Parkinson's disease
Conditions
Interventions
 
Sponsors
Radboud Universitair Medisch Centrum
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: - A diagnosis of idiopathic PD made by a movement disorder specialist - PD disease duration of 7 years or less, defined as time since diagnosis by a neurologist - A history of both resting and re-emergent postural tremor in the same arm
Exclusion criteria
Exclusion criteria: - Severe neurological co-morbidity - Co-existing other tremor (e.g., functional tremor, dystonic tremor, essential tremor) - Significant cognitive impairment: Montreal Cognitive Assessment (MoCA) <21 points - Contra-indications for MRI - Moderate to severe head tremor - Tremor latency duration >20 seconds after abrupt voluntary movement - Unclear tremor suppression after voluntary movement - Taking dopamine-agonists with a levodopa equivalent dose of more than 150mg per day
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Re-emergent postural tremor-related cerebral activity, as measured by combined electrophysiology-fMRI. This robust technique has already been widely applied to several different tremor syndromes, including Parkinsonian resting tremor, essential tremor, and dystonic tremor | — |
Secondary
| Measure | Time frame |
|---|---|
| Clinical assessments: disease severity using MDS-UPDRS Part III (motor examination), most-affected side, most-tremulous side, handedness (Edinburgh Handedness Inventory), and cognitive function (MoCA). Structural MRI: T1 and T2-weighted structural images, diffusion-tensor imaging (DTI) scan, and neuromelanin scan. The anatomical T1-image will be used for registration of the fMRI-scans and the T2-image for improved cerebellar segmentation. The DTI and neuromelanin scans will be used to look for the integrity of the substantia nigra and locus coeruleus (LC). These measures are then correlated to clinical and electrophysiological tremor characteristics, as well as cerebral tremor-related activity (see below). Functional MRI: the fMRI experiment will be used to investigate and localize cerebral tremor-related activity. Moreover, within-subject differences in cerebral activity patterns and connectivity strengths between resting tremor and re-emergent postural tremor will be investigated. The extent of activity and effective connectivity parameters of the tremor-circuit will be correlated with electrophysiological tremor characteristics (e.g., tremor amplitude, the duration of the latency, etc). Electrophysiology: tremor will be measured from surface-electromyography (EMG) and accelerometery. Surface EMG electrodes will be placed on the first dorsal interosseus, abductor pollicis brevis, extensor carpi radialis, flexor carpi radialis, biceps, and triceps on the most-tremulous side. In case of clear leg tremor, surface EMG-electrode may be placed on the gastrocnemius and/or tibialis anterior muscles. A tri-axial accelerometer will be placed on both the most and least-tremulous side (dorsum of the hand). These peripheral tremor measures will be used to characterize tremor, assess tremor-specific eligibility for the fMRI session, and during scanning to compute scan-by-scan fluctuations of tremor power, which will be used to obtain cerebral tremor-related activity, as done | — |
Countries
Netherlands
Contacts
Public ContactR.C.G. Helmich
Radboud Universitair Medisch Centrum
Outcome results
None listed