Changes in elbow flexion EMG morphology during adjustment of deep brain stimulator in advanced Parkinson's disease.

Autor: Ruonala V; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland., Pekkonen E; Department of Neurology, Helsinki University Hospital, Helsinki, Finland.; Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland., Airaksinen O; Department of Physiology and Rehabilitation Medicine, Kuopio University Hospital, Finland., Kankaanpää M; Department of Physiology and Rehabilitation Medicine, Tampere University Hospital, Tampere, Finland., Karjalainen PA; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland., Rissanen SM; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 Apr 14; Vol. 17 (4), pp. e0266936. Date of Electronic Publication: 2022 Apr 14 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0266936
Abstrakt: Objective: Deep brain stimulation (DBS) is an effective treatment for motor symptoms of advanced Parkinson's disease (PD). Currently, DBS programming outcome is based on a clinical assessment. In an optimal situation, an objectively measurable feature would assist the operator to select the appropriate settings for DBS. Surface electromyographic (EMG) measurements have been used to characterise the motor symptoms of PD with good results; with proper methodology, these measurements could be used as an aid to program DBS.
Methods: Muscle activation measurements were performed for 13 patients who had advanced PD and were treated with DBS. The DBS pulse voltage, frequency, and width were changed during the measurements. The measured EMG signals were analysed with parameters that characterise the EMG signal morphology, and the results were compared to the clinical outcome of the adjustment.
Results: The EMG signal correlation dimension, recurrence rate, and kurtosis changed significantly when the DBS settings were changed. DBS adjustment affected the signal recurrence rate the most. Relative to the optimal settings, increased recurrence rates (median ± IQR) 1.1 ± 0.5 (-0.3 V), 1.3 ± 1.1 (+0.3 V), 1.7 ± 0.4 (-30 Hz), 1.7 ± 0.8 (+30 Hz), 2.0 ± 1.7 (+30 μs), and 1.5 ± 1.1 (DBS off) were observed. With optimal stimulation settings, the patients' Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) score decreased by 35% on average compared to turning the device off. However, the changes in UPRDS-III arm tremor and rigidity scores did not differ significantly in any settings compared to the optimal stimulation settings.
Conclusion: Adjustment of DBS treatment alters the muscle activation patterns in PD patients. The changes in the muscle activation patterns can be observed with EMG, and the parameters calculated from the signals differ between optimal and non-optimal settings of DBS. This provides a possibility for using the EMG-based measurement to aid the clinicians to adjust the DBS.
Competing Interests: The authors have read the journal’s policy and have the following competing interests: Verneri Ruonala is an inventor in the patent applications PCT/FI2019/050163 and WO2020174122A1. Saara M. Rissanen and Pasi A. Karjalainen are inventors in the patent applications EP18159445.8, PCT/EP2019/055002, PCT/FI2019/050163, WO2020174122A1, and WO2019166557A1; they are also co-funders of the company Adamant Health Ltd., which develops software for surface electromyography analysis. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Databáze: MEDLINE
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