Displaying publications 1 - 20 of 29 in total

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  1. Lee RE, Chan PY
    Sci Rep, 2023 Oct 30;13(1):18622.
    PMID: 37903843 DOI: 10.1038/s41598-023-45802-z
    The distinction between Parkinson's disease (PD) and essential tremor (ET) tremors is subtle, posing challenges in differentiation. To accurately classify the PD and ET, BiLSTM-based recurrent neural networks are employed to classify between normal patients (N), PD patients, and ET patients using accelerometry data on their lower arm (L), hand (H), and upper arm (U) as inputs. The trained recurrent neural network (RNN) has reached 80% accuracy. The neural network is analyzed using layer-wise relevance propagation (LRP) to understand the internal workings of the neural network. A novel explainable AI method, called LRP-based approximate linear weights (ALW), is introduced to identify the similarities in relevance when assigning the class scores in the neural network. The ALW functions as a 2D kernel that linearly transforms the input data directly into the class scores, which significantly reduces the complexity of analyzing the neural network. This new classification method reconstructs the neural network's original function, achieving a 73% PD and ET tremor classification accuracy. By analyzing the ALWs, the correlation between each input and the class can also be determined. Then, the differentiating features can be subsequently identified. Since the input is preprocessed using short-time Fourier transform (STFT), the differences between the magnitude of tremor frequencies ranging from 3 to 30 Hz in the mean N, PD, and ET subjects are successfully identified. Aside from matching the current medical knowledge on frequency content in the tremors, the differentiating features also provide insights about frequency contents in the tremors in other frequency bands and body parts.
    Matched MeSH terms: Tremor; Essential Tremor*
  2. Choo XY, Lim SY, Chinna K, Tan YJ, Yong VW, Lim JL, et al.
    Neurol Sci, 2020 Oct;41(10):2831-2842.
    PMID: 32314118 DOI: 10.1007/s10072-020-04396-4
    INTRODUCTION: Little is known regarding the educational needs and perspectives of people living with Parkinson's disease (PD), particularly in Asia.

    OBJECTIVE: To assess knowledge and perceptions regarding PD in a large multiethnic urban Asian cohort of patients and caregivers.

    METHODS: We conducted a survey at a university hospital neurology clinic, using a novel Knowledge and Perception of Parkinson's Disease Questionnaire (KPPDQ).

    RESULTS: The KPPDQ had satisfactory psychometric properties among patients and caregivers. Five hundred subjects were recruited with a 97% response rate (211 patients, 273 caregivers). Non-motor symptoms such as urinary problems, visual hallucinations and pain were relatively poorly recognized. Many (≈ 50-80%) respondents incorrectly believed that all PD patients experience tremor, that PD is usually familial, and that there is a cure for PD. About one-half perceived PD to be caused by something the patient had done in the past, and that PD medications were likely to cause internal organ damage. Issues of stigma/shame were relevant to one-third of patients, and 70% of patients perceived themselves to be a burden to others. Two-thirds of participants felt that PD imposed a heavy financial toll. Participants were about equally divided as to whether they would consider treatment with deep brain stimulation, tube feeding or invasive ventilation. Over three-quarters of patients expressed a preference to die at home.

    CONCLUSIONS: Important knowledge gaps, misperceptions and perspectives on PD were identified, highlighting the need for further efforts to raise awareness and provide accurate information regarding PD, and to address patient's and caregivers' needs and preferences.

