New advanced wireless technologies for objective monitoring of motor symptoms in parkinson's disease

Edition of a Research topic of Frontiers in Neurology with 12 reviewed and accepted original papersPeer ReviewedPostprint (published version

Multisite recording of extracellular potentials produced by microchannel-confined neurons in-vitro

Towards establishing electrical interfaces with patterned in vitro neurons, we have previously described the fabrication of hybrid elastomer-glass devices polymer-on-multielectrode array technology and obtained single-electrode recordings of extracellular potentials from confined neurons (Claverol-Tinturé et al., 2005). Here, we demonstrate the feasibility of spatially localized multisite recordings from individual microchannel-guided neurites extending from microwell-confined somas with good signal-to-noise ratios (20 dB) and spike magnitudes of up to 300 μV. Single-cell current source density (scCSD) analysis of the spatio-temporal patterns of membrane currents along individual processes is illustrated.Peer Reviewe

Enhancing FoG detection by means of postural context using a waist accelerometer

Postprint (published version

Home detection of freezing of gait using Support Vector Machines through a single waist-worn triaxial accelerometer

Among Parkinson’s disease (PD) symptoms, freezing of gait (FoG) is one of the most debilitating. To assess FoG, current clinical practice mostly employs repeated evaluations over weeks and months based on questionnaires, which may not accurately map the severity of this symptom. The use of a non-invasive system to monitor the activities of daily living (ADL) and the PD symptoms experienced by patients throughout the day could provide a more accurate and objective evaluation of FoG in order to better understand the evolution of the disease and allow for a more informed decision-making process in making adjustments to the patient’s treatment plan. This paper presents a new algorithm to detect FoG with a machine learning approach based on Support Vector Machines (SVM) and a single tri-axial accelerometer worn at the waist. The method is evaluated through the acceleration signals in an outpatient setting gathered from 21 PD patients at their home and evaluated under two different conditions: first, a generic model is tested by using a leave-one-out approach and, second, a personalised model that also uses part of the dataset from each patient. Results show a significant improvement in the accuracy of the personalised model compared to the generic model, showing enhancement in the specificity and sensitivity geometric mean (GM) of 7.2%. Furthermore, the SVM approach adopted has been compared to the most comprehensive FoG detection method currently in use (referred to as MBFA in this paper). Results of our novel generic method provide an enhancement of 11.2% in the GM compared to the MBFA generic model and, in the case of the personalised model, a 10% of improvement with respect to the MBFA personalised model. Thus, our results show that a machine learning approach can be used to monitor FoG during the daily life of PD patients and, furthermore, personalised models for FoG detection can be used to improve monitoring accuracy.Peer ReviewedPostprint (published version

Analyzing human gait and posture by combining feature selection and kernel methods

This paper evaluates a set of computational algorithms for the automatic estimation of human postures and gait properties from signals provided by an inertial body sensor. The use of a single sensor device imposes limitations for the automatic estimation of relevant properties, like step length and gait velocity, as well as for the detection of standard postures like sitting or standing. Moreover, the exact location and orientation of the sensor is also a common restriction that is relaxed in this study. Based on accelerations provided by a sensor, known as the `9 2', three approaches are presented extracting kinematic information from the user motion and posture. Firstly, a two-phases procedure implementing feature extraction and Support Vector Machine based classi cation for daily living activity monitoring is presented. Secondly, Support Vector Regression is applied on heuristically extracted features for the automatic computation of spatiotemporal properties during gait. Finally, sensor information is interpreted as an observation of a particular trajectory of the human gait dynamical system, from which a reconstruction space is obtained, and then transformed using standard principal components analysis, nally Support Vector Regression is used for prediction. Daily living Activities are detected and spatiotemporal parameters of human gait are estimated using methods sharing a common structure based on feature extraction and kernel methods. The approaches presented are susceptible to be used for medical purposes.Peer ReviewedPreprin

Posture transition identification on PD patients through a SVM-based technique and a single waist-worn accelerometer

Identification of activities of daily living is essential in order to evaluate the quality of life both in the elderly and patients with mobility problems. Posture transitions (PT) are one of the most mechanically demanding activities in daily life and,thus, they can lead to falls in patients with mobility problems. This paper deals with PT recognition in Parkinson’s Disease (PD) patients by means of a triaxial accelerometer situated between the anterior and the left lateral part of the waist. Since sensor’s orientation is susceptible to change during long monitoring periods, a hierarchical structure of classifiers is proposed in order to identify PT while allowing such orientation changes. Results are presented based on signals obtained from 20 PD patients and 67 healthy people who wore an inertial sensor on different positions among the anterior and the left lateral part of the waist. The algorithm has been compared to a previous approach in which only the anterior-lateral location was analyzed improving the sensitivity while preserving specificity. Moreover, different supervised machine l earning techniques have been evaluated in distinguishing PT. Results show that the location of the sensor slightly affects method’s performance and, furthermore, PD motor state does not alter its accuracy.Peer ReviewedPostprint (author’s final draft

