Browsing by Author "Zauber, Sarah Elizabeth"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome: The International Tourette Syndrome Deep Brain Stimulation Public Database and Registry
    (American Medical Association, 2018-03-01) Martinez-Ramirez, Daniel; Jimenez-Shahed, Joohi; Leckman, James Frederick; Porta, Mauro; Servello, Domenico; Meng, Fan-Gang; Kuhn, Jens; Huys, Daniel; Baldermann, Juan Carlos; Foltynie, Thomas; Hariz, Marwan I.; Joyce, Eileen M.; Zrinzo, Ludvic; Kefalopoulou, Zinovia; Silburn, Peter; Coyne, Terry; Mogilner, Alon Y.; Pourfar, Michael H.; Khandhar, Suketu M.; Auyeung, Man; Ostrem, Jill Louise; Visser-Vandewalle, Veerle; Welter, Marie-Laure; Mallet, Luc; Karachi, Carine; Houeto, Jean Luc; Klassen, Bryan Timothy; Ackermans, Linda; Kaido, Takanobu; Temel, Yasin; Gross, Robert E.; Walker, Harrison C.; Lozano, Andres M.; Walter, Benjamin L.; Mari, Zoltan; Anderson, William S.; Changizi, Barbara Kelly; Moro, Elena; Zauber, Sarah Elizabeth; Schrock, Lauren E.; Zhang, Jian-Guo; Hu, Wei; Rizer, Kyle; Monari, Erin H.; Foote, Kelly D.; Malaty, Irene A.; Deeb, Wissam; Gunduz, Aysegul; Okun, Michael S.; Neurology, School of Medicine
    Importance: Collective evidence has strongly suggested that deep brain stimulation (DBS) is a promising therapy for Tourette syndrome. Objective: To assess the efficacy and safety of DBS in a multinational cohort of patients with Tourette syndrome. Design, Setting, and Participants: The prospective International Deep Brain Stimulation Database and Registry included 185 patients with medically refractory Tourette syndrome who underwent DBS implantation from January 1, 2012, to December 31, 2016, at 31 institutions in 10 countries worldwide. Exposures: Patients with medically refractory symptoms received DBS implantation in the centromedian thalamic region (93 of 163 [57.1%]), the anterior globus pallidus internus (41 of 163 [25.2%]), the posterior globus pallidus internus (25 of 163 [15.3%]), and the anterior limb of the internal capsule (4 of 163 [2.5%]). Main Outcomes and Measures: Scores on the Yale Global Tic Severity Scale and adverse events. Results: The International Deep Brain Stimulation Database and Registry enrolled 185 patients (of 171 with available data, 37 females and 134 males; mean [SD] age at surgery, 29.1 [10.8] years [range, 13-58 years]). Symptoms of obsessive-compulsive disorder were present in 97 of 151 patients (64.2%) and 32 of 148 (21.6%) had a history of self-injurious behavior. The mean (SD) total Yale Global Tic Severity Scale score improved from 75.01 (18.36) at baseline to 41.19 (20.00) at 1 year after DBS implantation (P < .001). The mean (SD) motor tic subscore improved from 21.00 (3.72) at baseline to 12.91 (5.78) after 1 year (P < .001), and the mean (SD) phonic tic subscore improved from 16.82 (6.56) at baseline to 9.63 (6.99) at 1 year (P < .001). The overall adverse event rate was 35.4% (56 of 158 patients), with intracranial hemorrhage occurring in 2 patients (1.3%), infection in 4 patients with 5 events (3.2%), and lead explantation in 1 patient (0.6%). The most common stimulation-induced adverse effects were dysarthria (10 [6.3%]) and paresthesia (13 [8.2%]). Conclusions and Relevance: Deep brain stimulation was associated with symptomatic improvement in patients with Tourette syndrome but also with important adverse events. A publicly available website on outcomes of DBS in patients with Tourette syndrome has been provided.
  • Thumbnail Image
    Item
    Objective Assessment and Scoring of Parkinsonian Tremors using Wrist Sensor Technology
    (2025-04-25) Sullivan, Megan E.; Shanghavi, Aditya A.; Rentley, Oliwia; Zauber, Sarah Elizabeth; Sereno, Anne B.
    Background: Parkinson’s Disease (PD) is the second leading cause of neurodegenerative disease in humans. The gold standard for assessing disease progression is the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Neurologists score motor symptoms from 0-4 and determine medication adjustments based on score variation between the OFF and ON medication states. Numerous studies have noted inter-rater variability due to the subjectivity of the visual-based MDS-UPDRS rating scale complicating treatment plans. Objective: This clinical study evaluated the use of wrist-worn inertial sensors as a more objective and reliable method for measuring the severity of Parkinsonian rest and postural tremors, in comparison to the current gold standard, the MDS-UPDRS. Methods: 30 PD patients and 30 age-matched healthy controls performed the rest and postural tasks. Shimmer3 IMU sensors, sampling at 100Hz, were attached to both wrists to record angular velocity and linear acceleration. Tremor Severity Score (TSS), a novel objective tremor scoring algorithm based on sensor signals, was developed to measure tremor severity. Results: In a subset of controls and PD patients tested only ON medication, the mean scores for rest and postural tremor showed significant differences using both MDS-UPDRS (0.53 vs 0.46) and TSS (0.53 vs 0.39) rating scales, with TSS showing a marginally greater effect size (0.07 vs 0.06). When comparing OFF/ON states in a subset of 7 PD patients, the MDS-UPDRS showed no significant difference between scores, while the TSS showed significantly lower scores in the ON vs OFF state for both postural (0.44 vs 1.1) and rest tremor (0.91 vs 1.97). Conclusion: Results suggest TSS is more sensitive to changes in tasks (rest, postural) and medication effects (OFF vs ON). The ability to more objectively assess tremor severity and progression has implications for early diagnosis, medication dose adjustments, and more accurate assessment of patients in the telehealth setting.