A double-blind, placebo controlled, crossover study of Divalproex sodium-induced tremor: Delayed versus extended release formulations

A randomized, double-blind, crossover study investigating tremor severity that occurs as a result of treatment with ER Depakote® (Abbott Laboratories, Abbott Park, Il) among a population of patients with epilepsy currently treated with DR Depakote®. Patients in the study suffer from clinically significant tremors. Tremor severity is quantified multiple ways: clinically, using rating scales, and objectively using surface EMG, accelerometry and spiral analysis.

Validation of spiral analysis in early Parkinson's disease

In collaboration with Dr. Rachel Saunders-Pullman of the Beth Israel Medical Center and Albert Einstein College of Medicine, we are performing a longitudinal study of patients identified with early Parkinson's disease. This study is investigating the correlation between a standard clinical rating scale (Unified Parkinson's Disease Rating Scale) and spiral indices with the goal of evaluating spiral analysis as a tool for quantifying clinical and sub-clinical motor control issues in Parkinson's disease. An additional goal is to monitor the change in test output over time, and explore the predictive value of spiral analysis.

A Phase I/II randomized controlled study of OGT 918 in adult and juvenile patients with Niemann-Pick Disease Type C

In collaboration with, Dr. Marc Patterson in the Pediatric Neurology division, the Clinical Motor Physiology Laboratory is part of a multi-center project to assess tremor in Niemann Pick Type C patients before and after treatment with study medication. A corollary goal is to provide the first motor physiology-based description of this rare disorder.

Open-label evaluation of the efficacy of botulinum toxin in the treatment of focal dystonia in musicians

Musician's Dystonia is one of the focal occupational conditions characterized by involuntary muscle spasms, abnormal postures and movements, tremors, and pain that can seriously impede a musician's ability to play, or even continue a professional career. The goal of this project is to use analysis of digitized musical performance to assess changes in dystonic symptoms before and after treatment with botulinum toxin Type B (Myobloc, Solstice Neurosciences, Inc.), a focal muscle relaxant.

Analysis of fine motor control in pre and post-operative deep brain stimulator (DBS) implant patients

Computerized analysis of freely drawn spirals is used to quantify improvements following DBS surgery for patients with essential tremor and Parkinson's disease. In addition to a pre to post comparison of the standard indices generated by the program, the hypothesis, that Parkinson's patients are particularly dependant on visuomotor control and external cue is being tested.

Physiological, clinical and epidemiological investigations of essential tremor and related disorders

In collaboration with Dr. Elan Louis of the Neurological Institute and the G.H. Sergievsky Center, the CMPL performs computerized physiological testing on patients with essential tremor and related disorders in population-based and other types of epidemiological studies. The overall goals are to help establish diagnoses in affected people and family members, quantify baseline status and post-treatment effects, and clarify subtle or unique motor control phenomena. Recent work has focused on the epidemiology of essential tremor in upper Manhattan, quantification of head tremors, and special kinematic issues related to tremor.

Clinical biomarkers for amyotrophic lateral sclerosis (ALS)

In collaboration with Dr. Hiroshi Mitsumoto, Chief of the Neuromuscular Division and Director of the Eleanor and Lou Gehrig MDA/ALS Center, the CMPL participates in this multi-modality study of ALS by providing Transcranial Magnetic Stimulation (TMS) to patients suffering from ALS at three month intervals over one to two years. TMS helps in the detection of upper motor neuron involvement and, in conjunction with other tests, help predict and track the progression of disease. Patient enrollment is currently complete.

Open-label study of sodium oxybate in severe essential tremor

In collaboration with Dr. Steven Frucht of our Movement Disorders division of the Neurological Institute of New York, we are currently performing an open-label study of sodium oxybate in 10 patients with ethanol-responsive essential tremor. Objective kinematic and physiologic information from computerized quantitative tremor analysis and spiral analysis is used to evaluate medication effects. The findings are analyzed in conjunction with clinical assessments and patient subjective impressions.

Digital analysis of facial affect in patients with Parkinson's disease

In collaboration with Dr. David Forrest from the Department of Psychiatry, we are developing an automatic method to determine and quantify abnormal facial expression and changes in emotional profiles - based on real-time video imaging. The effects of treatment and the progression of disease are monitored in a novel and potentially useful way. Affect, change in mood and emotion are among the most unique attributes of human interaction and are conveyed through facial expressions. Importantly, one of the more socially disabling aspects of neurologic diseases and psychiatric disorders is their devastating effects on facial expressiveness. Applying this to computerized facial measurements, we are trying to note dynamically changes in emotion and expression.

Spiral analysis normative data study (SANDS)

The purpose of this study is to determine detailed normative characteristics, properties, reliability and utility of the Spiral Analysis program. Recruitment and analysis of data for 100 healthy control subjects: 50 men and 50 women ranging in age from 20 to 69 years is currently underway. Subjects are asked to draw spirals on a graphics tablet attached to a computer both under standard conditions, and with and without visual feedback.

SPECT imaging and spiral analysis

In collaboration with Dr. Kenneth Marek, Founder and Director of the Institute for Neurodegenerative Disorders (New Haven, CT), the CMPL is participating in investigations for biomarkers of Parkinson's disease. This is being accomplished through the generating of criteria sets based on SPECT brain imaging and Spiral Analysis data that differentiate between individuals with and without Parkinson's disease, as well as patients with early versus late stages of development.