Wearables in epilepsy and Parkinson's disease-A focus group study.

OBJECTIVES: Wearable sensors that measure movement and physiological variables are attractive for clinical evaluation of neurological diseases such as epilepsy and Parkinson's disease (PD). The aim of this study was to explore perceptions regarding the use of wearable technology in disease monitoring and management as reported by individuals with epilepsy and Parkinson's disease as well as health professionals working with these patient groups. MATERIALS AND METHODS: Six patient groups (n=25) and two groups with health professionals (n=15) participated in this qualitative, descriptive study with focus group interviews. A manifest qualitative content analysis was used. RESULTS: Four categories and nine subcategories emerged from the analysis. Participants saw possible benefits for improved treatment effect and valued this benefit more than possible inconvenience of wearing the sensors. Discrete design and simplicity were considered as facilitators for improved usability. They emphasized the importance of interactive information between patients and health professionals. However, they were concerned about unclear information and inconclusive recordings and some fears about personal integrity were at odds with the expectations on interactivity. CONCLUSIONS: Patients need to feel well informed and find an added value in using wearables. Wearables need to be user-friendly, have an attractive design, and show clinical efficacy in improving disease management. Variations in perceptions regarding integrity, benefits, and effectiveness of monitoring indicate possible conflicts of expectations among participants. The engagement of end users, patients, and health professionals, in the design and implementation process, is crucial for the development of wearable devices that enhance and facilitate neurological rehabilitation practice.

Cerebrospinal fluid markers of neuronal and glial cell damage to monitor disease activity and predict long-term outcome in patients with autoimmune encephalitis.

BACKGROUND AND PURPOSE: Clinical symptoms and long-term outcome of autoimmune encephalitis are variable. Diagnosis requires multiple investigations, and treatment strategies must be individually tailored. Better biomarkers are needed for diagnosis, to monitor disease activity and to predict long-term outcome. The value of cerebrospinal fluid (CSF) markers of neuronal [neurofilament light chain protein (NFL), and total tau protein (T-tau)] and glial cell [glial fibrillary acidic protein (GFAP)] damage in patients with autoimmune encephalitis was investigated. METHODS: Demographic, clinical, magnetic resonance imaging, CSF and antibody-related data of 25 patients hospitalized for autoimmune encephalitis and followed for 1 year were retrospectively collected. Correlations between these data and consecutive CSF levels of NFL, T-tau and GFAP were investigated. Disability, assessed by the modified Rankin scale, was used for evaluation of disease activity and long-term outcome. RESULTS: The acute stage of autoimmune encephalitis was accompanied by high CSF levels of NFL and T-tau, whereas normal or significantly lower levels were observed after clinical improvement 1 year later. NFL and T-tau reacted in a similar way but at different speeds, with T-tau reacting faster. CSF levels of GFAP were initially moderately increased but did not change significantly later on. Final outcome (disability at 1 year) directly correlated with CSF-NFL and CSF-GFAP levels at all time-points and with CSF-T-tau at 3 ± 1 months. This correlation remained significant after age adjustment for CSF-NFL and T-tau but not for GFAP. CONCLUSION: In autoimmune encephalitis, CSF levels of neuronal and glial cell damage markers appear to reflect disease activity and long-term disability.

Dendritic transmitter release: a comparison of two model systems.

Information flow through neurones was historically considered to be linear, with dendrites receiving information from incoming synaptic terminals, the soma processing the information and the axon carrying it to the terminal that synapses upon another cell or end organ. However, recent studies have shown that dendrites can release transmitters themselves, and thereby communicate with neighbouring structures, whether these are adjacent neurones or incoming synapses. Due to their anatomical features, the magnocellular vasopressin and oxytocin containing neurones of the hypothalamic supraoptic and paraventricular nuclei and the dopamine neurones of the substantia nigra have revealed important aspects of dendritic function including mechanisms of dendritic transmitter release.

Central histaminergic modulation of vestibular function - a review.

Histaminergic drugs have long been used to treat balance disorders in man, but their mechanisms of action in the vestibular system are poorly understood. In this article we review the current literature on histaminergic neurotransmission in the brain focussing particularly in the brainstem vestibular nuclei, and the role of histamine in brain plasticity during "vestibular compensation", the behavioural recovery that takes place after unilateral peripheral vestibular damage. Evidence that histaminergic compounds may facilitate vestibular compensation is reviewed, and we discuss the potential of histaminergic drugs for clinical use.

Influence of R-type (Cav2.3) and t-type (Cav3.1-3.3) antagonists on nigral somatodendritic dopamine release measured by microdialysis.

