An ambulatory dyskinesia monitor
A J Mansona b, P Browna c, J D O'Sullivana b, P Asselmanb, D Buckwellb, A J Leesa b
a National Hospital
for Neurology and Neurosurgery, Queen Square, London, UK, b The Middlesex Hospital, London, UK, c MRC
Human Movement and Balance Unit, Queen Square, London, UK
Correspondence to: Dr A J Lees, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK email a.lees{at}ion.ucl.ac.uk
Received 22 March 1999 and in revised form 12 July 1999;
Accepted 7 September
1999
OBJECTIVES
New
treatments are now becoming available for the management of levodopa
induced dyskinesias in Parkinsons's disease. However, assessment of
their efficacy is limited by the inadequacies of current methods of
dyskinesia measurement. The objective was to develop and validate a
portable device capable of objectively measuring dyskinesias during
normal daily activities.
METHODSA portable
device was developed based on a triaxial accelerometer, worn on the
shoulder, and a data recorder that can record levodopa induced
dyskinesias. A computer program plots raw acceleration and acceleration
over 0.5 Hz frequency bands against time. The acceleration in the
different bands can then be compared with the raw acceleration trace,
enabling identification and exclusion of confounding activities such as
tremor and walking, which have a characteristic appearance on the
trace. The validity of this device was assessed on 12 patients and
eight age matched controls by comparing accelerations in the 1-3 Hz
frequency band with established clinical dyskinesia rating scales.
While wearing the monitor, subjects were videorecorded sitting and
during dyskinesia provocation tasks, including mental activation tasks,
eating, drinking, writing, putting on a coat, and walking. The
dyskinesias were graded with both modified abnormal involuntary
movement (AIM) and Goetz scales. The clinical ratings were then
compared with the mean acceleration scores.
RESULTSAcceleration
in the 1-3 Hz frequency band correlated well against both scales,
during all individual tasks. Acceleration produced by normal voluntary
activity (with the exception of walking, which produced large
accelerations, even in controls) was small compared with dyskinetic
activity. With walking excluded, the mean acceleration over the rest of
the recording time correlated strongly with both the modified AIM
(Spearman's rank (r=0.972, p<0.001) and
Goetz (r=0.951, p<0.001) scales.
CONCLUSIONSThis
method provides an accurate, objective means for dyskinesia assessment,
and compares favourably with established methods currently used.
Keywords: levodopa induced dyskinesias; ambulatory monitoring; accelerometers
© 2000 by Journal of Neurology, Neurosurgery, and Psychiatry
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