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Exploring the effects of deep brain stimulation and vision on tremor in Parkinson's disease - benefits from objective methods

Fransson, Per-Anders LU ; Nilsson, Maria H LU ; Niehorster, Diederick C LU ; Nyström, Marcus LU ; Rehncrona, Stig LU ; Tjernström, Fredrik LU ; Magnusson, Måns LU ; Johansson, Rolf LU and Patel, Mitesh LU (2020) In Journal of NeuroEngineering and Rehabilitation 17(1).
Abstract

BACKGROUND: Tremor is a cardinal symptom of Parkinson's disease (PD) that may cause severe disability. As such, objective methods to determine the exact characteristics of the tremor may improve the evaluation of therapy. This methodology study aims to validate the utility of two objective technical methods of recording Parkinsonian tremor and evaluate their ability to determine the effects of Deep Brain Stimulation (DBS) of the subthalamic nucleus and of vision.

METHODS: We studied 10 patients with idiopathic PD, who were responsive to L-Dopa and had more than 1 year use of bilateral subthalamic nucleus stimulation. The patients did not have to display visible tremor to be included in the study. Tremor was recorded with two... (More)

BACKGROUND: Tremor is a cardinal symptom of Parkinson's disease (PD) that may cause severe disability. As such, objective methods to determine the exact characteristics of the tremor may improve the evaluation of therapy. This methodology study aims to validate the utility of two objective technical methods of recording Parkinsonian tremor and evaluate their ability to determine the effects of Deep Brain Stimulation (DBS) of the subthalamic nucleus and of vision.

METHODS: We studied 10 patients with idiopathic PD, who were responsive to L-Dopa and had more than 1 year use of bilateral subthalamic nucleus stimulation. The patients did not have to display visible tremor to be included in the study. Tremor was recorded with two objective methods, a force platform and a 3 dimensional (3D) motion capture system that tracked movements in four key proximal sections of the body (knee, hip, shoulder and head). They were assessed after an overnight withdrawal of anti-PD medications with DBS ON and OFF and with eyes open and closed during unperturbed and perturbed stance with randomized calf vibration, using a randomized test order design.

RESULTS: Tremor was detected with the Unified Parkinson's Disease Rating Scale (UPDRS) in 6 of 10 patients but only distally (hands and feet) with DBS OFF. With the force platform and the 3D motion capture system, tremor was detected in 6 of 10 and 7 of 10 patients respectively, mostly in DBS OFF but also with DBS ON in some patients. The 3D motion capture system revealed that more than one body section was usually affected by tremor and that the tremor amplitude was non-uniform, but the frequency almost identical, across sites. DBS reduced tremor amplitude non-uniformly across the body. Visual input mostly reduced tremor amplitude with DBS ON.

CONCLUSIONS: Technical recording methods offer objective and sensitive detection of tremor that provide detailed characteristics such as peak amplitude, frequency and distribution pattern, and thus, provide information that can guide the optimization of treatments. Both methods detected the effects of DBS and visual input but the 3D motion system was more versatile in that it could detail the presence and properties of tremor at individual body sections.

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Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Parkinson’s disease, Tremor, Deep brain stimulation, Subthalamic nucleus
in
Journal of NeuroEngineering and Rehabilitation
volume
17
issue
1
article number
56
pages
14 pages
publisher
BioMed Central (BMC)
external identifiers
  • pmid:32334622
  • scopus:85084030939
ISSN
1743-0003
DOI
10.1186/s12984-020-00677-3
language
English
LU publication?
yes
id
f9e16952-6bfc-4a62-bc06-9904699a79d8
date added to LUP
2020-05-02 17:01:39
date last changed
2020-05-24 06:31:42
@article{f9e16952-6bfc-4a62-bc06-9904699a79d8,
  abstract     = {<p>BACKGROUND: Tremor is a cardinal symptom of Parkinson's disease (PD) that may cause severe disability. As such, objective methods to determine the exact characteristics of the tremor may improve the evaluation of therapy. This methodology study aims to validate the utility of two objective technical methods of recording Parkinsonian tremor and evaluate their ability to determine the effects of Deep Brain Stimulation (DBS) of the subthalamic nucleus and of vision.</p><p>METHODS: We studied 10 patients with idiopathic PD, who were responsive to L-Dopa and had more than 1 year use of bilateral subthalamic nucleus stimulation. The patients did not have to display visible tremor to be included in the study. Tremor was recorded with two objective methods, a force platform and a 3 dimensional (3D) motion capture system that tracked movements in four key proximal sections of the body (knee, hip, shoulder and head). They were assessed after an overnight withdrawal of anti-PD medications with DBS ON and OFF and with eyes open and closed during unperturbed and perturbed stance with randomized calf vibration, using a randomized test order design.</p><p>RESULTS: Tremor was detected with the Unified Parkinson's Disease Rating Scale (UPDRS) in 6 of 10 patients but only distally (hands and feet) with DBS OFF. With the force platform and the 3D motion capture system, tremor was detected in 6 of 10 and 7 of 10 patients respectively, mostly in DBS OFF but also with DBS ON in some patients. The 3D motion capture system revealed that more than one body section was usually affected by tremor and that the tremor amplitude was non-uniform, but the frequency almost identical, across sites. DBS reduced tremor amplitude non-uniformly across the body. Visual input mostly reduced tremor amplitude with DBS ON.</p><p>CONCLUSIONS: Technical recording methods offer objective and sensitive detection of tremor that provide detailed characteristics such as peak amplitude, frequency and distribution pattern, and thus, provide information that can guide the optimization of treatments. Both methods detected the effects of DBS and visual input but the 3D motion system was more versatile in that it could detail the presence and properties of tremor at individual body sections.</p>},
  author       = {Fransson, Per-Anders and Nilsson, Maria H and Niehorster, Diederick C and Nyström, Marcus and Rehncrona, Stig and Tjernström, Fredrik and Magnusson, Måns and Johansson, Rolf and Patel, Mitesh},
  issn         = {1743-0003},
  language     = {eng},
  month        = {04},
  number       = {1},
  publisher    = {BioMed Central (BMC)},
  series       = {Journal of NeuroEngineering and Rehabilitation},
  title        = {Exploring the effects of deep brain stimulation and vision on tremor in Parkinson's disease - benefits from objective methods},
  url          = {http://dx.doi.org/10.1186/s12984-020-00677-3},
  doi          = {10.1186/s12984-020-00677-3},
  volume       = {17},
  year         = {2020},
}