of Electrical and Information Engineering, Digital Signal Processing and System Theory, Kiel University, Kiel, Germany
| | - Christin Bald
- Faculty of Engineering, Institute of Electrical and Information Engineering, Digital Signal Processing and System Theory, Kiel University, Kiel, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Gerhard Schmidt
- Faculty of Engineering, Institute of Electrical and Information Engineering, Digital Signal Processing and System Theory, Kiel University, Kiel, Germany
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