Bilateral Magnetic Resonance Imaging-Guided Focused Ultrasound Thalamotomy for Essential Tremor

<b><i>Introduction:</i></b> Essential tremor is the most common movement disorder in adults. Bilateral symptoms are typical; however, bilateral thalamotomy for essential tremor is associated with a high probability of adverse events. We retrospectively investigated the efficacy and safety of staged bilateral ventral intermediate nucleus thalamotomy for refractory essential tremor using magnetic resonance imaging-guided focused ultrasound. <b><i>Methods:</i></b> We enrolled 5 consecutive patients with refractory essential tremor between September 2016 and March 2020. Patients underwent a second operation at least 1 year after the first operation. The second lesion was created asymmetrically to the first lesion. <b><i>Results:</i></b> Mean patient age was 57.6 years, and the mean interval between the 2 operations was 27.8 months. The second lesion center was superior to the first lesion in all patients. The mean baseline, second preoperative, and second postoperative Clinical Rating Scale for Tremor total scores were 63.6, 49.2, and 21.8, respectively. The mean baseline, second preoperative, and second postoperative Clinical Rating Scale for Tremor part C scores were 18.4, 8.2, and 2.6, respectively. One patient had permanent adverse events of slight dysarthria and discomfort in the tongue. No patient experienced dysphagia or cognitive dysfunction after the second operation. Four of the 5 patients were satisfied with the results of the bilateral treatment, including the patient who had permanent adverse events. <b><i>Conclusions:</i></b> Magnetic resonance imaging-guided focused ultrasound is an effective method for bilateral thalamotomy when adhering to the following considerations: (1) asymmetrical lesions are created and (2) sufficient interval (&#x3e;1 year) between operations.

Automatically Generated Smartphone Data in Young Patients With Newly Diagnosed Bipolar Disorder and Healthy Controls

Background: Smartphones may facilitate continuous and fine-grained monitoring of behavioral activities via automatically generated data and could prove to be especially valuable in monitoring illness activity in young patients with bipolar disorder (BD), who often present with rapid changes in mood and related symptoms. The present pilot study in young patients with newly diagnosed BD and healthy controls (HC) aimed to (1) validate automatically generated smartphone data reflecting physical and social activity and phone usage against validated clinical rating scales and questionnaires; (2) investigate differences in automatically generated smartphone data between young patients with newly diagnosed BD and HC; and (3) investigate associations between automatically generated smartphone data and smartphone-based self-monitored mood and activity in young patients with newly diagnosed BD.Methods: A total of 40 young patients with newly diagnosed BD and 21 HC aged 15–25 years provided daily automatically generated smartphone data for 3–779 days [median (IQR) = 140 (11.5–268.5)], in addition to daily smartphone-based self-monitoring of activity and mood. All participants were assessed with clinical rating scales.Results: (1) The number of outgoing phone calls was positively associated with scores on the Young Mania Rating Scale and subitems concerning activity and speech. The number of missed calls (p = 0.015) and the number of outgoing text messages (p = 0.017) were positively associated with the level of psychomotor agitation according to the Hamilton Depression Rating scale subitem 9. (2) Young patients with newly diagnosed BD had a higher number of incoming calls compared with HC (BD: mean = 1.419, 95% CI: 1.162, 1.677; HC: mean = 0.972, 95% CI: 0.637, 1.308; p = 0.043) and lower self-monitored mood and activity (p's &lt; 0.001). (3) Smartphone-based self-monitored mood and activity were positively associated with step counts and the number of outgoing calls, respectively (p's &lt; 0.001).Conclusion: Automatically generated data on physical and social activity and phone usage seem to reflect symptoms. These data differ between young patients with newly diagnosed BD and HC and reflect changes in illness activity in young patients with BD. Automatically generated smartphone-based data could be a useful clinical tool in diagnosing and monitoring illness activity in young patients with BD.

Reliability of Clinical Rating Scale in Evaluation of Head Control in children with Cerebral Palsy

Introduction The clinical rating scale for head control assesses control of head/neck in children with neurological conditions. Head control is important for activities of daily living and quality of life in children. Objectives The aim of the study was to determine the intra-rater and inter-rater reliability of the scale in children with Cerebral Palsy. Method The study was a cross-sectional study approved by Research ethics committees of Kano State Ministry of Health and Aminu Kano Teaching Hospital involving children with CP. Three independent raters assessed the children using Clinical Rating Scale for Head Control at two different times, and the intra-rater and inter-rater reliabilities were analyzed using kappa statistics and Bland-Altman analysis. Results Fifty children with CP with mean age, 24.17±12.17 months participated in the study. The result of the study showed that there were very good agreement in all the test positions for the three raters and between the first and the second ratings and in all the test positions between the three raters respectively (k>0.8). Similarly, there was no proportional bias between ratings in 24 of the measurements (p>0.05). Conclusion Clinical rating scale for head control seems to be a reliable instrument. Thus, it can be used to monitor the progress of rehabilitation in CP patients to help improve their quality of life.

