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P933: Quantification of movement disorders symptoms employing attitude sensors
Abstracts of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339
Conclusion: PB spasm is an involuntary and visible dimpling of hypothenar eminence corresponding with an abnormal spontaneous activity of single MUPs and/or myokymia in PB muscle. This spasm could be idiopathic (probably due to compression of superficial ulnar nerve branch in the wrist like an occupational syndrome) or associated with diffuse or focal demyelinating Ulnar nerve injury, isolated or in the context of Demyelinating Neuropathy (Multifocal Motor Neuropathy, Mononeuritis Multiplex with conduction blocks).
P933 Quantification of movement disorders symptoms employing attitude sensors O. Martinez Manzanera, N. Maurits, J.W. Elting University Medical Center Groningen, Neurology, Groningen, Netherlands Question: The diagnosis of movement disorders is a time intensive process in which the patient is interviewed and the symptoms are evaluated. However, even the most common types of movement disorders have a high percentage of misdiagnosis (depending on the clinical context, up to 30-50% for essential tremor [1] and 25% for Parkinson’s disease [2]). To increase diagnostic accuracy, attitude sensors can be placed on the patient during evaluation. They combine different signals to obtain their own orientation. The goal is to use these sensors to quantify characteristic features of the movement disorder (e.g. tremor, bradykinesia, ataxia) and determine the added value to current diagnostic evaluation techniques. Methods: During movement disorders evaluation, sensors are placed on the affected limbs of the patient. A computer model and algorithms have been developed to derive quantitative parameters from instantaneous device orientations resulting in movement speeds, frequencies, joint angles and distances travelled by the limbs. Sensors accuracy is determined by comparison against 3D optical tracking. Also, the possibility to extend the recordings outside the clinic is evaluated. Results: Results obtained from patients with tremor and bradykinetic Parkinson’s patients are compared against clinical evaluation (polymyography and UPDRS). Conclusions: Attitude sensors may have added value for the diagnosis of movement disorders in the clinic and open up the possibility of remote measurements of movement disorder symptoms outside the clinic. References: [1] Jain S. et al. Common misdiagnosis of a common neurological disorder: Arch. Neurol (2006).
S295
[2] Tolosa, E. et al. The diagnosis of Parkinson’s disease. Lancet neurology (2006).
P934 Long term effective thalamic DBS for neuropathic tremor in patients with hereditary motor-sensory polyneuropathy I. Regidor 1 , L. Cabañes Martínez 1 , G. de Blas 1 , M. del Álamo 2 Hospital Ramón y Cajal, Clinical Neurophysiology, Madrid, Spain; 2 Hospital Ramón y Cajal, Neurosurgery, Madrid, Spain
1
Question: Charcot Marie-Tooth disease (CMT) is an inherited disorder of the peripheral nervous system with many clinical and hereditary variants. Many CMT2 patients are affected by a type of tremor syndrome, very disabling, and which pathophysiology remains unclear. Deep brain stimulation (DBS) has been successfully applied to treat most types of tremors by implanting electrodes in the ventral intermedium nucleus of the thalamus (VIM). Methods: We present two patients with CMT who, during the course of the disease, developed a drug-resistant disabling neuropathic tremor. Genetics, clinical scales and neurophysiologic studies are presented. Due to the lack of response to pharmacological treatment, they were considered good candidates to treatment with DBS of the VIM. Results: Both patients responded positively to stimulation, with a significatively reduction of the disability scales, and with an improvement of their quality of life. Conclusion: DBS of the VIM is an established treatment for tremors of central origin. We presented two cases of tremors with a peripheral cause which responded well to this treatment.
P935 Distinguishing essential tremor from parkinsonian tremor: differences in spatiotemporal parameters in a 3D tremor analysis C. Blahak, T. Sauer, M. Wolf, M.G. Hennerici UniversitaetsMedizin Mannheim, University of Heidelberg, Neurology, Mannheim, Germany Objective: To determine differences in the spatiotemporal characteristics of postural tremor between patients with essential tremor (ET) and patients with Parkinson’s disease (PD). Background: The differential diagnosis of tremor is mainly based on clinical criteria. Electrophysiological studies can be a useful diagnostic tool, but
Abstract P935 – Figure 1
Conclusion: PB spasm is an involuntary and visible dimpling of hypothenar eminence corresponding with an abnormal spontaneous activity of single MUPs and/or myokymia in PB muscle. This spasm could be idiopathic (probably due to compression of superficial ulnar nerve branch in the wrist like an occupational syndrome) or associated with diffuse or focal demyelinating Ulnar nerve injury, isolated or in the context of Demyelinating Neuropathy (Multifocal Motor Neuropathy, Mononeuritis Multiplex with conduction blocks).
