Exploring the Effects of Deep Brain Stimulation and Vision on Tremor in Parkinson's Disease : Benefits from Objective Methods
(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.
(Less)
- author
- 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
- organization
-
- Otorhinolaryngology (Lund)
- Active and Healthy Ageing Research Group (research group)
- MultiPark: Multidisciplinary research focused on Parkinson´s disease
- Clinical Memory Research (research group)
- Department of Psychology
- Lund University Humanities Lab
- Neurosurgery
- Section IV
- Department of Automatic Control
- publishing date
- 2020-04-25
- 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
- project
- RobotLab LTH
- language
- English
- LU publication?
- yes
- id
- f9e16952-6bfc-4a62-bc06-9904699a79d8
- date added to LUP
- 2020-05-02 17:01:39
- date last changed
- 2024-09-18 22:35:34
@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}}, keywords = {{Parkinson’s disease; Tremor; Deep brain stimulation; Subthalamic nucleus}}, 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}}, }