Validation of digital spiral analysis as outcome parameter for clinical trials in essential tremor.
Validation of digital spiral analysis as outcome parameter for clinical trials in essential tremor.
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DOI：
10.1002/mds.23808
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发表时间：
2011-09
影响因子：
8.6
通讯作者：
Hallett, Mark
中科院分区：
文献类型：
--
作者：
Haubenberger, Dietrich;Kalowitz, Daniel;Nahab, Fatta B.;Toro, Camilo;Ippolito, Dominic;Luckenbaugh, David A.;Wittevrongel, Loretta;Hallett, Mark
特发性震颤是最常见的运动障碍之一，其特征是影响日常生活活动的运动性和姿势震颤。螺旋描记通常用于直观评估震颤强度，作为震颤常规临床评估的一部分，也是临床试验的一种工具。我们提出了一种策略，根据数字化平板电脑上绘制的螺旋图形来量化震颤的严重程度。我们用一种公认的视觉螺旋分级方法验证我们的方法，并比较两种方法在捕捉治疗效果方面的能力，根据酒精刺激后临床基本震颤分级的变化来定义。在标准化治疗干预中，9名对酒精敏感的原发性震颤患者在服用乙醇之前和之后的连续5个时间点使用数字化平板绘制了54个阿基米德螺线。通过对笔尖位置进行数值推导和傅立叶变换后的速度震颤峰值幅度来定量估计螺旋震颤的严重程度。在随机排序的集合中，由七名训练有素的评分员使用贝恩和芬德利的0到10评级标准对螺旋进行评分。计算机化分数与视觉分级相关(P<；0.0001)。无水乙醇前后各时间点的相关性均显著(P<；0.005)。在捕捉酒精挑战的影响方面，定量评级比视觉评级提供了更好的敏感性(P<；0.05)。使用标准化的处理方法，我们能够证明，肺图时间序列分析是记录震颤强度的一种有效、可靠的方法，并且比目前可用的视觉螺旋分级方法更敏感地测量微小影响。
Essential tremor, one of the most prevalent movement disorders, is characterized by kinetic and postural tremor affecting activities of daily living. Spiral drawing is commonly used to visually rate tremor intensity, as part of the routine clinical assessment of tremor and as a tool in clinical trials. We present a strategy to quantify tremor severity from spirals drawn on a digitizing tablet. We validate our method against a well-established visual spiral rating method and compare both methods on their capacity to capture a therapeutic effect, as defined by the change in clinical essential tremor rating scale after an ethanol challenge. Fifty-four Archimedes spirals were drawn using a digitizing tablet by nine ethanol-responsive patients with essential tremor before and at five consecutive time points after the administration of ethanol in a standardized treatment intervention. Quantitative spiral tremor severity was estimated from the velocity tremor peak amplitude after numerical derivation and Fourier transformation of pen-tip positions. In randomly ordered sets, spirals were scored by seven trained raters, using Bain and Findley’s 0 to 10 rating scale. Computerized scores correlated with visual ratings (P < 0.0001). The correlation was significant at each time point before and after ethanol (P < 0.005). Quantitative ratings provided better sensitivity than visual rating to capture the effects of an ethanol challenge (P < 0.05). Using a standardized treatment approach, we were able to demonstrate that spirography time-series analysis is a valid, reliable method to document tremor intensity and a more sensitive measure for small effects than currently available visual spiral rating methods.
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作者：
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