P933 Quantification of movement disorders symptoms employing attitude sensors O. Martinez Manzanera, N. Maurits, J.W. Elting University Medical Center Groningen, Neurology, Groningen, Netherlands Question: The diagnosis of movement disorders is a time intensive process in which the patient is interviewed and the symptoms are evaluated. However, even the most common types of movement disorders have a high percentage of misdiagnosis (depending on the clinical context, up to 30-50% for essential tremor [1] and 25% for Parkinson’s disease [2]). To increase diagnostic accuracy, attitude sensors can be placed on the patient during evaluation. They combine different signals to obtain their own orientation. The goal is to use these sensors to quantify characteristic features of the movement disorder (e.g. tremor, bradykinesia, ataxia) and determine the added value to current diagnostic evaluation techniques. Methods: During movement disorders evaluation, sensors are placed on the affected limbs of the patient. A computer model and algorithms have been developed to derive quantitative parameters from instantaneous device orientations resulting in movement speeds, frequencies, joint angles and distances travelled by the limbs. Sensors accuracy is determined by comparison against 3D optical tracking. Also, the possibility to extend the recordings outside the clinic is evaluated. Results: Results obtained from patients with tremor and bradykinetic Parkinson’s patients are compared against clinical evaluation (polymyography and UPDRS). Conclusions: Attitude sensors may have added value for the diagnosis of movement disorders in the clinic and open up the possibility of remote measurements of movement disorder symptoms outside the clinic. References: [1] Jain S. et al. Common misdiagnosis of a common neurological disorder: Arch. Neurol (2006).
S295
[2] Tolosa, E. et al. The diagnosis of Parkinson’s disease. Lancet neurology (2006).
P934 Long term effective thalamic DBS for neuropathic tremor in patients with hereditary motor-sensory polyneuropathy I. Regidor 1 , L. Cabañes Martínez 1 , G. de Blas 1 , M. del Álamo 2 Hospital Ramón y Cajal, Clinical Neurophysiology, Madrid, Spain; 2 Hospital Ramón y Cajal, Neurosurgery, Madrid, Spain
1
Question: Charcot Marie-Tooth disease (CMT) is an inherited disorder of the peripheral nervous system with many clinical and hereditary variants. Many CMT2 patients are affected by a type of tremor syndrome, very disabling, and which pathophysiology remains unclear. Deep brain stimulation (DBS) has been successfully applied to treat most types of tremors by implanting electrodes in the ventral intermedium nucleus of the thalamus (VIM). Methods: We present two patients with CMT who, during the course of the disease, developed a drug-resistant disabling neuropathic tremor. Genetics, clinical scales and neurophysiologic studies are presented. Due to the lack of response to pharmacological treatment, they were considered good candidates to treatment with DBS of the VIM. Results: Both patients responded positively to stimulation, with a significatively reduction of the disability scales, and with an improvement of their quality of life. Conclusion: DBS of the VIM is an established treatment for tremors of central origin. We presented two cases of tremors with a peripheral cause which responded well to this treatment.
P935 Distinguishing essential tremor from parkinsonian tremor: differences in spatiotemporal parameters in a 3D tremor analysis C. Blahak, T. Sauer, M. Wolf, M.G. Hennerici UniversitaetsMedizin Mannheim, University of Heidelberg, Neurology, Mannheim, Germany Objective: To determine differences in the spatiotemporal characteristics of postural tremor between patients with essential tremor (ET) and patients with Parkinson’s disease (PD). Background: The differential diagnosis of tremor is mainly based on clinical criteria. Electrophysiological studies can be a useful diagnostic tool, but
Abstract P935 – Figure 1