Subthalamic low beta bursts differ in Parkinson's disease phenotypes.

OBJECTIVE: Parkinson's disease (PD) patients may be categorized into tremor-dominant (TD) and postural-instability and gait disorder (PIGD) motor phenotypes, but the dynamical aspects of subthalamic nucleus local field potentials (STN-LFP) and the neural correlates of this phenotypical classification remain unclear. METHODS: 35 STN-LFP (20 PIGD and 15 TD) were investigated through continuous wavelet transform and machine-learning-based methods. The beta oscillation - the main band associated with motor impairment in PD - dynamics was characterized through beta burst parameters across phenotypes and burst intervals under specific proposed criteria for optimal burst threshold definition. RESULTS: Low-frequency (13-22 Hz) beta burst probability was the best predictor for PD phenotypes (75% accuracy). PIGD patients presented higher average burst duration (p = 0.018), while TD patients exhibited higher burst probability (p = 0.014). Categorization into shorter and longer than 400 ms bursts led to significant interaction between burst length categories and the phenotypes (p < 0.050) as revealed by mixed-effects models. Long burst durations and short bursts probability positively correlated, respectively, with rigidity-bradykinesia (p = 0.029) and tremor (p = 0.038) scores. CONCLUSIONS: Subthalamic low-frequency beta bursts differed between TD and PIGD phenotypes and correlated with motor symptoms. SIGNIFICANCE: These findings improve the PD phenotypes' electrophysiological characterization and may define new criteria for adaptive deep brain stimulation.

Aplicação de healthbots em língua portuguesa: revisão narrativa / Application of healthbots in Portuguese: narrative review / Aplicación de healthbots en portugués: revisión narrativa

Objetivo: Esse estudo objetivou levantar e caracterizar as aplicações de healthbots em língua portuguesa, considerando seus papéis na transformação digital da jornada do paciente. Métodos: Revisão de literatura narrativa pela qual se investigou a acessibilidade e a objetividade das aplicações, tendo o paciente como usuário final. Os artigos foram analisados quanto ao uso de bots, tecnologias da informação e dispositivos utilizados, objetivo das aplicações, área médica de intervenção e disciplinaridade no desenvolvimento das soluções. Resultados: De treze artigos selecionados na busca contendo aplicações com automatização de tarefas, apenas cinco descreveram a utilização de bots. Conclusão: Os healthbots possuem potencial para promover o aprimoramento da jornada do paciente. Contudo, o desenvolvimento e o emprego de tais aplicações ainda não estão difundidos no Brasil.

Objective: This study aimed to raise and characterize the applications of healthbots in Portuguese, considering their roles in the digital transformation of the patient's journey. Methods: Review of narrative literature through which the accessibility and objectivity of the applications were investigated, with the patient as the end user. The articles were analyzed regarding the use of bots, information technologies and devices used, purpose of applications, medical area of intervention and disciplinary action in the development of solutions. Results: Of thirteen articles selected in the search containing applications with task automation, only five described the use of bots. Conclusion: Healthbots have the potential to improve the patient journey. However, the development and use of such applications are still not widespread in Brazil.

Objetivo: Este estudio tuvo como objetivo plantear y caracterizar las aplicaciones de los healthbots en portugués, considerando sus roles en la transformación digital del viaje del paciente. Métodos: Revisión de literatura narrativa mediante la cual se investigó la accesibilidad y objetividad de las aplicaciones, con el paciente como usuario final. Los artículos fueron analizados en cuanto al uso de bots, tecnologías y dispositivos de información utilizados, finalidad de las aplicaciones, área médica de intervención y acción disciplinaria en el desarrollo de soluciones. Resultados: De trece artículos seleccionados en la búsqueda que contienen aplicaciones con automatización de tareas, solo cinco describieron el uso de bots. Conclusión: los Healthbots tienen el potencial de mejorar el viaje del paciente. Sin embargo, el desarrollo y uso de tales aplicaciones aún no está muy extendido en Brasil.

Spectral characteristics of subthalamic nucleus local field potentials in Parkinson's disease: Phenotype and movement matter.

Parkinson's disease (PD) is clinically heterogeneous across patients and may be classified in three motor phenotypes: tremor dominant (TD), postural instability and gait disorder (PIGD), and undetermined. Despite the significant clinical characterization of motor phenotypes, little is known about how electrophysiological data, particularly subthalamic nucleus local field potentials (STN-LFP), differ between TD and PIGD patients. This is relevant since increased STN-LFP bandpower at α-ß range (8-35 Hz) is considered a potential PD biomarker and, therefore, a critical setpoint to drive adaptive deep brain stimulation. Acknowledging STN-LFP differences between phenotypes, mainly in rest and movement states, would better fit DBS to clinical and motor demands. We studied this issue through spectral analyses on 35 STN-LFP in TD and PIGD patients during rest and movement. We demonstrated that higher ß2 activity (22-35 Hz) was observed in PIGD only during rest. Additionally, bandpower differences between rest and movement occurred at the α-ß range, but with different patterns as per phenotypes: movement-induced desynchronization concerned lower frequencies in TD (10-20 Hz) and higher frequencies in PIGD patients (21-28 Hz). Finally, when supervised learning algorithms were employed aiming to discriminate PD phenotypes based on STN-LFP bandpower features, movement information had improved the classification accuracy, achieving peak performances when TD and PIGD movement-induced desynchronization ranges were considered. These results suggest that STN-LFP ß-band encodes phenotype-movement dependent information in PD patients.