    Matched MeSH terms: Tremor
  3. Huang YH, Lee MT, Hsueh HY, Knutson DE, Cook J, Mihovilovic MD, et al.
    Neurotherapeutics, 2023 Mar;20(2):399-418.
    PMID: 36696034 DOI: 10.1007/s13311-023-01342-y
    Ethanol has been shown to suppress essential tremor (ET) in patients at low-to-moderate doses, but its mechanism(s) of action remain unknown. One of the ET hypotheses attributes the ET tremorgenesis to the over-activated firing of inferior olivary neurons, causing synchronic rhythmic firings of cerebellar Purkinje cells. Purkinje cells, however, also receive excitatory inputs from granule cells where the α6 subunit-containing GABAA receptors (α6GABAARs) are abundantly expressed. Since ethanol is a positive allosteric modulator (PAM) of α6GABAARs, such action may mediate its anti-tremor effect. Employing the harmaline-induced ET model in male ICR mice, we evaluated the possible anti-tremor effects of ethanol and α6GABAAR-selective pyrazoloquinolinone PAMs. The burrowing activity, an indicator of well-being in rodents, was measured concurrently. Ethanol significantly and dose-dependently attenuated action tremor at non-sedative doses (0.4-2.4 g/kg, i.p.). Propranolol and α6GABAAR-selective pyrazoloquinolinones also significantly suppressed tremor activity. Neither ethanol nor propranolol, but only pyrazoloquinolinones, restored burrowing activity in harmaline-treated mice. Importantly, intra-cerebellar micro-injection of furosemide (an α6GABAAR antagonist) had a trend of blocking the effect of pyrazoloquinolinone Compound 6 or ethanol on harmaline-induced tremor. In addition, the anti-tremor effects of Compound 6 and ethanol were synergistic. These results suggest that low doses of ethanol and α6GABAAR-selective PAMs can attenuate action tremor, at least partially by modulating cerebellar α6GABAARs. Thus, α6GABAARs are potential therapeutic targets for ET, and α6GABAAR-selective PAMs may be a potential mono- or add-on therapy.
    Matched MeSH terms: Tremor/drug therapy
  4. As'arry A, Md Zain MZ, Mailah M, Hussein M
    Proc Inst Mech Eng H, 2013 Nov;227(11):1171-80.
    PMID: 23901066 DOI: 10.1177/0954411913494325
    Patients with hand tremors may find routine activities such as writing and holding objects affected. In response to this problem, an active control technique has been examined in order to lessen the severity of tremors. In this article, an online method of a hybrid proportional-integral control with active force control strategy for tremor attenuation is presented. An intelligent mechanism using iterative learning control is incorporated into the active force control loop to approximate the estimation mass parameter. Experiments were conducted on a dummy hand model placed horizontally in a tremor test rig. When activated by a shaker in the vertical direction, this resembles a postural tremor condition. In the proportional-integral plus active force control, a linear voice coil actuator is used as the main active tremor suppressive element. A sensitivity analysis is presented to investigate the robustness of the proposed controller in a real-time control environment. The findings of this study demonstrate that the intelligent active force control and iterative learning controller show excellent performance in reducing tremor error compared to classic pure proportional, proportional-integral and hybrid proportional-integral plus active force control controllers.
    Matched MeSH terms: Tremor/physiopathology*; Tremor/therapy*
  5. Lim SY, Ishiura H, Ramli N, Shibata S, Almansour MA, Tan AH, et al.
    Parkinsonism Relat Disord, 2020 05;74:25-27.
    PMID: 32289521 DOI: 10.1016/j.parkreldis.2020.03.025
    Two ethnic Chinese men with clinico-radiologic features of Fragile X-associated tremor-ataxia syndrome (FXTAS) were found on genetic testing to have neuronal intranuclear inclusion disease (NIID), highlighting that NIID should be considered in the differential diagnosis of FXTAS. NIID may also be much more common than FXTAS in certain Asian populations.
    Matched MeSH terms: Tremor/diagnosis*; Tremor/physiopathology
  6. Lim KS, Hew YC, Lau HK, Lim TS, Tan CT
    Can J Neurol Sci, 2009 Jan;36(1):60-4.
    PMID: 19294890
    BACKGROUND AND OBJECTIVES: There is lack of published data on bulbar signs among the healthy population. This study aims to determine the range of normality of bulbar signs particularly among the elderly.

    METHODS: Systemic examination of bulbar signs was carried out according to a predetermined protocol on a cohort of young and elderly healthy subjects.

    RESULTS: A total of 206 subjects were recruited in the study, 104 young adults with mean age of 20 years, and 102 elderly with mean age of 73 years. Uvula deviation was seen in 28 (26.9%) young subjects and 22 (21.6%) elderly. Irregular tongue border was seen in 17 subjects, unilateral in 4 subjects. Fourteen (6.8%) subjects had deviation on tongue protrusion. Occasional tremor of tongue on protrusion is common in both young and old. Persistent (severe) tongue tremor on protrusion was seen in 18.6% of the elderly, and 4.8% of the young. None of the subjects had tremor of tongue at rest. In gag reflex, absence of gagging response was common in elderly, seen in two thirds of the subjects on stimulation of the posterior pharyngeal wall. However, all the subjects had uvular movement. Habituation or suppression of gagging response was seen in close to 90% of young males.

    CONCLUSION: There is wide range of normality in bulbar signs in normal population, particularly among the elderly.

