Tremor rating scales and laboratory tools for assessing tremor

Elble, Rodger J.; Ondo, William G.

doi:10.1016/j.jns.2022.120202

Cited by 22 publications

(13 citation statements)

References 112 publications

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“…It is expected that, over time, the use of objective measurement tools will be preferred by physicians as an addition to the internationally standardized clinical scales that are currently used to assess the course of PD symptoms [41]. As stated by Elble and Ondo, transducers, such as accelerometers, can complement clinical assessment to quantify tremor severity [42]. The clinical importance of this objective method lies in the reduction of inter-and intra-rater variability, allowing clinicians to rate patients more uniformly.…”

Section: Future Perspectivesmentioning

confidence: 99%

Intraoperative Quantification of MDS-UPDRS Tremor Measurements Using 3D Accelerometry: A Pilot Study

Smid

Elting

Dijk

et al. 2022

JCM

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The most frequently used method for evaluating tremor in Parkinson’s disease (PD) is currently the internationally standardized Movement Disorder Society—Unified PD Rating Scale (MDS-UPDRS). However, the MDS-UPDRS is associated with limitations, such as its inherent subjectivity and reliance on experienced raters. Objective motor measurements using accelerometry may overcome the shortcomings of visually scored scales. Therefore, the current study focuses on translating the MDS-UPDRS tremor tests into an objective scoring method using 3D accelerometry. An algorithm to measure and classify tremor according to MDS-UPDRS criteria is proposed. For this study, 28 PD patients undergoing neurosurgical treatment and 26 healthy control subjects were included. Both groups underwent MDS-UPDRS tests to rate tremor severity, while accelerometric measurements were performed at the index fingers. All measurements were performed in an off-medication state. Quantitative measures were calculated from the 3D acceleration data, such as tremor amplitude and area-under-the-curve of power in the 4–6 Hz range. Agreement between MDS-UPDRS tremor scores and objective accelerometric scores was investigated. The trends were consistent with the logarithmic relationship between tremor amplitude and MDS-UPDRS score reported in previous studies. The accelerometric scores showed a substantial concordance (>69.6%) with the MDS-UPDRS ratings. However, accelerometric kinetic tremor measures poorly associated with the given MDS-UPDRS scores (R2 < 0.3), mainly due to the noise between 4 and 6 Hz found in the healthy controls. This study shows that MDS-UDPRS tremor tests can be translated to objective accelerometric measurements. However, discrepancies were found between accelerometric kinetic tremor measures and MDS-UDPRS ratings. This technology has the potential to reduce rater dependency of MDS-UPDRS measurements and allow more objective intraoperative monitoring of tremor.

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Section: Future Perspectivesmentioning

confidence: 99%

Intraoperative Quantification of MDS-UPDRS Tremor Measurements Using 3D Accelerometry: A Pilot Study

Smid

Elting

Dijk

et al. 2022

JCM

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“…16 Although the minimum clinically important change for TETRAS-PS Item 4 score has not been determined, the minimum detectable change (MDC) for one upper limb is $2.4 points. 17 Sample size was based on 85% power for detecting a three-point difference in the CFB TETRAS-PS Item 4 scores between SAGE-324/BIIB124 and placebo with a standard deviation (SD) of 3.5, assuming a twosided test (α = 0.05) and a nonevaluability rate of 15%.…”

Section: Kinetic (Nct04305275mentioning

confidence: 99%

A Randomized Phase 2 KINETIC Trial Evaluating SAGE‐324/BIIB124 in Individuals with Essential Tremor

Elble,

Ondo,

Lyons

et al. 2024

Movement Disorders

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BackgroundSAGE‐324/BIIB124 is an investigational positive allosteric modulator of GABAA receptors.ObjectiveKINETIC (NCT04305275), a double‐blind, randomized, placebo‐controlled, phase 2 study, evaluated SAGE‐324/BIIB124 in individuals with essential tremor (ET).MethodsIndividuals aged 18 to 80 years were randomly assigned 1:1 to orally receive 60 mg of SAGE‐324/BIIB124 or placebo once daily for 28 days. The primary endpoint was change from baseline in The Essential Tremor Rating Assessment Scale‐Performance Subscale (TETRAS‐PS) Item 4 (upper‐limb tremor) at day 29 with SAGE‐324/BIIB124 versus placebo.ResultsBetween May 2020 and February 2021, 69 U.S. participants were randomly assigned to receive SAGE‐324/BIIB124 (n = 34) or placebo (n = 35). There was a significant reduction from baseline in TETRAS‐PS Item 4 at day 29 with SAGE‐324/BIIB124 versus placebo (least squares mean [standard error]: –2.31 [0.401] vs. –1.24 [0.349], P = 0.0491). The most common treatment‐emergent adverse events included somnolence, dizziness, fatigue, and balance disorder.ConclusionThese results support further development of SAGE‐324/BIIB124 for potential ET treatment. © 2024 Sage Therapeutics, Inc and The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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“…Moreover, the other tremor characteristics (frequency, power, and entropy) carry relevant information that cannot be perceived and discriminated with the naked eye [45]. In this sense, the understanding of the behaviour of these inherent tremor characteristics may contribute to an improved characterisation of tremor, the effect of external inputs on its generating mechanisms, and even its discrimination according to the disorder it is associated with.…”

Section: On Signal Processing Stagesmentioning

confidence: 99%

On the Effect of Vibrotactile Stimulation in Essential Tremor

Cabral,

Lora-Millán,

Pereira

et al. 2024

Healthcare

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(1) Background: Vibrotactile stimulation has been studied for tremor, but there is little evidence for Essential Tremor (ET). (2) Methods: This research employed a dataset from a previous study, with data collected from 18 individuals subjected to four vibratory stimuli. To characterise tremor changes before, during, and after stimuli, time and frequency domain features were estimated from the signals. Correlation and regression analyses verified the relationship between features and clinical tremor scores. (3) Results: Individuals responded differently to vibrotactile stimulation. The 250 Hz stimulus was the only one that reduced tremor amplitude after stimulation. Compared to the baseline, the 250 Hz and random frequency stimulation reduced tremor peak power. The clinical scores and amplitude-based features were highly correlated, yielding accurate regression models (mean squared error of 0.09). (4) Conclusions: The stimulation frequency of 250 Hz has the greatest potential to reduce tremors in ET. The accurate regression model and high correlation between estimated features and clinical scales suggest that prediction models can automatically evaluate and control stimulus-induced tremor. A limitation of this research is the relatively reduced sample size.

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Tremor rating scales and laboratory tools for assessing tremor

Cited by 22 publications

References 112 publications

Intraoperative Quantification of MDS-UPDRS Tremor Measurements Using 3D Accelerometry: A Pilot Study

Intraoperative Quantification of MDS-UPDRS Tremor Measurements Using 3D Accelerometry: A Pilot Study

A Randomized Phase 2 KINETIC Trial Evaluating SAGE‐324/BIIB124 in Individuals with Essential Tremor

On the Effect of Vibrotactile Stimulation in Essential Tremor

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