The release of dopamine from soma and dendrites of dopaminergic neurons in substantia nigra has been reported to be calcium-dependent, but it remains to be determined which calcium channels mediate this effect. We have used in vivo microdialysis in rat substantia nigra and striatum to investigate the effect of Ca(v)3.1-3.3 (T-type) and Ca(v)2.3 (R-type) calcium channel antagonists on somatodendritic and terminal dopamine release. Local reverse dialysis administration of 0.1-10 microM of the Ca(v)2.3 inhibitor SNX-482, or 100 microM of mibefradil, decreased the concentrations of dopamine and its metabolites in dialysate from substantia nigra, whereas 1 microM mibefradil or 40-80 microM nickel(II) induced an increase in nigral dialysate dopamine concentrations. Dopamine concentrations in striatal dialysates were decreased only by 10 microM of SNX-482 or 100 microM of mibefradil. Nickel(II) induced an increase in striatal dialysate dopamine concentration similar to that in substantia nigra. The results indicate a role for Ca(v)2.3 (R-type) voltage sensitive calcium channels in the calcium dependency of somatodendritic dopamine release, but argue against a calcium dependency mediated substantially by Ca(v)3.1-3.3 (T-type) channels.

An investigation of dopaminergic metabolites in the striatum and in the substantia nigra in vivo utilising radiolabelled L-DOPA and high performance liquid chromatography: a new approach in the search for transmitter metabolites.

Although the major routes of dopamine metabolism seem to be established, at least in terminal regions such as the striatum, it is important to search for previously unknown metabolites and to investigate the relevance of previously suggested minor alternative pathways. An urgent issue is to verify and quantify the transformation of dopamine to putative toxic species, another is to further explore metabolism of dopamine located in cell bodies/dendrites, e.g. in the substantia nigra. We have developed a new method in order to widen the search for alternative metabolites of dopamine. The method is based on systemic injection of tritiated L-DOPA to rats in vivo. Brain tissue was homogenised and centrifuged and the resulting supernatant fractioned following passage through a liquid chromatography system. The radioactivity of each fraction was measured using a scintillation system. By identifying fractions containing major catecholamines and metabolites, according to a standard solution, novel metabolites can be searched for in the remaining fractions. It was possible to obtain sufficient radioactivity in separate fractions of supernatant of homogenised tissue, even from such a small brain nucleus as substantia nigra. Radioactivity was obtained in those fractions that contained the major catecholamines and their metabolites, as well as in other fractions where it may represent previously unknown metabolites of L-DOPA/dopamine. The method was used to evaluate the possibility that cytochrome P450 2E1 is involved in the metabolism of dopamine in the substantia nigra. Significant changes in the radioactivity pattern were induced by inhibition of the enzyme but conclusions about whether cytochrome P450 2E1 is involved in the metabolism of dopamine or not requires further studies. The method can be used to study the metabolism of dopamine and can be extended, by using other radiolabelled precursors, also to evaluate metabolism of other transmitters, e.g. serotonin.

Inhibition of cytochrome P450 2E1 induces an increase in extracellular dopamine in rat substantia nigra: a new metabolic pathway?

We presented data previously on dopamine (DA) synthesis and catabolism in the rat substantia nigra (SN) suggesting that a substantial part of the synthesized DA in this brain part is metabolized by unknown nonclassical metabolic pathways. On the basis of that a relatively high density of cytochrome P450 2E1 (CYP 2E1) has been detected in rat SN the aim of the present study was to investigate the possibility that this enzyme is involved in the metabolism of DA. Systemic administration of either phenylethyl isothiocyanate (100 mg/kg ip), diethyldithiocarbamate (500 mg/kg, ip) or diallyl sulfide (200 mg/kg, sc or ip), three different inhibitors of cytochrome P450 2E1, induced an increase of the extracellular DA concentration in the SN, measured with microdialysis in awake rats, by 130%, 90%, and 35%, respectively. A tendency to increased concentrations of the classical DA metabolites in the dialysate from the SN was also observed in some experiments. In the striatum, no profound effects were induced by the drugs on the concentrations of DA or its metabolites. The results show that CYP 2E1 activity affects dopaminergic neurotransmission in the SN, possibly by participating in DA metabolism. Other mechanisms, such as the influence on the DA transporter or the release process cannot, however, be ruled out.

Effects of local administration of L-, N-, and P/Q-type calcium channel blockers on spontaneous dopamine release in the striatum and the substantia nigra: a microdialysis study in rat.