    Matched MeSH terms: Tremor/pathology; Tremor/physiopathology
  7. McWhirter L, Morris S
    Eur Addict Res, 2010;16(4):229-31.
    PMID: 20798544 DOI: 10.1159/000320288
    Kratom (Mitragyna speciosa) has been used for medicinal and recreational purposes. It has reported analgesic, euphoric and antitussive effects via its action as an agonist at opioid receptors. It is illegal in many countries including Thailand, Malaysia, Myanmar, South Korea and Australia; however, it remains legal or uncontrolled in the UK and USA, where it is easily available over the Internet. We describe a case of kratom dependence in a 44-year-old man with a history of alcohol dependence and anxiety disorder. He demonstrated dependence on kratom with withdrawal symptoms consisting of anxiety, restlessness, tremor, sweating and cravings for the substance. A reducing regime of dihydrocodeine and lofexidine proved effective in treating subjective and objective measures of opioid-like withdrawal phenomena, and withdrawal was relatively short and benign. There are only few reports in the literature of supervised detoxification and drug treatment for kratom dependence. Our observations support the idea that kratom dependence syndrome is due to short-acting opioid receptor agonist activity, and suggest that dihydrocodeine and lofexidine are effective in supporting detoxification.
    Matched MeSH terms: Tremor/chemically induced*
  8. Fadilah SA, Raymond AA, Cheong SK
    Postgrad Med J, 2001 Apr;77(906):268-269; discussion 277-8.
    PMID: 11264499
    Matched MeSH terms: Tremor/etiology*
  9. Chang SH, Lim CS, Low TS, Chong HT, Tan SY
    Transplant Proc, 2001 12 26;33(7-8):3700-1.
    PMID: 11750577
    Matched MeSH terms: Tremor/chemically induced
  10. Dahmardeh N, Shabani M, Basiri M, Kalantaripour TP, Asadi-Shekaari M
    Malays J Med Sci, 2019 Jul;26(4):28-38.
    PMID: 31496891 DOI: 10.21315/mjms2019.26.4.4
    Background: There is a meaningful necessity for a targeted therapy of essential tremor (ET), as medications have not been developed specifically for ET. For nearly a century, many drugs have been applied in the treatment of tremor but the drug treatment of ET remains still unknown. Some potential therapeutic factors such fingolimod (FTY720) can be effectively used to treat ET in animals. In the present research, the effect of FTY720, the immunomodulatory sphingosine 1-phosphate (S1P) analog, on degeneration of cerebellar and olivary neurons induced by harmaline in male rats was investigated.

    Methods: The animals were allotted into control dimethyl sulfoxide (DMSO), saline + harmaline [30 mg/kg, intraperitoneally, (i.p.)], harmaline + FTY720 (1 mg/kg, i.p, 1 h and 24 h before harmaline injection) groups (n = 10). The cerebellum and inferior olive nucleus (ION) were studied for neuronal degeneration using immunohistochemistry (IHC) and ultrastructural study by transmission electron microscopy (TEM) techniques.

    Results: Harmaline caused neuronal cell loss, caspase-3 mediated apoptosis, astrocytosis and ultrastructural changes in cerebellar Purkinje cells and inferior olive neurons. FTY720 exhibited neuroprotective effects on cerebellar Purkinje cells and inferior olivary neurons.

    Conclusion: These results suggest that FTY720 has potential efficacy for prevention of ET neurodegeneration and astrocytosis induced by harmaline in male rats.

    Matched MeSH terms: Tremor; Essential Tremor
  11. Chan PY, Mohd Ripin Z, Abdul Halim S, Kamarudin MI, Ng KS, Eow GB, et al.
    Sci Rep, 2019 May 31;9(1):8117.
    PMID: 31148550 DOI: 10.1038/s41598-019-44142-1
    There is a lack of evidence that either conventional observational rating scale or biomechanical system is a better tremor assessment tool. This work focuses on comparing a biomechanical system and the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale in terms of test-retest reliability. The Parkinson's disease tremors were quantified by biomechanical system in joint angular displacement and predicted rating, as well as assessed by three raters using observational ratings. Qualitative comparisons of the validity and function are made also. The observational rating captures the overall severity of body parts, whereas the biomechanical system provides motion- and joint-specific tremor severity. The tremor readings of the biomechanical system were previously validated against encoders' readings and doctors' ratings; the observational ratings were validated with previous ratings on assessing the disease and combined motor symptoms rather than on tremor specifically. Analyses show that the predicted rating is significantly more reliable than the average clinical ratings by three raters. The comparison work removes some of the inconsistent impressions of the tools and serves as guideline for selecting a tool that can improve tremor assessment. Nevertheless, further work is required to consider more variabilities that influence the overall judgement.
    Matched MeSH terms: Tremor/diagnosis*
  12. Low HL, Ismail MNBM, Taqvi A, Deeb J, Fuller C, Misbahuddin A
    Clin Neurol Neurosurg, 2019 Oct;185:105466.
    PMID: 31466022 DOI: 10.1016/j.clineuro.2019.105466
    OBJECTIVE: To compare posterior subthalamic area deep brain stimulation (PSA-DBS) performed in the conventional manner against diffusion tensor imaging and tractography (DTIT)-guided lead implantation into the dentatorubrothalamic tract (DRTT).

