Speech and tremor tester : monitoring of neurodegenerative diseases using smartphone technology

One of the most frequently diagnosed neurodegenerative disorders, along with Alzheimer’s disease, is Parkinson’s disease. It is a slowly progressing disease of the central nervous system that affects parts of the brain which are responsible for one’s motor functions. Despite the frequency of its occurrence among the elderly population, there has not yet been established a universal approach towards its certain diagnostics ante mortem. The study presents a pilot experiment regarding the assessment of the usefulness of simultaneous processing and analysis of speech signal and hand tremor accelerations for patient’s screening and monitoring of the progress in healing, using the data acquired with a mid-range Android smartphone. During the study, a mobile device of this kind was used to record the patients of the Department of Neurology, University Hospital of the Jagiellonian University in Kraków and a control group of healthy persons over the age of 50. The samples were then analysed and an attempt towards classification was made using statistical methods and machine learning techniques (PCA, SVM, LDA). It was shown that even for a limited population, the classifier reaches about 85% accuracy. Another topic discussed in the study is the possibility of implementing a fully automated mobile system for the monitoring of the disease’s progression. Propositions of further research were also drawn.Jednym z najczęściej diagnozowanych zaburzeń neurodegeneracyjnych, obok choroby Alzheimera, jest choroba Parkinsona. To wolno postępująca choroba zwyrodnieniowa ośrodkowego układu nerwowego, która zajmuje obszary mózgu odpowiedzialne za motorykę. Pomimo powszechności choroby wśród osób starszych, do tej pory nie została opisana uniwersalna metoda jej pewnego zdiagnozowania. Praca przedstawia pilotażowe badanie dotyczące określenia przydatności i możliwości wykorzystania metod jednoczesnego przetwarzania i analizy sygnału mowy oraz sygnału przyspieszenia drgań kończyny górnej w kontekście badań przesiewowych lub obiektywnego monitorowania postępu leczenia chorób neurodegeneracyjnych, z wykorzystaniem danych pozyskanych za pomocą średniej klasy smartfonu z systemem Android. W ramach badania wykonano za pomocą urządzenia mobilnego nagrania pacjentów Oddziału Neurologii Szpitala Uniwersyteckiego w Krakowie ze zdiagnozowaną chorobą Parkinsona oraz osób zdrowych powyżej 50 roku życia. Próbki poddano analizie i wstępnej klasyfikacji z wykorzystaniem metod statystycznych oraz technik uczenia maszynowego (PCA, SVM, LDA). Pokazano, że skuteczność klasyfikacji już dla niewielkiej populacji sięga około 85%. W pracy omówiono również możliwość implementacji w pełni automatycznego systemu mobilnego monitorowania przebiegu choroby, a także przedstawiono propozycję dalszych badań w tym kierunku

Deep brain stimulation in the treatment of Holmes tremor – A long-term case observation

We present the patient with Holmes tremor secondary to the infarction of thalamus, successfully treated with the deep brain stimulation (DBS) of the area between ventralis oralis anterior and zona incerta for a long time, in whom the severe tremor reappeared after removal of the DBS lead. This is the first presentation of the effective DBS on this location. Our case does not support the hypothesis that the DBS treatment could lead to sustained relief of symptoms after cessation of stimulation

Visual disturbances in patients with Parkinson’s Disease treated with oral medications or deep brain stimulation

Aim of the study. Ophthalmological symptoms are common in patients with Parkinson’s Disease (PD) and can be evaluated by the Visual Impairment in Parkinson’s Disease Questionnaire (VIPD-Q). This study aimed to assess the prevalence of ophthalmological symptoms in PD depending on the type of treatment used i.e. pharmacological or subthalamic nucleus deep brain stimulation (STN-DBS). Material and methods. We performed a cross-sectional study. The data was gathered from a VIPD-Q and from medical records. Patients with PD were divided into two groups based on the type of treatment – pharmacological (control group, CG) (39 patients) or STN-DBS (40 patients). Results. The great majority of patients — 72 (91.1%) — experienced an ophthalmological symptom. The prevalence of three symptoms differed significantly between the groups. A burning sensation or a gritty feeling in the eyes occurred more often in patients in the STN-DBS group (40.0% vs. 15.4%; p = 0.015). On the other hand, the inability to read plain text on a coloured or grey background and problems with rapid changes of light intensity were more common in the CG group (38.5% vs. 15.0%, p = 0.018 and 28.2% vs. 10.0%, p = 0.039, respectively). Conclusions and clinical implications. The prevalence of ophthalmological symptoms in PD is high. Despite significant differences in the three symptoms, the overall prevalence of ophthalmological clinical features was similar in the evaluated groups

Deep brain stimulation in the treatment of Holmes tremor : a long-term case observation

We present the patient with Holmes tremor secondary to the infarction of thalamus, successfully treated with the deep brain stimulation (DBS) of the area between ventralis oralis anterior and zona incerta for a long time, in whom the severe tremor reappeared after removal of the DBS lead. This is the first presentation of the effective DBS on this location. Our case does not support the hypothesis that the DBS treatment could lead to sustained relief of symptoms after cessation of stimulatio

Opposite effects of l-dopa and DBS-STN on saccadic eye movements in advanced Parkinson's disease

