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

Reversing dabigatran effect with idarucizumab to enable intravenous thrombolysis in patients with acute ischaemic stroke — a single centre experience

Introduction. Our study analysed the safety and effectiveness of idarucizumab in enabling intravenous thrombolysis (IVT) in dabigatran-treated patients with acute ischaemic stroke (AIS). Clinical rationale for the study. New oral anticoagulants (NOAC), including dabigatran, are the first-choice treatment option for preventing ischaemic stroke in patients with non-valvular atrial fibrillation (AF). However, a significant percentage of AF patients develops AIS despite NOAC treatment. According to current guidelines, treatment with IVT is contraindicated in patients who have received NOAC within the last 48 hours. Idarucizumab is a fragment of a monoclonal antibody that reverses the anticoagulation effect of dabigatran. The latest research shows that it can enable safe and successful IVT in patients with recent dabigatran intake, but more data is needed to confirm the safety and effectiveness of such treatment. Material and methods. Our study included dabigatran-treated patients who received idarucizumab to allow AIS treatment with IVT in the University Hospital in Kraków (Poland) from December 2018 to June 2023. We gathered data on their past medical history, stroke severity, course of treatment and outcomes as defined by modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores at discharge. A good functional outcome was defined as mRS 0–2 points at discharge. Results. This observational study included 19 patients (13 male and six female) with a median age of 74 (IQR = 13) years. In all patients (100%), the reason for dabigatran treatment was AF. A good functional outcome after treatment (mRS 0–2) was achieved in 68.4% of patients, but mRS was already ≥ 3 points before stroke onset in three (15.8%) patients. Haemorrhagic transformation of stroke occurred in three (15.8%) patients, including symptomatic intracranial haemorrhage in two (10.5%). The mortality rate was 5.3%. Conclusions and clinical implications. Our study results are in line with previous research on this topic, showing that IVT after idarucizumab can be successfully administered and is reasonably safe in dabigatran-treated patients with AIS

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

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

4C Mortality Score correlates with in-hospital functional outcome after COVID-19-associated ischaemic stroke

Aim of the study. The 4C Mortality Score was created to predict mortality in hospitalised patients with COVID-19 and has to date been evaluated only in respiratory system disorders. The aim of this study was to investigate its application in patients with COVID-19-associated acute ischaemic stroke (AIS).Clinical rationale for study. COVID-19 is a risk factor for AIS. COVID-19-associated AIS results in higher mortality and worse functional outcome. Predictors of functional outcome in COVID-19-associated AIS are required.Materials and methods. This was a retrospective observational study of patients with AIS hospitalised in seven neurological wards in Małopolska Voivodship (Poland) between August and December 2020. We gathered data concerning the patients’ age, sex, presence of cardiovascular risk factors, type of treatment received, and the presence of stroke-associated infections (including pneumonia, urinary tract infection and infection of unknown source). We calculated 4C Mortality Score at stroke onset, and investigated whether there was a correlation with neurological deficit measured using the National Health Institute Stroke Scale (NIHSS) and functional outcome assessed using the modified Rankin Scale (mRS) at discharge.Results. The study included 52 patients with COVID-19-associated AIS. The 4C Mortality Score at stroke onset correlated with mRS (rs = 0.565, p < 0.01) at discharge. There was also a statistically significant difference in the mean 4C Mortality Score between patients who died and patients who survived the stroke (13.08 ± 2.71 vs. 9.85 ± 3.47, p = 0.04).Conclusions and clinical implications. 4C Mortality Score predicts functional outcome at discharge in COVID-19-associated AIS patients

Neurological symptoms in hospitalised patients with COVID-19 and their association with in-hospital mortality

Objectives. To evaluate the spectrum of neurological symptoms in patients with COVID-19 during the first 14 days of hospitalisation and its association with in-hospital mortality. Material and methods. We included 200 patients with RT-PCR-confirmed COVID-19 admitted to University Hospital in Krakow, Poland. In 164 patients, a detailed questionnaire concerning neurological symptoms and signs was performed prospectively within 14 days of hospitalisation. In the remaining 36 patients, such questionnaires were completed retrospectively based on daily observations in the Department of Neurology. Results. During hospitalisation, 169 patients (84.5%) experienced neurological symptoms; the most common were: fatigue (62.5%), decreased mood (45.5%), myalgia (43.5%), and muscle weakness (42.5%). Patients who died during hospitalisation compared to the remainder were older (79 [70.5–88.5] vs. 63.5 [51–77] years, p = 0.001), and more often had decreased level of consciousness (50.0% vs. 9.3%, p < 0.001), delirium (33.3% vs. 4.4%, p < 0.001), arterial hypotension (50.0% vs. 19.6%, p = 0.005) or stroke during (18.8% vs. 3.3%, p = 0.026) or before hospitalisation (50.0% vs. 7.1, p < 0.001), whereas those who survived more often suffered from headache (42.1% vs. 0%, p = 0.012) or decreased mood (51.7% vs. 0%, p = 0.003). Conclusions. Most hospitalised patients with COVID-19 experience neurological symptoms. Decreased level of consciousness, delirium, arterial hypotension, and stroke during or before hospitalisation increase the risk of in-hospital mortality