    PATIENTS AND METHODS: Double-blind, randomised study involving 34 patients with either tremor-dominant Parkinson's disease or essential tremor. Patients were randomised to Group A (DBS leads inserted using conventional landmarks) or Group B (leads guided into the DRTT using DTIT). Tremor (Fahn-Tolosa-Marin) and quality-of-life (PDQ-39) scores were evaluated 0-, 6-, 12-, 36- and 60-months after surgery.

    RESULTS: PSA-DBS resulted in marked tremor reduction in both groups. However, Group B patients had significantly better arm tremor control (especially control of intention tremor), increased mobility and activities of daily living, reduced social stigma and need for social support as well as lower stimulation amplitudes and pulse widths compared to Group A patients. The better outcomes were sustained for up to 60-months from surgery. The active contacts of Group B patients were consistently closer to the centre of the DRTT than in Group A. Speech problems were more common in Group A patients.

    CONCLUSION: DTIT-guided lead placement results in better and more stable tremor control and fewer adverse effects compared to lead placement in the conventional manner. This is because DTIT-guidance allows closer and more consistent placement of leads to the centre of the DRTT than conventional methods.

    Matched MeSH terms: Essential Tremor/physiopathology; Essential Tremor/therapy*
  13. Lim SY, Hodaie M, Fallis M, Poon YY, Mazzella F, Moro E
    Arch. Neurol., 2010 May;67(5):584-8.
    PMID: 20457958 DOI: 10.1001/archneurol.2010.69
    Gamma knife thalamotomy (GKT) has been used as a therapeutic option for patients with disabling tremor refractory to medications. Impressive improvement of tremor has been reported in the neurosurgical literature, but the reliability of such data has been questioned.
    Matched MeSH terms: Essential Tremor/pathology; Essential Tremor/physiopathology; Essential Tremor/surgery*
  14. Bhidayasiri R, Rattanachaisit W, Phokaewvarangkul O, Lim TT, Fernandez HH
    Parkinsonism Relat Disord, 2019 Feb;59:74-81.
    PMID: 30502095 DOI: 10.1016/j.parkreldis.2018.11.005
    The proper diagnosis of parkinsonian disorders usually involves three steps: identifying core features of parkinsonism; excluding other causes; and collating supportive evidence based on clinical signs or investigations. While the recognition of cardinal parkinsonian features is usually straightforward, the appreciation of clinical features suggestive of specific parkinsonian disorders can be challenging, and often requires greater experience and skills. In this review, we outline the clinical features that are relevant to the differential diagnosis of common neurodegenerative parkinsonian disorders, including Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration. We aim to make this process relatable to clinicians-in-practice, therefore, have categorised the list of clinical features into groups according to the typical sequence on how clinicians would elicit them during the examination, starting with observation of facial expression and clinical signs of the face, spotting eye movement abnormalities, examination of tremors and jerky limb movements, and finally, examination of posture and gait dysfunction. This review is not intended to be comprehensive. Rather, we have focused on the most common clinical signs that are potentially key to making the correct diagnosis and those that do not require special skills or training for interpretation. Evidence is also provided, where available, such as diagnostic criteria, consensus statements, clinicopathological studies or large multi-centre registries. Pitfalls are also discussed when relevant to the diagnosis. While no clinical signs are pathognomonic for certain parkinsonian disorders, certain clinical clues may assist in narrowing a differential diagnosis and tailoring focused investigations for the individual patient.
    Matched MeSH terms: Tremor
  15. Sohayla M. Attalla, Nur Syamimi Syuhada bt Safiee, Sakinah Ruhi
    MyJurnal
    Introduction: Cell phone is a device that has been used almost every day for all age groups. It connects everyone and everything around the world as it provides various social platforms. However, not many people realized that cell phone is a source of non-ionizing electromagnetic waves that can be associated with various physical effects. Therefore, the aim of this research is to identify the physical side effects associated with exposure to the electromagnetic waves emitted by cell phone use and to detect if these effects are associated with specific pattern of use. Methods: A cross-sectional study was conducted on 166 participants randomly selected from university students. Results: showed that those suffering side effects associated with cell phone usage are usually using more than one cell phone (79%) since about 5 – 10 years (41.9%) for more than 5 hours daily (65.7%) for entertainment (34.3%) and
