Application of Tremor Analysis in Parkinson's Disease and Its Related Diseases

Completed

• Conditions: Parkinson Disease
• Interventions: Other: Transcranial parenchymal color Doppler ultrasound (TCS); Other: Electromyography (EMG) tremor analysis

• Registration Number: NCT04970745
• Lead Sponsor: Peking University Third Hospital

Brief Summary

This is a longitudinal study to evaluate the brainstem of patients at different stages through VEMP neck, masticatory muscle and eye tests on patients with early and middle-advanced PD (20 cases each) and healthy controls (40 cases) The function of various parts is affected. At the same time, combining the patient's neurological function score and non-motor symptom score to find evidence of early involvement and early intervention.

Detailed Description

\[Background\] Tremor is an important symptom of extrapyramidal diseases, and it is also an early symptom of a variety of complex diseases. The classification of tremor has not been completely unified, mainly including essential tremor, Parkinson's disease tremor, etc., each form of tremor has Crossover and connection make clinical differential diagnosis difficult. At the same time, many diseases related to tremor lack pathological, serological and imaging characteristic changes. Therefore, it is particularly important to find accurate and objective evaluation indicators for tremor.

By recording a pair of antagonist muscles (active muscles and passive muscles), electromyography can objectively record the type, degree, amplitude, burst pattern (whether the burst activity of the antagonistic muscles are synchronized or alternate), and weight-bearing The effect of drugs on tremor is very valuable for the diagnosis and differential diagnosis of tremor; especially for patients with Parkinson's disease, it can be several years or even decades before they develop motor symptoms, that is, tremor, rigidity, slowness of movement, and postural instability. There are a wide range of non-motor symptoms, such as smell, mood, sleep, mental behavior and many other aspects. Compared with dyskinesia, non-motor symptoms are both a precursor to the onset and an indication of disease progression. Fully understanding and exploring the law of the occurrence and development of these non-motor symptoms can provide clues for our early diagnosis and provide us with opportunities for early implementation of neuroprotective treatment.

The early clinical symptoms of Parkinson's disease (Pakinson's disease, PD) are often atypical, and it is difficult to diagnose it only based on the history and clinical manifestations. However, when the diagnosis is made when the clinical symptoms are obvious, the patient's substantia nigra dopamine neurons have been reduced by 60-70%, and the opportunity for early treatment is lost. A Berg study also showed that treatment when most neurons in the pre-exercise period have not undergone degeneration can better protect the nerves and may delay the clinical progress of PD. Therefore, early diagnosis and early treatment of PD patients are particularly important.

The clinical manifestations of Parkinson's disease include motor symptoms and non-motor symptoms (NMS), the latter of which is often ignored by clinicians. It includes common neuropsychiatric symptoms: such as depression, anxiety, apathy, lack of affect, distraction, and even hallucinations, delusions, delusions, dementia, obsessive-compulsive symptoms, panic attacks; sleep disorders: periodic limb movement disorders, excessive sleep during the day and so on. Some of these symptoms can appear before the movement disorder of Parkinson's disease, some are accompanied by the movement disorder, and some appear in the middle and late stages of Parkinson's disease, and aggravate with the aggravation of the movement symptoms. And its NMS is closely related to the severity of the entire disease of PD.

\[Objective\] To explore the significance of tremor analysis in judging the early diagnosis of Parkinson's disease.

Discuss the significance of tremor analysis for the prognosis of the disease. To explore the diagnostic significance of tremor analysis in patients with Parkinson's disease and benign tremor.

\[Design\] This is a longitudinal study to evaluate the brainstem of patients at different stages through VEMP neck, masticatory muscle and eye tests on patients with early and middle-advanced PD (20 cases each) and healthy controls (40 cases) The function of various parts is affected. At the same time, combining the patient's neurological function score and non-motor symptom score to find evidence of early involvement and early intervention.

Study Timeline

• Study Start: 2018-01-01
• Primary Completion: 2019-06-30
• Study Completion: 2019-08-01
• Status Verified: 2021-06
• Study First Submitted: 2021-06-27
• Study First Submitted QC: 2021-07-12
• Last Update Submitted: 2021-07-12
• Study First Posted: 2021-07-21
• Last Update Posted: 2021-07-21

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 120

Inclusion Criteria

• Enrollment criteria: All patients from the outpatient and inpatient department of neurological movement disorders, aged 45-75 years, meet the following symptom scores greater than or equal to 4 points: olfactory disorder (2 points), rapid eye movement sleep behavior disorder (2 points) , Constipation (1 point), anxiety and depression symptoms (1 point), muscle stiffness (1 point), tremor (1 point), balance disorder (1 point), signed informed consent;

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Exclusion Criteria

• exclusion criteria: a. Clear cerebellar abnormalities; b. Downward vertical supranuclear gaze palsy, or selective downward vertical saccade slowed down; c. Within the first 5 years of onset, diagnosed as possible behavioral variant frontotemporal dementia or primary Progressive aphasia; d. The onset of Parkinson's syndrome that is still limited to the lower limbs for 3 years; e. Parkinson's syndrome caused by drugs; f. The effect of levodopa is not good; g. Cortical sensory loss.

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
risk	Transcranial parenchymal color Doppler ultrasound (TCS)	After performing midbrain ultrasound and tremor analysis, patients with positive results of 1 out of 2 tests are considered risk patients
high-risk	Transcranial parenchymal color Doppler ultrasound (TCS)	After performing midbrain ultrasound and tremor analysis, patients with positive results of both tests are considered very high-risk patients,
high-risk	Electromyography (EMG) tremor analysis	After performing midbrain ultrasound and tremor analysis, patients with positive results of both tests are considered very high-risk patients,
low-risk	Transcranial parenchymal color Doppler ultrasound (TCS)	After performing midbrain ultrasound and tremor analysis, patients with negative results of both tests are considered risk patients
risk	Electromyography (EMG) tremor analysis	After performing midbrain ultrasound and tremor analysis, patients with positive results of 1 out of 2 tests are considered risk patients
low-risk	Electromyography (EMG) tremor analysis	After performing midbrain ultrasound and tremor analysis, patients with negative results of both tests are considered risk patients

Primary Outcome Measures

Name	Time	Method
nigrostriatal echogenic area	1 week after enrollment	using the Transcranial parenchymal color Doppler ultrasound (TCS) to trace the nigrostriatal echogenic area
Electromyography (EMG) tremor analysis	1 week after enrollment	EMG amplitude (amplitude)

Trial Locations

Locations (1)

Peking University Third Hospital; 🇨🇳 Beijing, China