NeuroTREMOR: A novel concept for support to diagnosis and remote management of tremor.
The most common movement disorder experienced as human beings become older is tremors. In fact, around 65 per cent of the population with tremors are likely to struggle with difficulties in performing daily activities. Whilst tremors themselves are not life-threatening, some of the resulting functional disabilities and social inconveniences can be very distressing for the elderly. Currently, the most common way to manage tremors is through either medication, surgery or deep brain stimulation. The problem is that for nearly one quarter of all patients these treatments are ineffective.
NeuroTREMOR studied a novel concept for the study, assessment, and suppression of upper limb tremor. The system takes the form of a neuroprosthesis that attenuates the tremor through implantable neuromodulation. NeuroTREMOR performed the most advanced to date recordings of the central and peripheral nervous systems and the biomechanics of the affected limb in tremor patients. This allowed the development of the first non-invasive way of supporting tremor diagnosis based on the behavior of individual motor units in tremor, and of accessing the tremulous component of movement. NeuroTREMOR platform also use information from MRI to support clinicians in the differential diagnosis of tremors from Parkinson and Essential tremor.
NeuroTREMOR developed and implemented functional prototypes of a neuroprothesis to evaluate tremor suppression through neuromodulation of tremor mechanisms. These prototypes incorporated the implantable electrodes, the sensors that interface with the user and the control electronics, with their corresponding software. Up to 27 users suffering from different types of tremor participated in a series of proof of concept sessions. The final outcome is that the novel strategies for tremor suppression defined in NeuroTREMOR has the potential to compensate tremors but further validation is required.
Tremor is the most common movement disorder and is strongly increasing in incidence and prevalence with ageing. Pathological tremors arise due to various conditions, making it very complicated to differentiate them according to their aetiology. This motivates the occurrence of exceedingly common misdiagnosis. Since treatment of tremors is disease specific, accurate diagnosis plays a fundamental role in tremor management.
The tool will provide support to both clinical tremor diagnosis and pathophysiological and neurophysiological research studies. Accurate and objective computer-aided quantification of pathological tremor will promote evidence-based tremor diagnosis, personalized tremor treatment and pathophysiological studies of different subgroups of tremor patients. Starting in the NeuroTREMOR project and further developed within the framework of the foreseen multicenter validation, a large database of reference tremor patients and their subgroups will be created, providing and interconnecting standardized neurophysiological, clinical, neuroimaging and psychological profiles of pathological tremor patients, along with computer-aided measures of deviation of individual patients from these profiles. In order to promote the use of the system, the results of patient’s classification and profile developments will be integrated into new clinical tremor assessment scales.