accelerometry during ablative thalamic surgery for parkinsonian tremor authors: j. ciurea v....
TRANSCRIPT
ACCELEROMETRY DURING ACCELEROMETRY DURING ABLATIVE THALAMIC SURGERY FOR ABLATIVE THALAMIC SURGERY FOR
PARKINSONIAN TREMORPARKINSONIAN TREMOR
Authors:
J. Ciurea V. Nestianu*, Ileana Simoca, Dept. of Neurosurgery, University Hospital “ Bagdasar
Arseni”, Bucharest, Romania* Dept. of Neurophysiology, University of Medicine
Craiova, Romania
OBJECTIVEOBJECTIVE
• Tremor assessment during thalamotomy for Parkinson disease under the effects of electrical stimulation
• Comparison accelerometer vs. neurologist assessment
PATIENTS AND METHODPATIENTS AND METHOD
• Total number of patients: 8• Stereotactic target
– Vim
• Gender: 5 men and 3 women. • Age
– The mean age was 52 years – Range between 32 to 68 years. All patients exhausted drug therapy or did not
respond or tolerate it.
PATIENTS AND METHODPATIENTS AND METHOD
• The following parameters were recorded during electrical stimulation of the target :
• Frequency (Hz) • Amplitude• Occurrence of tremor • Comparison with neurological direct observation. • The lowest stimulation tremor suppression electrical
threshold was used to select the optimal lesion site.
RESULTSRESULTS
• Improvement:– United Parkinsonian Disease Rating Scale– Schwalb & England Scale – Hohen & Yahr Score.
Tremor:
Rest
Positional
Intention
DEEP BRAIN ELECTRICAL STIMULATIONDEEP BRAIN ELECTRICAL STIMULATION AND TREMOR AND TREMOR
• Monitoring:– EMG
• + standardized clinical tool• - only groups of muscle and movements can affect the position of the
electrode– Acceleromerter
• + vectorial components of movement• - the amplitude is a derivate and depends of frequency
– Optical – photocouple - diode and receiver • +simple • - only frequency, interference with other sources
– Piezo• +sensitive• -frequency response dependent on “crystal resonance”
– Video+ state of art-three simultaneous cameras and a analysis soft, retrospective
DEEP BRAIN ELECTRICAL STIMULATIONDEEP BRAIN ELECTRICAL STIMULATION AND TREMOR AND TREMOR
• The 2 - 100 Hz stimulation
EFFECT OF STIMULATIONEFFECT OF STIMULATION
WATERFALL PRESENTATION OF WATERFALL PRESENTATION OF ELECTRICAL STIMULATION EFFECTSELECTRICAL STIMULATION EFFECTS
REST TREM OR +LOAD
0
20
40
60
80
100
120
1 77 153 229 305 381 457 533 609 685 761 837 913 989 1065 1141 1217 1293 1369 1445 1521 1597 1673
t (1=0.03 sec.)
AU Ampl.
Accelerometer vs. ObserverAccelerometer vs. Observer
Accelerometer sy. identification - earlier than Accelerometer sy. identification - earlier than clinical observerclinical observer
CONCLUSIONCONCLUSION
– IS TREMOR MONITORING NECESSARY?– IS TREMOR MONITORING USEFUL?
• TREMOR MONITORING IS AN OBJECTIVE AND
EFFICIENT METHOD.