Assuntos
Transtornos dos Movimentos/congênito , Transtornos dos Movimentos/diagnóstico por imagem , Neuroimagem/métodos , Adolescente , Encéfalo/diagnóstico por imagem , Movimentos Oculares , Humanos , Imageamento por Ressonância Magnética , Masculino , Transtornos dos Movimentos/genética , Linhagem , Gravação em VídeoRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Meningites Bacterianas/diagnóstico , Streptococcus pneumoniae/isolamento & purificação , Infecções Pneumocócicas/diagnóstico , Encefalite por Varicela Zoster/diagnóstico , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Pandemias , Diagnóstico DiferencialRESUMO
Essential tremor (ET) is a major cause of disability and is not effectively managed in half of the patients. We investigated whether mechanical vibration could reduce tremor in ET by selectively recruiting afferent pathways. We used piezoelectric actuators to deliver vibratory stimuli to the hand and forearm during long trials (4 min), while we monitored the tremor using inertial sensors. We analyzed the effect of four stimulation strategies, including different constant and variable vibration frequencies, in 18 ET patients. Although there was not a clear homogeneous response to vibration across patients and strategies, in most cases (50-72%) mechanical vibration was associated with an increase in the amplitude of their tremor. In contrast, the tremor was reduced in 5-22% of the patients, depending on the strategy. However, these results are hard to interpret given the intrinsic variability of the tremor: during equally long trials without vibration, the tremor changed significantly in 67% of the patients (increased in 45%; decreased in 22%). We conclude that mechanical vibration of the limb does not have a systematic effect on tremor in ET. Moreover, the observed intrinsic variability of the tremor should be taken into account when designing future experiments to assess tremor in ET and how it responds to any intervention.
Assuntos
Tremor Essencial/fisiopatologia , Contração Muscular , Músculos/fisiopatologia , Tremor/prevenção & controle , Vibração , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , Tremor/epidemiologiaRESUMO
Wearable technology used in Parkinson's disease (PD) research has become an increasing focus of interest in this field. Our group assessed the feasibility, clinical correlation, reliability, and acceptance of smartwatches in order to quantify arm resting tremors in PD patients. An Android application on a smartwatch was used to obtain raw data from the smartwatch's gyroscopes. Twenty-two PD patients were consecutively recruited and followed for 1â¯year. Arm rest tremors were video filmed and scored by two independent raters using the motor subscale of the Unified Parkinson's Disease Rating Scale (UPDRS-III). The tremor intensity parameter was defined by the root mean square of the angular speed measured by the smartwatch at the wrist. Sixty-four smartwatch evaluations were completed. The Spearman coefficient among the mean of the resting tremor (UPDRS-III) scores and smartwatch measurements for tremor intensity was 0.81 (pâ¯<â¯.001); smartwatch reliability to quantify tremors was checked by intraclass reliability coefficient with a resting tremorâ¯=â¯0.89, minimum detectable changeâ¯=â¯59.03%. Good acceptance of the system was shown. Smartwatch use for PD tremor analysis is possible, reliable, well-correlated with clinical scores, and well-accepted by patients for clinical follow-up. The results from these experiments suggest that this commodity hardware has the potential to quantify PD patients' tremors objectively in a consulting-room.
Assuntos
Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Tremor/diagnóstico , Tremor/fisiopatologia , Dispositivos Eletrônicos Vestíveis/normas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Tremor/complicaçõesRESUMO
The interaction with electronic devices is crucial in our technological society. Hand kinetic tremor complicates mouse driving in Essential tremor patients. To solve this issue some technological solutions are available and accessible online. We present a 71-year-old patient with prominent mouse controlling tremor who improved with one of these systems.
Assuntos
Computadores , Tremor Essencial/reabilitação , Tecnologia Assistiva , Idoso , Mãos , Humanos , Masculino , Destreza MotoraRESUMO
BACKGROUND: The use of wearable technology is an emerging field of research in movement disorders. This paper introduces a clinical study to evaluate the feasibility, clinical correlation and reliability of using a system based in smartwatches to quantify tremor in essential tremor (ET) patients and check its acceptance as clinical monitoring tool. NEW METHOD: The system is based on a commercial smartwatch and an Android smartphone. An investigational Android application controls the process of recording raw data from the smartwatch three-dimensional gyroscopes. Thirty-four ET patients were consecutively enrolled in the experiments and assessed along one year. Arm tremor was videofilmed and scored using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). Tremor intensity was quantified with the root mean square of angular velocity measured in the patients' wrists. RESULTS: Eighty-two assessments with smartwatches were performed. Spearman's correlation coefficients (ρ) between clinical tremor (FTM-TRS) scores and smartwatch measures for tremor intensity were 0.590 at rest; ρâ¯=â¯0.738 in steady posture; ρâ¯=â¯0.189 in finger-to-nose maneuvers; and ρâ¯=â¯0.652 in pouring water task. Smartwatch reliability was checked by intraclass realiability coefficients: 0.85, 0.95, 0.91, 0.95 respectively. Most of patients showed good acceptance of the system. COMPARISON WITH EXISTING METHOD(S): This commodity hardware contributes to quantify tremor objectively in a consulting-room by customized Android smart devices as clinical monitoring tool. CONCLUSIONS: The NetMD system for tremor analysis is feasible, well-correlated with clinical scores, reliable and well-accepted by patients to tremor follow-up. Therefore, it could be an option to objectively quantify tremor in ET patients during their regular follow-up.
