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A Smart Device System to Identify New Phenotypical Characteristics in Movement Disorders.

ABSTRACT: Parkinson's disease and Essential Tremor are two of the most common movement disorders and are still associated with high rates of misdiagnosis. Collected data by technology-based objective measures (TOMs) has the potential to provide new promising and highly accurate movement data for a better understanding of phenotypical characteristics and diagnostic support. A technology-based system called Smart Device System (SDS) is going to be implemented for multi-modal high-resolution acceleration measurement of patients with PD or ET within a clinical setting. The 2-year prospective observational study is conducted to identify new phenotypical biomarkers and train an Artificial Intelligence System. The SDS is going to be integrated and tested within a 20-min assessment including smartphone-based questionnaires, two smartwatches at both wrists and tablet-based Archimedean spirals drawing for deeper tremor-analyses. The electronic questionnaires will cover data on medication, family history and non-motor symptoms. In this paper, we describe the steps for this novel technology-utilizing examination, the principal steps for data analyses and the targeted performances of the system. Future work considers integration with Deep Brain Stimulation, dissemination into further sites and patient's home setting as well as integration with further data sources as neuroimaging and biobanks. Study Registration ID on ClinicalTrials.gov: NCT03638479.

SUBMITTER: Varghese J

PROVIDER: S-EPMC6363699 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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A Smart Device System to Identify New Phenotypical Characteristics in Movement Disorders.

Varghese Julian J Niewöhner Stephan S Soto-Rey Iñaki I Schipmann-Miletić Stephanie S Warneke Nils N Warnecke Tobias T Dugas Martin M

Frontiers in neurology 20190130

Parkinson's disease and Essential Tremor are two of the most common movement disorders and are still associated with high rates of misdiagnosis. Collected data by technology-based objective measures (TOMs) has the potential to provide new promising and highly accurate movement data for a better understanding of phenotypical characteristics and diagnostic support. A technology-based system called Smart Device System (SDS) is going to be implemented for multi-modal high-resolution acceleration mea ...[more]

PMID: 30761078

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Project description:Background: Functional (psychogenic) movement disorders often have distinguishable clinical features in the orofacial region. Tonic mandibular deviation accompanying ipsilateral downward and lateral lip pulling is the most common phenotype seen in patients with facial functional movement disorders. However, functional movement disorders in the stomatognathic system are underrecognized. Objective: This study aimed to evaluate clinical characteristics and phenomenology in patients with functional movement disorders in the stomatognathic system. Methods: Ten-item inclusion criteria (point range: 0-10) for functional movement disorders in the stomatognathic system was produced, based on previously established criteria for functional movement disorders and general signs of functional facial dystonia, to determine subject inclusion. The criteria included inconsistency, incongruence, and paroxysm in symptoms; rapid onset; distractibility; suggestibility; static course; spreading to multiple sites; spontaneous remission; and lack of sensory tricks. Fifty-eight patients [42 women (72.4%), 16 men (27.6%); mean age: 46.2 years] scored over 7 points on the criteria and were included in further analyses. Characteristic features, including the pattern and site of abnormal movements, were assessed in clinical examination. Results: Frequent items in the scale were inconsistent symptoms (93.1%), incongruous symptoms (91.4%), spreading to multiple sites (89.7%), paroxysmal symptoms (86.2%), and lack of sensory tricks (81%). Sixty percent of patients exhibited a pattern resembling dystonia. Some patients had a combination of organic and functional disease. Common involuntary movements included jaw deviation (74.1%), jaw closing (50%), lip pulling (34.5%), and tongue movement (31%). A functional dystonia phenotype (unilateral lower lip pulling and jaw deviation) was observed in 26 patients (44.8%). Characteristic features of functional stomatognathic movement disorders were rapidly repeating mandibular (lateral or tapping) and tongue movements (27.6%), which fluctuated in speed and direction. Conclusion: In 58 patients with functional movement disorders in the stomatognathic system, the functional dystonia phenotype was observed in 44.8%. Furthermore, 27.6% of patients showed the most characteristic type of functional stomatognathic movement disorders: very fast repeated jaw and/or lingual movements.

