An ambulatory dyskinesia monitor

A J Manson, P Brown, J D O'Sullivan, P Asselman, D Buckwell, A J Lees

New treatments are now becoming available for the management of levodopa induced dyskinesias in Parkinsons's disease. However, assessment of their efficacy is limited by the inadequacies of current methods of dyskinesia measurement. The objective was to develop and validate a portable device capable of objectively measuring dyskinesias during normal daily activities. A portable device was developed based on a triaxial accelerometer, worn on the shoulder, and a data recorder that can record levodopa induced dyskinesias. A computer program plots raw acceleration and acceleration over 0.5 Hz frequency bands against time. The acceleration in the different bands can then be compared with the raw acceleration trace, enabling identification and exclusion of confounding activities such as tremor and walking, which have a characteristic appearance on the trace. The validity of this device was assessed on 12 patients and eight age matched controls by comparing accelerations in the 1-3 Hz frequency band with established clinical dyskinesia rating scales. While wearing the monitor, subjects were videorecorded sitting and during dyskinesia provocation tasks, including mental activation tasks, eating, drinking, writing, putting on a coat, and walking. The dyskinesias were graded with both modified abnormal involuntary movement (AIM) and Goetz scales. The clinical ratings were then compared with the mean acceleration scores. Acceleration in the 1-3 Hz frequency band correlated well against both scales, during all individual tasks. Acceleration produced by normal voluntary activity (with the exception of walking, which produced large accelerations, even in controls) was small compared with dyskinetic activity. With walking excluded, the mean acceleration over the rest of the recording time correlated strongly with both the modified AIM (Spearman's rank (r=0.972, p<0.001) and Goetz (r=0.951, p<0.001) scales. This method provides an accurate, objective means for dyskinesia assessment, and compares favourably with established methods currently used.