Objective To assess the effects of l-dopa and deep brain stimulation of the subthalamic nucleus (DBS-STN) on saccadic eye movements in patients with Parkinson's disease (PD). Methods Visually and internally guided horizontal saccades were evaluated using a saccadometer in 64 patients with advanced PD and 48 healthy controls. Forty-four pharmacologically treated patients were assessed in their “med-off” (OFF) and “med-on” (ON) status, whereas 20 DBS-STN treated patients were assessed in their “med-off, stim-off” (OFF) and “med-off, stim-on” (ON) status. Results In all PD patients the saccades in the OFF status were delayed, slower and smaller (p<0.01) than in controls. In pharmacologically treated patients all studied parameters showed tendency to worsen in the ON status as compared to the OFF status. In contrast, activating DBS-STN showed tendency to improve all studied parameters. Comparison of the studied saccade parameters between the ON status of DBS-STN treated patients, ON status of the pharmacologically treated patients and the controls showed that 73% of these parameters in the DBS-STN treated patients were similar as in the controls. While in the pharmacologically treated patients only 26% of these parameters were similar as in the controls. Conclusion This prospective study comparing the influence of l-dopa and DBS-STN on saccades in advanced PD showed contrasting results between these two treatments; the majority of the studied parameters in patients on DBS-STN were similar as in the controls

KinesioTaping: impact on non-motor symptoms in cervical dystonia patients treated with botulinum toxin injection

Aim of the study. To assess whether combined therapy with botulinum toxin injections (BoNT) and KinesioTaping could be helpful in managing non-motor symptoms (NMS) of cervical dystonia (CD). Material and methods. Seventeen patients with CD were enrolled in this single-centre, prospective, evaluator-blinded, randomised, crossover trial. We compared three forms of treatment: BoNT treatment alone, or combined with KinesioTaping, or combined with ShamTaping. NMS were assessed using the 14-item self-reported questionnaire proposed by Klingelhoefer, the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI). Results. There were no significant differences between the groups concerning mean results of HADS and PSQI scales, or mean total number of NMS after the procedures. The mean change from baseline HADS and PSQI scores, and total number of NMS after the procedure, also did not differ significantly between groups. ShamTaping combined with BoNT significantly increased the prevalence of pain. Conclusions and clinical implications. Our study did not confirm the effectiveness of combined therapy of BoNT and KinesioTaping in the management of NMS in patients with CD. Due to a potential negative effect of improper taping on pain in CD, patients with CD should only experience KinesioTaping as an adjunctive therapy, and if it is performed by a trained, experienced physiotherapist

Opposite effects of l-dopa and DBS-STN on saccadic eye movements in advanced Parkinson's disease

Objective: To assess the effects of L-dopa and deep brain stimulation of the subthalamic nucleus (DBS-STN) on saccadic eye movements in patients with Parkinson's disease (PD). Methods: Visually and internally guided horizontal saccades were evaluated using a saccadometer in 64 patients with advanced PD and 48 healthy controls. Forty-four pharmacologically treated patients were assessed in their ‘‘med-off’’ (OFF) and ‘‘med-on’’ (ON) status, whereas 20 DBS-STN treated patients were assessed in their ‘‘med-off, stim-off’’ (OFF) and ‘‘med-off, stim-on’’ (ON) status. Results: In all PD patients the saccades in the OFF status were delayed, slower and smaller ( p < 0.01) than in controls. In pharmacologically treated patients all studied parameters showed tendency to worsen in the ON status as compared to the OFF status. In contrast, activating DBS-STN showed tendency to improve all studied parameters. Comparison of the studied saccade parameters between the ON status of DBS-STN treated patients, ON status of the pharmacologically treated patients and the controls showed that 73% of these parameters in the DBS-STN treated patients were similar as in the controls. While in the pharmacologically treated patients only 26% of these parameters were similar as in the controls. Conclusion: This prospective study comparing the influence of L-dopa and DBS-STN on saccades in advanced PD showed contrasting results between these two treatments; the majority of the studied parameters in patients on DBS-STN were similar as in the controls

Rekomendacje interdyscyplinarnej grupy ekspertów w zakresie kompleksowego i długofalowego leczenia spastyczności toksyną botulinową typu A

Skuteczność i bezpieczeństwo leczenia spastyczności iniekcjami toksyny botulinowej są dobrze udokumentowane. Terapia ta, objęta w Polsce programem lekowym, należy dziś do standardu w leczeniu powikłań ruchowych po udarze mózgu. Autorzy niniej­szych rekomendacji przedstawiają w interdyscyplinarny sposób poglądy na wybrane zagadnienia: leczenie innych etiologicznie form spastyczności, skuteczność długofalowego podawania toksyny botulinowej, bezpieczeństwo stosowania większych dawek leku w kontekście jednoczesnego leczenia spastyczności zarówno kończyny górnej, jak i dolnej, różnice w dawkowaniu poszczególnych postaci leku, zalecenia związane z prowadzeniem rehabilitacji w trakcie terapii, rekomendacje międzynarodowych i narodowych grup ekspertów w tym zakresie

Botulinum toxin type-A preparations are not the same medications — basic science (Part 1)

Botulinum neurotoxin type A (BoNT/A) formulations are widely used in clinical practice. Although they share a common mechanism of action resulting in presynaptic block in acetylocholine release, their structure and pharmacological properties demonstrate some similarities and many differences. Bioequivalence has been discussed since the onset of the clinical use of BoNT/A. In this review, we provide an update on the studies and compare the molecular structure, mechanisms of action, diffusion and spread, as well as immunogenicity and dose equivalence of onabotulinumtoxinA, abobotulinumtoxinA and incobotulinumtoxinA