Browsing by Subject "Neurological manifestations"

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    Accelerated symptom improvement in Parkinson’s disease via remote internet-based optimization of deep brain stimulation therapy: a randomized controlled multicenter trial
    (Springer Nature, 2025-01-31) Gharabaghi, Alireza; Groppa, Sergiu; Navas-Garcia, Marta; Schnitzler, Alfons; Muñoz-Delgado, Laura; Marshall, Vicky L.; Karl, Jessica; Zhang, Lin; Alvarez, Ramiro; Feldman, Mary S.; Soileau, Michael J.; Luo, Lan; Zauber, S. Elizabeth; Walter, Benjamin L.; Wu, Chengyuan; Lei, Hong; Herz, Damian M.; Chung, Ming-Hua; Pathak, Yagna; Blomme, Bram; Cheeran, Binith; Luca, Corneliu; Weiss, Daniel; Neurology, School of Medicine
    Background: Deep brain stimulation (DBS) has emerged as an important therapeutic intervention for neurological and neuropsychiatric disorders. After initial programming, clinicians are tasked with fine-tuning DBS parameters through repeated in-person clinic visits. We aimed to evaluate whether DBS patients achieve clinical benefit more rapidly by incorporating remote internet-based adjustment (RIBA) of stimulation parameters into the continuum of care. Methods: We conducted a randomized controlled multicenter study (ClinicalTrails.gov NCT05269862) involving patients scheduled for de novo implantation with a DBS System to treat Parkinson's Disease. Eligibility criteria included the ability to incorporate RIBA as part of routine follow-up care. Ninety-six patients were randomly assigned in a 1:1 ratio using automated allocation, blocked into groups of 4, allocation concealed, and no stratification. After surgery and initial configuration of stimulation parameters, optimization of DBS settings occurred in the clinic alone (IC) or with additional access to RIBA. The primary outcome assessed differences in the average time to achieve a one-point improvement on the Patient Global Impression of Change score between groups. Patients, caregivers, and outcome assessors were not blinded to group assignment. Most of the data collection took place in the patient's home environment. Results: Access to RIBA reduces the time to symptom improvement, with patients reporting 15.1 days faster clinical benefit (after 39.1 (SD 3.3) days in the RIBA group (n = 48) and after 54.2 (SD 3.7) days in the IC group (n = 48)). None of the reported adverse events are related to RIBA. Conclusions: This study demonstrates safety and efficacy of internet-based adjustment of DBS therapy, while providing clinical benefit earlier than in-clinic optimization of stimulation parameters by increasing patient access to therapy adjustment.
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    Smartphone language features may help identify adverse post-traumatic neuropsychiatric sequelae and their trajectories
    (Springer Nature, 2025) Vizer, Lisa; Pierce, Jennifer; Ji, Yinyao; Bucher, Meredith A.; Liu, Mochuan; Ungar, Lyle; Giorgi, Salvatore; Xing, Zhaopeng; House, Stacey L.; Beaudoin, Francesca L.; Stevens, Jennifer S.; Neylan, Thomas C.; Clifford, Gari D.; Jovanovic, Tanja; Linnstaedt, Sarah D.; Zeng, Donglin; Germine, Laura T.; Bollen, Kenneth A.; Rauch, Scott L.; Haran, John P.; Storrow, Alan B.; Lewandowski, Christopher; Musey, Paul I., Jr.; Hendry, Phyllis L.; Sheikh, Sophia; Jones, Christopher W.; Punches, Brittany E.; Hudak, Lauren A.; Pascual, Jose L.; Seamon, Mark J.; Harris, Erica; Pearson, Claire; Peak, David A.; Merchant, Roland C.; Domeier, Robert M.; O'Neil, Brian J.; Sergot, Paulina; Sanchez, Leon D.; Bruce, Steven E.; Harte, Steven E.; Kessler, Ronald C.; Koenen, Karestan C.; McLean, Samuel A.; An, Xinming; Emergency Medicine, School of Medicine
    Language features may reflect underlying cognitive and emotional processes following a traumatic event that portend clinical outcomes. The authors sought to determine whether language features from usual smartphone use were markers associated with concurrent posttraumatic symptoms and worsening or improving posttraumatic symptoms over time following a traumatic exposure. This investigation was a secondary analysis of the Advancing Understanding of RecOvery afteR traumA study, a longitudinal study of traumatic outcomes among survivors recruited from 33 emergency departments across the United States. Adverse posttraumatic sequelae were assessed over the six months following the initial traumatic exposure. Language features were extracted from usual smartphone use in a specialized app. Bivariate linear mixed models were used to identify and validate language features that are markers associated with posttraumatic symptoms. Participants were 1744 trauma survivors, with a mean age of 39 [SD = 13] years old, and 56% were female. Fourteen language features were associated with severity level of posttraumatic symptoms at specific timepoints (cross-sectional markers) and five features were associated with change in severity level of posttraumatic symptoms (longitudinal markers). References to the body and health or illness were predictive of worsening pain, somatic, and thinking/concentration/fatigue symptom severity over time. An increase in references to others was associated with improvement in somatic symptom severity over time and increases in expressions of causation or cognitive processes were associated with improvement in pain symptom severity over time. Language features derived from usual smartphone use can convey important information about health, functioning, and recovery following a traumatic event. Clinicians might utilize such information to determine who may experience a high symptom burden or risk of worsening posttraumatic symptoms.