Assuntos
Tremor Essencial/diagnóstico , Aplicativos Móveis , Smartphone , Dispositivos Eletrônicos Vestíveis , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/normas , Aceitação pelo Paciente de Cuidados de Saúde , Reprodutibilidade dos TestesAssuntos
Lateralidade Funcional/fisiologia , Mioclonia , Músculos Palatinos/fisiopatologia , Acidente Vascular Cerebral/complicações , Adulto , Eletroencefalografia , Feminino , Humanos , Mioclonia/diagnóstico por imagem , Mioclonia/etiologia , Mioclonia/patologia , Músculos Palatinos/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Insuficiência Vertebrobasilar/complicações , Gravação em VídeoRESUMO
Madelung's disease (benign symmetric lipomatosis) is a rare syndrome in which there are multiple lipomas around the neck, upper limbs and trunk in the context of chronic alcoholism. We report on a female patient with lipomas and slightly progressive myoclonus, neuropathy, myopathy, ataxia and respiratory systemic involvement (labelled in the past as Madelung's disease). Multisystem involvement and family history of lipomas led to the development of mitochondrial genetic tests, which can assess two concurrent mitochondrial mutations: the m.8344A>G mutation in MT-TK gene, related MERRF (myoclonic epilepsy with ragged-red fibre) phenotype and m.14484T>C mutation in the MT-ND6 gene responsible for Leber hereditary optic neuropathy phenotype.
Assuntos
Lipoma/patologia , Lipomatose Simétrica Múltipla/patologia , Mitocôndrias/genética , Doenças Mitocondriais/diagnóstico , Mioclonia/diagnóstico , Pescoço/patologia , Ataxia/diagnóstico , Feminino , Marcha/fisiologia , Humanos , Lipomatose Simétrica Múltipla/diagnóstico , Lipomatose Simétrica Múltipla/genética , Síndrome MERRF/genética , Pessoa de Meia-Idade , Doenças Mitocondriais/complicações , Doenças Mitocondriais/genética , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/etiologia , Mutação , Mioclonia/tratamento farmacológico , Mioclonia/etiologia , NADH Desidrogenase/genética , Avaliação de Resultados em Cuidados de Saúde , Fenótipo , Doenças RarasAssuntos
Ataxia/genética , Cromossomos Humanos X/genética , Síndrome do Cromossomo X Frágil/genética , Deficiências da Aprendizagem/genética , Insuficiência Ovariana Primária/genética , Tremor/genética , Idoso , Feminino , Proteína do X Frágil de Retardo Mental/genética , Humanos , Masculino , LinhagemRESUMO
Mobile technology is opening a wide range of opportunities for transforming the standard of care for chronic disorders. Using smartphones as tools for longitudinally tracking symptoms could enable personalization of drug regimens and improve patient monitoring. Parkinson's disease (PD) is an ideal candidate for these tools. At present, evaluation of PD signs requires trained experts to quantify motor impairment in the clinic, limiting the frequency and quality of the information available for understanding the status and progression of the disease. Mobile technology can help clinical decision making by completing the information of motor status between hospital visits. This paper presents an algorithm to detect PD by analyzing the typing activity on smartphones independently of the content of the typed text. We propose a set of touchscreen typing features based on a covariance, skewness, and kurtosis analysis of the timing information of the data to capture PD motor signs. We tested these features, both independently and in a multivariate framework, in a population of 21 PD and 23 control subjects, achieving a sensitivity/specificity of 0.81/0.81 for the best performing feature and 0.73/0.84 for the best multivariate method. The results of the alternating finger-tapping, an established motor test, measured in our cohort are 0.75/0.78. This paper contributes to the development of a home-based, high-compliance, and high-frequency PD motor test by analysis of routine typing on touchscreens.
Assuntos
Diagnóstico por Computador/métodos , Técnicas de Diagnóstico Neurológico , Aplicativos Móveis , Transtornos dos Movimentos/diagnóstico , Doença de Parkinson/diagnóstico , Smartphone , Telemedicina/métodos , Diagnóstico por Computador/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/fisiopatologia , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Telemedicina/instrumentação , Processamento de Texto/instrumentaçãoRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Creatina Quinase/análise , Cãibra Muscular/complicações , Cãibra Muscular/diagnóstico , Carbamazepina/uso terapêutico , Polissonografia/instrumentação , Polissonografia/métodos , Debilidade Muscular/complicações , Anamnese/métodos , Anamnese/normas , Biópsia/métodos , Mialgia/complicaçõesRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Síndrome de Sneddon/complicações , Síndrome de Sneddon/diagnóstico , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral , Afasia/complicações , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética/métodos , Rituximab/uso terapêutico , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Vincristina/uso terapêutico , Prednisona/uso terapêuticoRESUMO
Bilateral obturator nerve injury during pelvic surgery is an infrequent cause of lower limb paraparesis. We report the case of a 45-year-old woman with a large uterine leiomyoma who underwent simple total hysterectomy and bilateral salpingectomy. At 24 h after the surgery, the patient noticed loss of muscle strength when adducting both legs. She had no problem with other movements and no sensory or sphincter abnormalities. Neurological examination confirmed that there was loss of strength only in the adductor muscles, with preserved sensory function and reflexes, suggesting bilateral obturator nerve involvement. Pelvic MRI showed a small postsurgical haematoma in the Douglas recess, but far from the obturator nerves. 2 weeks later, electromyography showed positive sharp waves and low motor unit recruitment in the adductor magnus muscles, confirming acute, bilateral obturator nerve neuropathy. The few cases of bilateral obturator neuropathy that have been reported were mostly related to abdominopelvic interventions.