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... Since only neural data may be used in our classifier and the presence of stimulation is known to alter neural dynamics, data must be collected in each state with stimulation both active and disabled. In order to take these considerations into account, training data must be collected with patients in each To obtain data during each of the four possible patient states described above, 30 seconds of data were collected with the patient at rest with hands in lap with stimulation active and with stimulation disabled, and 30 seconds while the patient was continuously conducting the finger-to-nose task of the Fahn-Tolosa-Marin (FTM) tremor rating scale with stimulation active and with stimulation disabled [25]. These two minutes' total data were used to train an intrinsically personalized classifier. ...
... For the quantified portion of classifier evaluation, patients were asked to begin at rest with hands in their lap. At a semi-randomized time-stamped prompt, the patient was asked to conduct the finger-to-nose task of the FTM tremor rating scale [25] continuously until the next prompt, at which point they were asked to return to rest. IMU data was streamed continuously throughout the experiment, while stimulation amplitude was recorded on the Activa PC+S device during experiments and downloaded for analysis following the experiment. ...
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Objective: Deep brain stimulation (DBS) is a safe and established treatment for essential tremor (ET) and several other movement disorders. One approach to improving DBS therapy is adaptive DBS (aDBS), in which stimulation parameters are modulated in real time based on biofeedback from either external or implanted sensors. Previously tested systems have fallen short of translational applicability due to the requirement for patients to continuously wear the necessary sensors or processing devices, as well as privacy and security concerns. Approach: We designed and implemented a translation-ready training data collection system for fully implanted aDBS. Two patients chronically implanted with electrocorticography strips over the hand portion of M1 and DBS probes in the ipsilateral ventral intermediate nucleus of the thalamus for treatment of ET were recruited for this study. Training was conducted using a translation-ready distributed training procedure, allowing a substantially higher degree of control over data collection than previous works. A linear classifier was trained using this system, biased towards activating stimulation in accordance with clinical considerations. Main Results: The clinically relevant average false negative rate, defined as fraction of time during which stimulation dropped below 1/2 clinical levels during movement epochs, was 0.036. Tremor suppression, calculated through analysis of gyroscope data, was 33.2% more effective on average with aDBS than with continuous DBS. During a period of free movement with aDBS, one patient reported a slight paresthesia; patients noticed no difference in treatment efficacy between systems. Significance: Here is presented the first translation-ready training procedure for a fully embedded aDBS control system for MDs and one of the first examples of such a system in ET, adding to the consensus that fully implanted aDBS systems are sufficiently mature for broader deployment in treatment of movement disorders.
... (b) A multicenter and prospective design with long-term follow-up. (c) Patients should undergo periodic clinical evaluations, including rating scales for tremor 83,84 and the Unified Parkinson's Disease Rating Scale (UPDRS). 85 (d) Patients should undergo DAT-SPECT studies at the beginning and at end of the follow-up period, and there should be further study if a diagnosis of associated PD is made. ...
... 5 One of the earlier tremor scales developed that is still in use today is the Fahn-Tolosa-Marin Tremor Rating Scale (TRS). 6 This 5-point scale rates tremor severity based on tremor amplitude, from 0 (no tremor) to 4 (severe tremor) in each part of the body, and includes assessments of specific abilities and functional disability. A number of other scales have been developed, which include smaller severity gradations 7 or are disease specific. ...
... In addition, bilateral kinetic tremor of the upper extremities became evident (frequency 5 Hz, variable amplitude up to 8 cm). The tremor was scored according to the Fahn-Tolosa-Marin Tremor Scale: at rest 5 0, with posture 5 3 (right) and 4 (left), and with action 5 4. 7,8 Repeat MRI showed partial resorption of the hemorrhage. Digital subtraction angiography showed an arteriovenous malformation (Spetzler-Martin grade III) within the tectum and tegmentum of the right mesencephalon extending to the superior cerebellar peduncle. ...
... Postural tremor was assessed by ataxia specialists based on the related maneuver from the Fahn-Tolosa-Marin tremor rating scale. 24 During the neurological examination, postural tremor was assessed in two maneuvers: forward horizontal reach posture and lateral ''wing beating'' posture. Both the forward horizontal posture and the wing beating posture were held for 10 seconds, respectively. ...
... Eleven studies used the Fahn-Tolosa-Marin tremor rating scale (TRS) total scores or motor scores when presenting overall tremor outcomes after DBS [16]. The Washington Heights-Inwood genetic study of essential tremor scale (WHIGET) was used in one study [17]. ...
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Dystonic tremor (DT) is defined as the tremor in body parts affected by dystonia. Although deep brain stimulation (DBS) has been used to manage medically-refractory DT patients, its efficacy has not been well established. The objective of this study is to provide an up-to-date systematic review of DBS outcomes for DT patients. We conducted a literature search using Medline, Embase, and Cochrane Library databases in February 2020 according to the PRISMA guidelines. From 858 publications, we identified 30 articles involving 89 DT patients who received DBS of different targets. Thalamic DBS was the most common (n = 39) and improved tremor by 40–50% potentially in the long-term over five years with variable effects on dystonic symptoms. Globus pallidus internus (GPi), subthalamic, and subthalamic nucleus (STN) DBS improved both tremor and dystonic symptoms; however, data were limited. A few studies have reported better tremor and dystonia outcomes with combinations of different targets. Concerning adverse effects, gait/balance disorders, and ataxia seemed to be more common among patients treated with thalamic or subthalamic DBS, whereas parkinsonian adverse effects were observed only in patients treated with subthalamic or GPi DBS. Comparative benefits and limitations of these targets remain unclear because of the lack of randomized controlled trials. In conclusion, DBS of these targets may improve tremor with a variable effect on dystonia with different adverse effect profiles. The shortcomings in the literature include long-term motor outcomes, quality of life outcomes, optimal DBS targeting, and DBS programming strategy.