Project description:IntroductionMovement disorders are increasingly described in hospitalized and milder cases of SARS-CoV-2 infection, despite a very low prevalence compared to the total patients.MethodsWe reviewed the scientific literature published in English, spanning from the initial descriptions of COVID-19 until January 25, 2021, in the PubMed/MEDLINE database.ResultsWe identified 93 new-onset movement disorders cases (44 articles) from 200 papers screened in the database or reference lists. Myoclonus was present in 63.4% (n = 59), ataxia in 38.7% (n = 36), action/postural tremor in 10.8% (n = 10), rigid-akinetic syndrome in 5.38% (n = 5), oculomotor abnormalities in 20.4% (n = 19), catatonia in 2.1% (n = 2), dystonia in 1.1% (n = 1), chorea in 1.1% (n = 1), functional (psychogenic) movement disorders in 3.2% (n = 3) of the reported COVID-19 cases with any movement disorder. Encephalopathy was a common association (n = 37, 39.78%).DiscussionComprehensive neurophysiological, clinical, and neuroimaging descriptions of movement disorders in the setting of SARS-CoV-2 infection are still lacking, and their pathophysiology may be related to inflammatory, postinfectious, or even indirect mechanisms not specific to SARS-CoV-2, such as ischemic-hypoxic brain insults, drug effects, sepsis, kidney failure. Cortical/subcortical myoclonus, which the cited secondary mechanisms can largely cause, seems to be the most common hyperkinetic abnormal movement, and it might occur in association with encephalopathy and ataxia.ConclusionThis brief review contributes to the clinical description of SARS-CoV-2 potential neurological manifestations, assisting clinical neurologists in identifying features of these uncommon syndromes as a part of COVID-19 symptomatology.Highlights- Movement disorders are probably uncommon neurological manifestations in SARS-CoV-2 infection;- Myoclonus is the most reported movement disorder associated with COVID-19, its clinical complications or pharmacological management;- The pathophysiology is yet not well-understood but can include systemic inflammation, autoimmune mechanisms, or hypoxia.

Project description:BackgroundMultiple system atrophy (MSA) is a rare neurodegenerative disorder, and its parkinsonian variant can be difficult to delineate from Parkinson's disease (PD). Despite laryngeal dysfunction being associated with decreased life expectancy and quality of life, systematic assessments of laryngeal dysfunction in large cohorts are missing.ObjectivesThe objective of this study was to systematically assess laryngeal dysfunction in MSA and PD and identify laryngeal symptoms that allow for differentiating MSA from PD.MethodsPatients with probable or possible MSA underwent flexible endoscopic evaluation of swallowing performing a systematic task protocol. Findings were compared with an age-matched PD cohort.ResultsA total of 57 patients with MSA (64 [59-71] years; 35 women) were included, and task assessments during endoscopic examination compared with 57 patients with PD (67 [60-73]; 28 women). Patients with MSA had a shorter disease duration (4 [3-5] years vs 7 [5-10]; P < 0.0001) and higher disease severity (Hoehn & Yahr stage 4 [3-4] vs 3 [2-4]; P < 0.0001). Of the patients with MSA, 43.9% showed clinically overt laryngeal dysfunction with inspiratory stridor. During endoscopic task assessment, however, 93% of patients with MSA demonstrated laryngeal dysfunction in contrast with only 1.8% of patients with PD (P < 0.0001). Irregular arytenoid cartilages movements were present in 91.2% of patients with MSA, but in no patients with PD (P < 0.0001). Further findings included vocal fold motion impairment (75.4%), paradoxical vocal fold motion (33.3%), and vocal fold fixation (19.3%). One patient with PD showed vocal fold motion impairment.ConclusionLaryngeal movement disorders are highly prevalent in patients with MSA when assessed by a specific task protocol despite the lack of overt clinical symptoms. Our data suggest that irregular arytenoid cartilage movements could be used as a clinical marker to delineate MSA from PD with a specificity of 1.0 and sensitivity 0.9. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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A Smart Device System to Identify New Phenotypical Characteristics in Movement Disorders.

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A Smart Device System to Identify New Phenotypical Characteristics in Movement Disorders.

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