Ambulatory surface electromyography with accelerometry for evaluating daily motor fluctuations in Parkinson's disease

Abstract

Objective: To evaluate motor fluctuations in patients with advanced Parkinson's disease (PD) using a small-sized wearable device for surface electromyography (EMG) with accelerometry (ACC) for 24 hours.

Methods: Seven PD patients with medication were measured once, and nine patients with directional deep brain stimulation (dDBS) twice: before and after the dDBS reprogramming. EMG and ACC parameters were compared with clinical rating scores and patients' home diaries.

Results: The combination of EMG and ACC parameters (first principal component PC₁) correlated significantly with patient's condition as quantified by the motor score of Unified Parkinson's Disease Rating Scale and it changed significantly with dDBS reprogramming in line with decreased PD symptoms. Monitoring data detected in comparison with the home diaries: 91 % concordance with tremor, 76 % with rigidity, and 74 % with dyskinesia. In the DBS group, the wake-up time with abnormal neuromuscular function was reduced with reprogramming in all except one patient based on measurements.

Conclusions: A wearable device measuring simultaneously both muscle activity and motion can provide continuous and dynamic information about patient's condition and motor fluctuations at home.

Significance: The present method may help to modify pharmacologic management and DBS treatment in advanced PD.

Keywords: Accelerometry (ACC); Ambulatory monitoring; Directional deep brain stimulation (dDBS); Motor fluctuations; Parkinson’s disease (PD); Surface electromyography (EMG).