An Objective Fluctuation Score for Parkinson's Disease

Horne, Malcolm; McGregor, S. Elizabeth; Bergquist, Filip

doi:10.1371/journal.pone.0124522

Cited by 78 publications

(73 citation statements)

References 10 publications

(8 reference statements)

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“…The finding that the median BKS and median DKS closely correlate with the UPDRS III and mAIMS support the contention that the original algorithms can classify motor symptoms as rated by an objective observer [7] and can distinguish between fluctuating and non-fluctuating patients [19]. Thus the mismatch seems more likely to be between the objective and subjective observer.…”

Section: Discussionmentioning

confidence: 57%

Correlation of Quantitative Motor State Assessment Using a Kinetograph and Patient Diaries in Advanced PD: Data from an Observational Study

et al. 2016

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IntroductionEffective management and development of new treatment strategies for response fluctuations in advanced Parkinson’s disease (PD) largely depends on clinical rating instruments such as the PD home diary. The Parkinson’s kinetigraph (PKG) measures movement accelerations and analyzes the spectral power of the low frequencies of the accelerometer data. New algorithms convert each hour of continuous PKG data into one of the three motor categories used in the PD home diary, namely motor Off state and On state with and without dyskinesia.ObjectiveTo compare quantitative motor state assessment in fluctuating PD patients using the PKG with motor state ratings from PD home diaries.MethodsObservational cohort study on 24 in-patients with documented motor fluctuations who completed diaries by rating motor Off, On without dyskinesia, On with dyskinesia, and asleep for every hour for 5 consecutive days. Simultaneously collected PKG data (recorded between 6 am and 10 pm) were analyzed and calibrated to the patient’s individual thresholds for Off and dyskinetic state by novel algorithms classifying the continuous accelerometer data into these motor states for every hour between 6 am and 10 pm.ResultsFrom a total of 2,040 hours, 1,752 hours (87.4%) were available for analyses from calibrated PKG data (7.5% sleeping time and 5.1% unclassified motor state time were excluded from analyses). Distributions of total motor state hours per day measured by PKG showed moderate-to-strong correlation to those assessed by diaries for the different motor states (Pearson’s correlations coefficients: 0.404–0.658), but inter-rating method agreements on the single-hour-level were only low-to-moderate (Cohen’s κ: 0.215–0.324).ConclusionThe PKG has been shown to capture motor fluctuations in patients with advanced PD. The limited correlation of hour-to-hour diary and PKG recordings should be addressed in further studies.

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Section: Discussionmentioning

confidence: 57%

Correlation of Quantitative Motor State Assessment Using a Kinetograph and Patient Diaries in Advanced PD: Data from an Observational Study

et al. 2016

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“…Thus, we collected data in defined medication states: after 12 hour withdrawal of antiparkinsonian medications ("off"), and after a suprathreshold dose of levodopa/carbidopa ("on"). The on-medication state was associated with the expected reduction in subthalamic beta band (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) Hz) activity in each individual case (Figure 3c) and across all 16 subthalamic recordings (p < 0.001, Generalized Estimating Equations (GEE)) (Fig 3d). Thus, acute effects of levodopa observed previously with externalized leads were validated here by wireless data transmission from an implanted device, recorded 2-4 weeks after surgery.…”

Section: Data Characteristics Movement Related Activity and Effect mentioning

confidence: 95%

“…Short term testing using externalized leads has suggested that adaptive DBS could offer improved efficacy 10 and reduced adverse effects 11 compared with standard, continuous DBS. There is a candidate biomarker for bradykinesia identified from acute, peri-operative recordings from externalized leads: the amplitude of beta band (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) Hz) oscillatory activity in basal ganglia field potential recordings 2 . However, cortical biomarkers of parkinsonian motor signs have also been proposed [12][13][14] and it is not known which site (cortical or basal ganglia) is most effective for motor state decoding.…”

Section: Introductionmentioning

confidence: 99%

Chronic wireless streaming of invasive neural recordings at home for circuit discovery and adaptive stimulation

Gilron

Little

Perrone

et al. 2020

Preprint

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Invasive neural recording in humans shows promise for understanding the circuit basis of brain disorders. Most recordings have been done for short durations from externalized brain leads in hospital settings, or from first-generation implantable sensing devices that offer only intermittent brief streaming of time series data. Here we report the first human use of an implantable neural interface for wireless multichannel streaming of field potentials over long periods, with and without simultaneous therapeutic neurostimulation, untethered to receiving devices. Four Parkinson's disease patients streamed bilateral 4-channel motor cortical and basal ganglia field potentials at home for over 500 hours, paired with wearable monitors that behaviorally categorize states of inadequate or excessive movement. Motor state during normal home activities was efficiently decoded using either supervised learning or unsupervised clustering algorithms. This platform supports adaptive deep brain stimulation, and may be widely applicable to brain disorders treatable by invasive neuromodulation.

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“…Currently, none of the available detection systems fulfill all of the criteria defined herein . However, the most advanced systems have begun to generate target parameters that are easy to understand (individual scores) and that have a great potential to complement the information needed to improve therapeutic decisions . Because this review cannot be comprehensive, we include illustrative examples of useful technology‐based systems that assess PD features.…”

Section: Which Pd Features Should Be Prioritized In the Development Omentioning

confidence: 99%

“…Moreover, PD patients with suboptimal (oral) medication compliance are at higher risk of developing exacerbated PD symptoms than are patients who comply, and poor medication compliance is relatively common in PD, especially among young patients with many doses/day and depressed patients . Technology‐based assessment of motor fluctuations has been demonstrated with a simple and easy‐to‐use system, including a proposal for a target range to differentiate between motor and nonmotor fluctuations and a retrospective analysis of the clinical effects of the system …”

Section: Which Pd Features Should Be Prioritized In the Development Omentioning

confidence: 99%

A clinical view on the development of technology-based tools in managing Parkinson's disease

2016

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Recently, quantitative, objective, and easy-to-use technology-based tools that can assess PD features over long time periods have been developed and generate clinically relevant and comparable patient information. Herein, we present a clinician's view on technological developments that have the potential to revolutionize clinical management concepts in PD. According to prominent examples in clinical medicine (e.g., blood glycosylated hemoglobin and blood pressure), we argue that the consideration of technology-based assessment in the clinical management of PD must be based on specific assumptions: (1) It provides a valid and accurate parameter of a clinically relevant feature of the disease; (2) there is confirmed evidence that the parameter has an ecologically relevant effect on the specific clinical application; (3) a target range can be defined wherein the parameter reflects the adequate treatment response; and (4) implementation is simple to allow repetitive use. Currently, there are no technology-based tools available that fulfil all these assumptions; however, assessments of akinesia, dyskinesia, motor fluctuations, physical inactivity, gait impairment, and postural instability seem relatively close to the specifications described. An iterative process of integration is recommended to bring technology-based tools into clinical practice. © 2016 International Parkinson and Movement Disorder Society.

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An Objective Fluctuation Score for Parkinson's Disease

Cited by 78 publications

References 10 publications

Correlation of Quantitative Motor State Assessment Using a Kinetograph and Patient Diaries in Advanced PD: Data from an Observational Study

Correlation of Quantitative Motor State Assessment Using a Kinetograph and Patient Diaries in Advanced PD: Data from an Observational Study

Chronic wireless streaming of invasive neural recordings at home for circuit discovery and adaptive stimulation

A clinical view on the development of technology-based tools in managing Parkinson's disease

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