Electrical stimulation for the suppression of pathological tremor

Maneski, Lana Popović; Jorgovanović, Nikola; Ilić, Vojin; Došen, Strahinja; Keller, Thierry; Popović, Mirjana; Popović, Dejan B.

doi:10.1007/s11517-011-0803-6

Cited by 106 publications

(47 citation statements)

References 17 publications

(25 reference statements)

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“…Such treatments, however, can be invasive, expensive, and may not produce effective, long-lasting tremor suppression tremor for all patients. As a potential alternative, studies have suggested the use of external devices to suppress tremor by mechanical loading (Pledgie et al, 2000; Rocon et al, 2007) or electrical stimulation (Javidan et al, 1992; Prochazka et al, 1992; Gillard et al, 1999; Popović Maneski et al, 2011; Gallego et al, 2013; Bó et al, 2014; Dosen et al, 2015). Although the efficacy of both methodologies has been proven, electrical stimulation arguably allows for a more compact and comfortable implementation.…”

Section: Introductionmentioning

confidence: 99%

Electrical Stimulation of Afferent Pathways for the Suppression of Pathological Tremor

et al. 2017

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Pathological tremors are involuntary oscillatory movements which cannot be fully attenuated using conventional treatments. For this reason, several studies have investigated the use of neuromuscular electrical stimulation for tremor suppression. In a recent study, however, we found that electrical stimulation below the motor threshold also suppressed tremor, indicating involvement of afferent pathways. In this study, we further explored this possibility by systematically investigating how tremor suppression by afferent stimulation depends on the stimulation settings. In this way, we aimed at identifying the optimal stimulation strategy, as well as to elucidate the underlying physiological mechanisms of tremor suppression. Stimulation strategies varying the stimulation intensity and pulse timing were tested in nine tremor patients using either intramuscular or surface stimulation. Significant tremor suppression was observed in six patients (tremor suppression > 75% was observed in three patients) and the average optimal suppression level observed across all subjects was 52%. The efficiency for each stimulation setting, however, varied substantially across patients and it was not possible to identify a single set of stimulation parameters that yielded positive results in all patients. For example, tremor suppression was achieved both with stimulation delivered in an out-of-phase pattern with respect to the tremor, and with random timing of the stimulation. Overall, these results indicate that low-current stimulation of afferent fibers is a promising approach for tremor suppression, but that further research is required to identify how the effect can be maximized in the individual patient.

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Section: Introductionmentioning

confidence: 99%

Electrical Stimulation of Afferent Pathways for the Suppression of Pathological Tremor

et al. 2017

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“…Numerous methods with different sensors, including EMG [2,15,17,25,44], spirograms [7,37], and gyroscopes [23,32,38], have been used to quantify tremor. Accelerometers have been applied outside the operating room (OR) for a wide variety of purposes, e.g., to characterize pathological tremor [8,13], to compare it with physiological tremor [20,35,36], and to evaluate the severity and evolution of tremor [28,29,40] and the tremor-alleviating effect of drugs or DBS [22,36,47].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative acceleration measurements to quantify improvement in tremor during deep brain stimulation surgery

Shah

Coste

Lemaire

et al. 2016

Med Biol Eng Comput

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Intraoperative acceleration measurements to quantify improvement in tremor during deep brain stimulation surgery. Medical and Biological Engineering and Computing, Springer Verlag, 2017, 55 (5) AbstractDeep brain stimulation (DBS) surgery is extensively used in the treatment of movement disorders. Nevertheless, methods to evaluate the clinical response during intraoperative stimulation tests to identify the optimal position for the implantation of the chronic DBS lead remain subjective. In this paper, we describe a new, versatile method for quantitative intraoperative evaluation of improvement in tremor with an acceleration sensor that is mounted on the patient's wrist during surgery. At each anatomical test position, the improvement in tremor compared to the initial tremor is estimated on the basis of extracted outcome measures. This method was tested on 15 tremor patients undergoing DBS surgery in two centers. Data from 359 stimulation tests were acquired. Our results suggest that accelerometric evaluation detects tremor changes more sensitively than subjective visual ratings. The effective stimulation current amplitudes identified from the quantitative data (1.1 ± 0.8 mA) are lower than those identified by visual evaluation (1.7 ± 0.8 mA) for similar improvement in tremor. Additionally, if these data had been used to choose the chronic implant position of the DBS lead, 15 of the 26 choices would have been different. These results show that our method of accelerometric evaluation can potentially improve DBS targeting.

