ACCELEROMETRY DURING ABLATIVE THALAMIC SURGERY FOR PARKINSONIAN TREMOR

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ACCELEROMETRY DURING ABLATIVE THALAMIC SURGERY
FOR PARKINSONIAN 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

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OBJECTIVE

• Tremor assessment during thalamotomy for
  Parkinson disease under the effects of
  electrical stimulation
• Comparison accelerometer vs. neurologist
  assessment

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PATIENTS 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.

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PATIENTS 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.

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RESULTS

• Improvement
• United Parkinsonian Disease Rating Scale
• Schwalb England Scale
• Hohen Yahr Score.
• Tremor
• Rest
• Positional
• Intention

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DEEP BRAIN ELECTRICAL STIMULATION 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

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DEEP BRAIN ELECTRICAL STIMULATION AND TREMOR

• The 2 - 100 Hz stimulation

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EFFECT OF STIMULATION
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WATERFALL PRESENTATION OF ELECTRICAL STIMULATION
EFFECTS
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Accelerometer vs. Observer
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Accelerometer sy. identification - earlier than
clinical observer
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CONCLUSION

• IS TREMOR MONITORING NECESSARY?
• IS TREMOR MONITORING USEFUL?
• TREMOR MONITORING IS AN OBJECTIVE AND
• EFFICIENT METHOD.