Browsing by Author "Bukhari-Parlakturk, Noreen"
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Item Open Access Suitability of Automated Writing Measures for Clinical Trial Outcome in Writer's Cramp.(Movement disorders : official journal of the Movement Disorder Society, 2023-01) Bukhari-Parlakturk, Noreen; Lutz, Michael W; Al-Khalidi, Hussein R; Unnithan, Shakthi; Wang, Joyce En-Hua; Scott, Burton; Termsarasab, Pichet; Appelbaum, Lawrence G; Calakos, NicoleBackground
Writer's cramp (WC) dystonia is a rare disease that causes abnormal postures during the writing task. Successful research studies for WC and other forms of dystonia are contingent on identifying sensitive and specific measures that relate to the clinical syndrome and achieve a realistic sample size to power research studies for a rare disease. Although prior studies have used writing kinematics, their diagnostic performance remains unclear.Objective
This study aimed to evaluate the diagnostic performance of automated measures that distinguish subjects with WC from healthy volunteers.Methods
A total of 21 subjects with WC and 22 healthy volunteers performed a sentence-copying assessment on a digital tablet using kinematic and hand recognition softwares. The sensitivity and specificity of automated measures were calculated using a logistic regression model. Power analysis was performed for two clinical research designs using these measures. The test and retest reliability of select automated measures was compared across repeat sentence-copying assessments. Lastly, a correlational analysis with subject- and clinician-rated outcomes was performed to understand the clinical meaning of automated measures.Results
Of the 23 measures analyzed, the measures of word legibility and peak accelerations distinguished subjects with WC from healthy volunteers with high sensitivity and specificity and demonstrated smaller sample sizes suitable for rare disease studies, and the kinematic measures showed high reliability across repeat visits, while both word legibility and peak accelerations measures showed significant correlations with the subject- and clinician-rated outcomes.Conclusions
Novel automated measures that capture key aspects of the disease and are suitable for use in clinical research studies of WC dystonia were identified. © 2022 International Parkinson and Movement Disorder Society.Item Open Access Transcranial magnetic stimulation: the road to clinical therapy for dystonia(Dystonia) Mulcahey, Patrick J; Peterchev, Angel V; Calakos, Nicole; Bukhari-Parlakturk, NoreenDespite many research studies, transcranial magnetic stimulation (TMS) is not yet an FDA-approved clinical therapy for dystonia patients. This review describes the four major challenges that have historically hindered the clinical translation of TMS. The four challenges described are limited types of clinical trial designs, limited evidence on objective behavioral measures, variability in the TMS clinical response, and the extensive TMS parameters to optimize for clinical therapy. Progress has been made to diversify the types of clinical trial design available to clinical researchers, identify evidence-based objective behavioral measures, and reduce the variability in TMS clinical response. Future studies should identify objective behavioral measures for other dystonia subtypes and expand the optimal TMS stimulation parameters for clinical therapy. Our review highlights the key progress made to overcome these barriers and gaps that remain for TMS to develop into a long-lasting clinical therapy for dystonia patients.