The pivotal role for voltage-sensitive calcium channels in initiating synaptic transmitter release is undisputed, but it is only partly known to what extent the different subtypes contribute in vivo. Their importance for the dendritic release of dopamine has not been investigated in vivo previously. To evaluate comprehensively the relative importance of different voltage-sensitive calcium channel subtypes for striatal dopamine release, and to further investigate the mechanism of dendritic dopamine release in the reticulate part of substantia nigra, dopamine was measured by in vivo microdialysis in the striatum or substantia nigra of awake rats. The calcium channel blockers nimodipine, omega-conotoxin-GVIA, omega-agatoxin-IVA, and neomycin were administered locally through the dialysis probes and compared with calcium-free perfusion. Results indicate that dopamine release in the striatum is mainly dependent on N- and P/Q-type channels, but the dendritic dopamine release in the substantia nigra is mediated mainly by some other calcium-dependent mechanism, for example, calcium mobilization through T-, O-, or R-type calcium channels. A portion of the dendritic release is calcium independent but can be inhibited partially by neomycin, which might suggest a role for inositol 4,5-bisphosphate breakdown products.

3-Methoxytyramine formation following monoamine oxidase inhibition is a poor index of dendritic dopamine release in the substantia nigra.

This study was undertaken, using microdialysis, to compare the extracellular concentration of 3-methoxytyramine and dopamine in dialysate from the striatum and substantia nigra, after pargyline (75 mg/kg), after pargyline plus amphetamine (3 mg/kg), and after pargyline plus reserpine (5 mg/kg) administration. Treatment with pargyline alone increased the extracellular dopamine concentration by 70% in the striatum and by 140% in the substantia nigra and induced in both regions a time-dependent accumulation of 3-methoxytyramine. The addition of d-amphetamine to pargyline increased the extracellular dopamine concentration, compared with pargyline-treated controls, to the same extent in both the substantia nigra (maximally by 360%) and the striatum (maximally by 400%), but the concomitant increase of 3-methoxytyramine accumulation in the dialysate was relatively smaller in the substantia nigra compared with the striatum. Reserpine treatment decreased the extracellular dopamine concentration in both regions below the detection level (<10% of basal value). When pargyline was added to reserpine, the striatal extracellular dopamine concentration increased to 50% of pargyline-treated controls and the striatal 3-methoxytyramine accumulation was less than in pargyline-treated controls. However, in the substantia nigra, the addition of pargyline to reserpine resulted in dopamine concentrations as high as after pargyline only and the 3-methoxytyramine accumulation was not changed compared with pargyline-treated controls. In summary, our results indicate that dopamine in the substantia nigra is released from reserpine-sensitive storage sites and that pargyline-induced 3-methoxytyramine accumulation is a poor indicator of the local dopamine release. The latter observation may be explained by the fact that the dopamine-metabolizing enzyme, catechol-O-methyltransferase, is located inter alia in the dopamine-containing cell bodies/dendrites in the substantia nigra, in contrast to the situation in the terminals in the striatum where catechol-O-methyltransferase is located only in nondopaminergic cells.

Use of computer-assisted image analysis for noninvasive evaluation of oral lichenoid reactions and oral leukoplakia.

The objective of the present study was to elaborate and to evaluate a method in which the clinical appearance of a mucosal lesion could be expressed by means of color and morphologic features extracted from digitized images. The ability to express mucosal changes with image features was evaluated, as was the accuracy of a classification of the lesions on the basis of image feature analysis. Computer-assisted image analysis was performed on digitized color slides from 76 patients with lichenoid reactions that included both oral lichen planus and contact lesions and 20 patients with homogenous oral leukoplakia. Color features were measured according to the intensity-hue-saturation color system, and morphologic features were estimated by tracing the hyperkeratotic area. Hyperkeratinizing and inflammatory tissue reactions could be demonstrated and defined by image analysis. Image features indicating inflammatory tissue reactions were more pronounced in cases of oral lichenoid reactions. Morphologic parameters could express the anatomic appearance of the lesions. The comparison between histopathologic diagnosis and a classification through computerized analysis demonstrated that 90.5% of oral lichenoid reactions could be separated from homogenous oral leukoplakia by linear discriminant analysis.

Computer analysis in oral lichenoid reactions.

To improve diagnostic procedures and facilitate clinical decision-making, computer-assisted image analysis was performed on color slides from 30 patients with histopathologically verified oral lichenoid reactions. Areas from white hyperkeratotic and adjacent red inflamed areas of the lesions were selected and subjected to image analysis. The digitization of the color slides was done by means of an image scanner, and the digital information was transmitted to a personal computer for subsequent feature extraction and analysis. The different oral lesions were characterized as the difference in mean values between white hyperkeratotic and red inflamed areas, respectively, compared with clinically normal tissue. Statistical analyses were made on three different color systems: Red-Green-Blue (RGB), normalized red-green-blue (rgb), and Intensity-Hue-Saturation (IHS). The results showed statistically significant differences in all color systems for both the hyperkeratotic areas and adjacent inflammatory reactions. A linear correlation was obtained when the results of the image analysis of color variations were compared with a clinical score system for hyperkeratosis and inflammation evaluated by two investigators independently.