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“…To verify amplifiers characteristics in the presence of the stimulation artifact, we used monophasic and biphasic stimulation pulses by the INTFES V1 electronic stimulator [22] and monophasic compensated pulse by the TremUNA stimulator [23].…”

Section: Testing Of the Novel Fast Recovery Emg Amplifiermentioning

confidence: 99%

A novel fully fast recovery EMG amplifier for the control of neural prosthesis

et al. 2016

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Original scientific article This paper presents a novel EMG (electromyography) fast recovery amplifier, which can be used as a neural prosthesis control interface. The basis of the proposed circuit is standard three op-amp amplifier with integrator in the negative feed-back loop of the differential amplifier. The Standard three op-amp instrumentation amplifier has been modified by introducing analog delay line between the first stage (differential input -differential output amplifier) and the second stage (differential amplifier). The main purpose of the analog delay line is to delay EMG signal and the stimulus artifact between the first and the second stage. It is shown that by introducing a delay line in the standard three op-amp instrumentation amplifier, stimulus artifact can be detected before it appears at the output of the amplifier. Thus the control circuits of the amplifier have enough time to disable the integrator in the differential amplifier, and prevent charge accumulation in the integrators capacitor. It is also shown that this configuration of the EMG amplifier has ultrafast recovery time, so it can be used as a control interface of the neural prosthesis. Keywords: analog delay line; EMG Amplifier; instrumentation amplifier; neural prosthesis Novo u potpunosti brzo oporavljivo EMG pojačalo za kontrolu neuronskih protezaIzvorni znanstveni članak Ovaj članak predstavlja novo EMG (elektromiografsko) brzo oporavljivo pojačalo, koje se može koristiti kao sučelje za kontrolu neuronskih proteza. Osnova predloženog električnog kruga je standardno instrumentacijsko pojačalo implementirano pomoću tri operacijska pojačala s integratorom u negativnoj povratnoj petlji diferencijalnog pojačala. Standardno instrumentacijsko pojačalo s tri operacijska pojačala je modificirano uvođenjem analogne linije za kašnjenje između prvog stupnja (diferencijalni ulaz -diferencijalno izlazno pojačalo) i drugog stupnja (diferencijalno pojačalo). Glavna svrha analogne linije za kašnjenje je kašnjenje EMG signala i poticaj artefakta između prvog i drugog stupnja. Uvođenjem linije za kašnjenje u standardnom instrumentacijskom pojačalu s tri operacijska pojačala, pokazano je da se poticaj artefakta može otkriti prije nego što se pojavi na izlazu iz pojačala. Na taj način kontrolni sklopovi pojačala imaju dovoljno vremena da onemoguće integrator u diferencijalnom pojačalu, i spriječe nakupljanje naboja u kondenzatoru integratora. Također je pokazano da ova konfiguracija EMG pojačala ima ultra brzo vrijeme oporavka, tako da se može koristiti kao sučelje za kontrolu neuronskih proteza. Ključne riječi: analogna linija za kašnjenje; EMG pojačalo; instrumentacijsko pojačalo; neuronske proteze

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Electrical stimulation for the suppression of pathological tremor

Cited by 106 publications

References 17 publications

Electrical Stimulation of Afferent Pathways for the Suppression of Pathological Tremor

Electrical Stimulation of Afferent Pathways for the Suppression of Pathological Tremor

Intraoperative acceleration measurements to quantify improvement in tremor during deep brain stimulation surgery

A novel fully fast recovery EMG amplifier for the control of neural prosthesis

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