A heterogeneous database for movement knowledge extraction in Parkinson's disease

This paper presents the design and methodology used to create a heterogeneous database for knowledge movement extraction in Parkinson's Disease. This database is being constructed as part of REM- PARK project and is composed of movement measurements acquired from inertial sensors, standard medical scales as Uni ed Parkinson's Disease Rating Scale, and other information obtained from 90 Parkinson's Disease patients. The signals obtained will be used to create movement disorder detection algorithms using supervised learning techniques. The different sources of information and the need of labelled data pose many challenges which the methodology described in this paper addresses. Some preliminary data obtained are presented.Postprint (published version

REMPARK system assessment: Main results

Parkinson's Disease (PD) is a neurodegenerative disorder that manifests with motor and non-motor symptoms. PD treatment is symptomatic and tries to alleviate the associated symptoms through an adjustment of the medication. As the disease is evolving and this evolution is patient specific, it could be very difficult to properly manage the disease. The current available technology (electronics, communication, computing, etc.), correctly combined with wearables, can be of great use for obtaining and processing useful information for both clinicians and patients allowing them to become actively involved in their condition. Parkinson's Disease Management through ICT: The REMPARK Approach presents the work done, main results and conclusions of the REMPARK project (2011 - 2015) funded by the European Union under contract FP7-ICT-2011-7-287677. REMPARK system was proposed and developed as a real Personal Health Device for the Remote and Autonomous Management of Parkinson's Disease, composed of different levels of interaction with the patient, clinician and carers, and integrating a set of interconnected sub-systems: sensor, auditory cueing, Smartphone and server. The sensor subsystem, using embedded algorithmics, is able to detect the motor symptoms associated with PD in real time. This information, sent through the Smartphone to the REMPARK server, is used for an efficient management of the disease. Implementation of REMPARK will increase the independence and Quality of Life of patients; and improve their disease management, treatment and rehabilitation.Peer ReviewedPostprint (published version

A “HOLTER” for Parkinson's disease: validation of the ability to detect on-off states using the REMPARK system

The treatment of Parkinson's disease (PD) with levodopa is very effective. However, over time, motor complications (MCs) appear, restricting the patient from leading a normal life. One of the most disabling MCs is ON-OFF fluctuations. Gathering accurate information about the clinical status of the patient is essential for planning treatment and assessing its effect. Systems such as the REMPARK system, capable of accurately and reliably monitoring ON-OFF fluctuations, are of great interest. Objective To analyze the ability of the REMPARK System to detect ON-OFF fluctuations. Methods Forty-one patients with moderate to severe idiopathic PD were recruited according to the UK Parkinson's Disease Society Brain Bank criteria. Patients with motor fluctuations, freezing of gait and/or dyskinesia and who were able to walk unassisted in the OFF phase, were included in the study. Patients wore the REMPARK System for 3 days and completed a diary of their motor state once every hour. Results The record obtained by the REMPARK System, compared with patient-completed diaries, demonstrated 97% sensitivity in detecting OFF states and 88% specificity (i.e., accuracy in detecting ON states). Conclusion The REMPARK System detects an accurate evaluation of ON-OFF fluctuations in PD; this technology paves the way for an optimisation of the symptomatic control of PD motor symptoms as well as an accurate assessment of medication efficacy.Peer ReviewedPostprint (published version

Seroprevalence of SARS-CoV-2 in a Cohort of Patients with Multiple Sclerosis under Disease-Modifying Therapies

Background: Disease-modifying therapies (DMTs) used to treat multiple sclerosis (MS) alter the immune system and therefore increase the risk of infection. There is growing concern about the impact of COVID-19 on patients with MS (pwMS), especially those treated with DMTs. Methods: This is a single-center prospective observational study based on data from the Esclerosis Múltiple y COVID-19 (EMCOVID-19) study. Demographic characteristics, MS history, laboratory data and SARS-CoV-2 serology, and symptoms of COVID-19 in pwMS treated with any DTM were extracted. The relationship among demographics, MS status, DMT, and COVID-19 was evaluated. Results: A total of 259 pwMS were included. The administration of interferon was significantly associated with the presence of SARS-CoV-2 antibodies (26.4% vs. 10.7%, p = 0.006). Although patients taking interferon were significantly older (49.1 vs. 43.5, p = 0.003), the association of interferon with the presence of SARS-CoV-2 antibodies was still significant in the multivariate analysis (OR 2.99 (1.38; 6.36), p = 0.006). Conclusions: According to our data, pwMS present a higher risk of COVID-19 infection compared with results obtained from the general population. There is no evidence of a worse COVID-19 outcome in pwMS. DMTs did not significantly change the frequency of COVID-19, except for interferon; however, these findings must be interpreted with caution given the small sample of pwMS taking each DMT