    making about 1-5 calls daily (41%) with average call duration 1 – 30 min (56.2%). 66.7% of them started using cell phone at age 7 – 12 years old, mostly handheld (61%), at their right side (40%), at all times of the day (64.8%). Most common side effects associated with cell phone usage include ear pain (52.4%), headache (79.5%), fatigue, anxiety or insomnia (57.8%), tremors and eye pain beside statistically significant (P
    Matched MeSH terms: Tremor
  16. Ponnusamy, S., Shazli Ezzat Ghazali
    MyJurnal
    This paper reports a clinical case study on the effectiveness of Cognitive-Behavioral Treatment (CBT) in treating panic attack with agoraphobia in a local health psychology clinic. M.N., a 24 year old male, complained of nightmares, heart palpitations, sweating, tremors and fearful feelings for the past one and a half years. He felt anxious about going to crowded places such as bus stations, night markets, supermarkets, and mosques and being left alone in any place which he was not familiar with. This case study adopted an ABC design whereby the subject was assessed at three different phases: pre-treatment, mid-treatment and post-treatment. Four standard assessment measures were administered: Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Anxiety Scale of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and State-Trait Anxiety Inventory (STAI). The subject responded well to 12 sessions of intervention employed in the study based on CBT model and this could be noticed by minimal score on the entire psychological test administered. The application of behavioral and cognitive strategies became more effective due to patient’s ability to understand and also due to his cooperative behavior. He responded well to imagery exposure and in-vivo gradual exposure and successfully went to shopping malls, used lifts at Kuala Lumpur Tower, went to night markets and used public transport.
    Matched MeSH terms: Tremor
  17. Chan, Y.F., Zainal, N.Z.
    MyJurnal
    Parkinson Disease (PD) is a neurodegenerative disorder of the central nervous system that often impairs the patient’s motor skills, speech and other functions. The four cardinal signs of parkinsonism are resting tremor, bradykinesia, cogwheel rigidity and postural instability. The prevalence of depression in PD ranges from 4% to 75%. However depression in PD is often mistakenly as the presentation of the disease itself. Therefore this paper reviewed the clinical feature of depression in PD and explored the aetiology of depression in PD.
    Matched MeSH terms: Tremor
  18. Obaid, Kadhim Jawad, Sood, Suneet
    Medical Health Reviews, 2009;2009(1):59-73.
    MyJurnal
    Robotic surgery is a technique that uses mechanical, computercontrolled arms to conduct surgical operations. It carries the advantages of minimal access associated with laparoscopic surgery, and of precision associated with open surgery. It is also feasible to conduct robotic surgery with the surgeon far away, by “telerobotics”. The robot is more versatile than the human arm, and less susceptible to tremors. The view is excellent, and it is possible to conduct more intricate procedures than are possible with the human hand. Robotics has been in use for over seven years, and the initial experience shows that the success rate is over 90%, with only about 10% of cases needing to be converted to open surgery. Blood loss is low, and tumour margins in cancer surgery are satisfactory. Surgeons have used robotics for procedures in urology, gastrointestinal surgery, gynecology, cardiac surgery, neurosurgery, orthopedics, and other specialties. Presently, robotics suffers from two major disadvantages: one, that it is very expensive, and two, that robotic procedures take significantly longer than do open or laparoscopic procedures.
    Matched MeSH terms: Tremor
  19. Hur, Tae Hun, Kim, Hyung Jun, Choi, Yun Im, Jeong, Du Shin, Park, Hyung Kook, Yang, Kwang Ik
    Neurology Asia, 2013;18(1):99-101.
    MyJurnal
    Acute mountain sickness is an illness caused by climbing to a high altitude without prior acclimatization. Neurological consequences, like parkinsonism following acute mountain sickness without lesion of brain MRI have been reported rarely. A healthy 56-year-old man presented with dysarthria and gait disturbance. Neurological examination revealed tremor of hands, limb rigidity, and bradykinesia. The symptoms developed approximately 30 days following a 3,500 m climb of the Annapurna in the Himalayas. Brain MRI did not reveal any abnormalities including globus pallidus. The parkinsonism symptoms persisted for about 3 months before a complete recovered was made. We suggest that parkinsonism can develop after climbing to a high altitude but that the symptoms can be transient if a brain MRI detects no abnormalities.
    Matched MeSH terms: Tremor
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