Effect of audio and audio-visual distraction aids in reducing anxiety during pedodontic care

The use of audio-visual and audio distraction tools can lead to the improvement of the quality of treatment and benefit both the dentist and the patient. It is of interest to evaluate the anxiety levels using audio and audio-visual distraction aids during pedodontic care. We collected data on 30 children between 6 to 12 years old. Subjects were randomly assigned into three groups of ten each. The three groups were control group, audio distraction group and audio-visual distraction group. The pulse rate of all the patients were assessed, Venham’s picture test and Venham’s Clinical Rating scale was recorded for all the subjects during the first and second visits. A statistically significant (p<0.01) difference in pulse rates was observed when audio and audio-visual groups were used during treatment. This implies that distraction aids help to reduce the levels of anxiety pedodontic care.

Preoperative Anxiety Assessment in Adult Patients Undergoing Elective Surgeries: A Cross-Sectional Observational Study

Introduction Anxiety is the subjective unpleasant feeling of dread over something unlikely to happen. The incidence of preoperative anxiety ranges from 32% to 76.7%. We aimed to measure the preoperative anxiety level using Amsterdam Preoperative Anxiety and Information Scale questionnaire and clinical rating scale given by attending anesthesiologist / anesthesia residents. MethodsIt was cross-sectional observational study conducted in wards. We enrolled 110 adult patients planned for elective gynecological and gastrointestinal surgeries. After taking informed written consent, principal investigator interviewed the patient, one day prior to surgery in wards using a structured questionnaire of Amsterdam Preoperative Anxiety and Information Scale. Demographics characters were recorded. The attending anesthesia residents (blinded to patient response) performed preanesthetic assessment, provided their subjective rating about patient anxiety and need for information using Clinical Rating Scale. ResultsOut of 110 patient, 57(51.81%) were found to have higher anxiety level. Comparing the APAIS score with various factors, we found younger age, female gender, unemployed status, higher level of education, adverse events in previous surgery and higher grade of surgery was associated with higher anxiety score. Comparing APAIS with Clinical Rating Score, there was poor correlation. ConclusionThe incidence of preoperative anxiety is high (51.81%) in adult patients undergoing elective surgery. During the preoperative anesthetic checkup, APAIS can be used as a screening tool. It provides relevant information on the presence of preoperative anxiety and need for information, which helps to achieve patient satisfaction and better outcome.

Protocol for PD SENSORS: Parkinson’s Disease Symptom Evaluation in a Naturalistic Setting producing Outcome measuRes using SPHERE technology. An observational feasibility study of multi-modal multi-sensor technology to measure symptoms and activities of daily living in Parkinson’s disease

IntroductionThe impact of disease-modifying agents on disease progression in Parkinson’s disease is largely assessed in clinical trials using clinical rating scales. These scales have drawbacks in terms of their ability to capture the fluctuating nature of symptoms while living in a naturalistic environment. The SPHERE (Sensor Platform for HEalthcare in a Residential Environment) project has designed a multi-sensor platform with multimodal devices designed to allow continuous, relatively inexpensive, unobtrusive sensing of motor, non-motor and activities of daily living metrics in a home or a home-like environment. The aim of this study is to evaluate how the SPHERE technology can measure aspects of Parkinson’s disease.Methods and analysisThis is a small-scale feasibility and acceptability study during which 12 pairs of participants (comprising a person with Parkinson’s and a healthy control participant) will stay and live freely for 5 days in a home-like environment embedded with SPHERE technology including environmental, appliance monitoring, wrist-worn accelerometry and camera sensors. These data will be collected alongside clinical rating scales, participant diary entries and expert clinician annotations of colour video images. Machine learning will be used to look for a signal to discriminate between Parkinson’s disease and control, and between Parkinson’s disease symptoms ‘on’ and ‘off’ medications. Additional outcome measures including bradykinesia, activity level, sleep parameters and some activities of daily living will be explored. Acceptability of the technology will be evaluated qualitatively using semi-structured interviews.Ethics and disseminationEthical approval has been given to commence this study; the results will be disseminated as widely as appropriate.