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We herein to describe the response and the potential treatment mechanism of low dose rituximab in patients with treatment-resistant chronic inflammatory demyelinating polyneuropathy (CIDP) with antibodies against neurofascin-155 (NF-155). Patients received 100 mg rituximab once weekly for 4 weeks followed by 100 mg per month for 2 additional doses. Clinical function scores, Fahn- Tolosa-Marin Tremor Rating Scale (FTMTRS) and flow cytometry of peripheral blood were scheduled before and at 1, 3, 6 months after rituximab treatment. All clinical function score including MRC, INCAT, Hughes, mRS, ODSS and FTMTRS scores showed obvious improvement at the post-treatment follow-up 1,3,6 months in comparison with baseline values. The proportion of CD19 + CD27+, CD19 + CD38+ and CD138 in lymphocytes of all patients declined at 1,3,6 month and the proportion of CD19 + CD24hiCD38hi in one patient was increased at 6 months after rituximab treatment. Low dose rituximab can significant improve disease severity and disabling tremor of CIDP patients with anti-NF155 antibody by the powerful role of B cell depletion within six months and subsequent reestablishment of B-cell subsets including increasing regulatory B cells, inhibiting memory B cells and reducing plasmablasts.
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Digital health metrics promise to advance the understanding of impaired body functions, for example in neurological disorders. However, their clinical integration is challenged by an insufficient validation of the many existing and often abstract metrics. Here, we propose a data-driven framework to select and validate a clinically relevant core set of digital health metrics extracted from a technology-aided assessment. As an exemplary use-case, the framework is applied to the Virtual Peg Insertion Test (VPIT), a technology-aided assessment of upper limb sensorimotor impairments. The framework builds on a use-case-specific pathophysiological motivation of metrics, models demographic confounds, and evaluates the most important clinimetric properties (discriminant validity, structural validity, reliability, measurement error, learning effects). Applied to 77 metrics of the VPIT collected from 120 neurologically intact and 89 affected individuals, the framework allowed selecting 10 clinically relevant core metrics. These assessed the severity of multiple sensorimotor impairments in a valid, reliable, and informative manner. These metrics provided added clinical value by detecting impairments in neurological subjects that did not show any deficits according to conventional scales, and by covering sensorimotor impairments of the arm and hand with a single assessment. The proposed framework provides a transparent, step-by-step selection procedure based on clinically relevant evidence. This creates an interesting alternative to established selection algorithms that optimize mathematical loss functions and are not always intuitive to retrace. This could help addressing the insufficient clinical integration of digital health metrics. For the VPIT, it allowed establishing validated core metrics, paving the way for their integration into neurorehabilitation trials.
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Background Smaller expansions of CGG trinucleotide repeats in the FMR1 X-linked gene termed ‘premutation’ lead to a neurodegenerative disorder: Fragile X Associated Tremor/Ataxia Syndrome (FXTAS) in nearly half of aged carrier males, and 8-16% females. Core features include intention tremor, ataxia, and cognitive decline, and white matter lesions especially in cerebellar and periventricular locations. A ‘toxic’ role of elevated and expanded FMR1 mRNA has been linked to the pathogenesis of this disorder. The emerging issue concerns the trajectory of the neurodegenerative changes: is the pathogenetic effect confined to overt clinical manifestations? Here we explore the relationships between motor and cognitive scale scores in a sample of 57 asymptomatic adult female premutation carriers of broad age range. Methods Three motor scale scores (ICARS-for tremor/ataxia, UPDRS-for parkinsonism, and the Clinical Tremor) were related to 11 cognitive tests and two psychiatric pathology scores - DASS and SCL-90 - using Spearman’s rank correlations. Robust regression, applied in relationships between all phenotypic measures, and genetic molecular and demographic data, identified age and educational levels as common correlates of these measures, which were incorporated as confounders in correlation analysis. Results Cognitive tests demonstrating significant correlations with motor scores were those assessing psychomotor speed/visual attention (SDMT; TMT-A) and those dependent on various aspects of executive functioning for their execution: sequencing and alternation (TMTB-A); working memory (DS backwards); and non-verbal reasoning (MR). The largest number of motor x cognitive correlations involved ICARS and Tremor scales, which reflect the type of motor dysfunctions seen in FXTAS. Conclusions Subtle motor impairments correlating with cognitive deficits may occur in female premutation carriers not meeting diagnostic criteria for FXTAS. This pattern of cognitive deficits is consistent with those seen in other cerebellar disorders. Our results provide evidence that more than one category of clinical manifestation reflecting cerebellar changes – motor and cognitive - may be simultaneously affected by premutation carriage across a broad age range in asymptomatic carriers. Future longitudinal studies should determine whether cognitive dysfunction tracking motor impairments is driven by the premutation status common to all carriers, or only to a subset of carriers who will develop FXTAS in older age.
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