Movement Disorders: Parkinson’s Disease and Essential Tremor—A General Perspective

  • Robert LeMoyne
  • Timothy Mastroianni
  • Donald Whiting
  • Nestor Tomycz
Part of the Smart Sensors, Measurement and Instrumentation book series (SSMI, volume 31)


Movement disorders manifesting in tremor influence the quality of life for millions of people. In particular, two prevalent types of movement disorder are Parkinson’s disease and Essential tremor. The neurological foundation for Parkinson’s disease is attributed to dysfunction of the substantia nigra and associated aspects of the basal ganglia. By contrast, Essential tremor is not conclusively defined. However, notable amplified cerebellar activity is a characteristic for Essential tremor. Traditional strategies for diagnosing the severity of Parkinson’s disease and Essential tremor apply expert clinical although subjective interpretation of ordinal scales. This ordinal scale approach is the subject of contention regarding reliability. Traditional therapy involves the prescription of medication. As a last resort, permanent disruption of the deep brain neural pathways is an alternative. Recent developments have demonstrated the utility of wearable and wireless systems for the objective and quantified measurement of tremor symptoms. Furthermore, wearable and wireless systems have been amalgamated with deep brain stimulation for the determination of therapy efficacy. Near-term future objectives implicate the opportunity for real-time patient-specific optimization of deep brain stimulation tuning parameters. These developments lead to the presence of Network Centric Therapy for the treatment of movement disorders, such as Parkinson’s disease and Essential tremor.


Movement disorder Parkinson’s disease Essential tremor Unified Parkinson’s Disease Rating Scale (UPDRS) Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Conventional medical intervention Levodopa Propranolol Pallidotomy Thalamotomy Wearable and wireless systems Deep brain stimulation Network Centric Therapy 


  1. 1.
    Kandel ER, Schwartz JH, Jessell TM (2000) Principles of neural science. McGraw-Hill, New York, Ch 43Google Scholar
  2. 2.
    Nolte J, Sundsten JW (2002) The human brain: an introduction to its functional anatomy, St. Louis, Mosby, Ch 19Google Scholar
  3. 3.
    Helmich RC, Toni I, Deuschl G, Bloem BR (2013) The pathophysiology of essential tremor and Parkinson’s tremor. Curr Neurol Neurosci Rep 13(9):378CrossRefGoogle Scholar
  4. 4.
    Parkinson J (1817) An essay on the shaking palsy. Whittingham and Rowland, LondonGoogle Scholar
  5. 5.
    Seeley RR, Stephens TD, Tate P (2003) Anatomy and physiology. McGraw-Hill, Boston, Ch 14Google Scholar
  6. 6.
    Bickley LS, Szilagyi PG (2003) Bates’ guide to physical examination and history taking. Lippincott Williams and Wilkins, Philadelphia, Ch 16Google Scholar
  7. 7.
    Diamond MC, Scheibel AB, Elson LM (1985) The human brain coloring book. Harper Perennial, New York, Ch 5Google Scholar
  8. 8.
    Louis ED (2005) Essential tremor. Lancet Neurol 4(2):100–110MathSciNetCrossRefGoogle Scholar
  9. 9.
    Louis ED (2000) Essential tremor. Arch Neurol (JAMA Neurology) 57(10):1522–1524Google Scholar
  10. 10.
  11. 11.
    Deuschl G, Raethjen J, Hellriegel H, Elble R (2011) Treatment of patients with essential tremor. Lancet Neurol 10(2):148–161CrossRefGoogle Scholar
  12. 12.
    Habib-ur-Rehman (2000) Diagnosis and management of tremor. Arch Intern Med 160(16):2438–2444CrossRefGoogle Scholar
  13. 13.
    Paris-Robidas S, Brochu E, Sintes M, Emond V, Bousquet M, Vandal M, Pilote M, Tremblay C, Di Paolo T, Rajput AH, Rajput A, Calon F (2012) Defective dentate nucleus GABA receptors in essential tremor. Brain 135(1):105–116CrossRefGoogle Scholar
  14. 14.
    Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N (2008) Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 23(15):2129–2170CrossRefGoogle Scholar
  15. 15.
    Fahn S, Tolosa E, Marin C (1988) Clinical rating scale for tremor. In: Parkinson’s disease and movement disorders. Urban & Schwarzenberg, Baltimore, pp 225–234Google Scholar
  16. 16.
    Elble RJ (2016) The essential tremor rating assessment scale. J Neurol Neuromed 1(4):34–38Google Scholar
  17. 17.
    Movement Disorder Society Task Force on Rating Scales for Parkinson’s Disease (2003) The Unified Parkinson’s Disease Rating Scale (UPDRS): status and recommendations. Mov Disord 18(7):738–750Google Scholar
  18. 18.
    Fahn S, Elton RL, UPDRS Program Members (1987) Unified Parkinson’s Disease Rating Scale. In: Recent developments in Parkinson’s disease, Vol. 2. Macmillan Healthcare Information, Florham Park, pp 153–163, 293–304.Google Scholar
  19. 19.
    LeMoyne R (2013) Wearable and wireless accelerometer systems for monitoring Parkinson’s disease patients—a perspective review. Adv Park Dis 2(4):113–115CrossRefGoogle Scholar
  20. 20.
    Giller CA, Dewey RB, Ginsburg MI, Mendelsohn DB, Berk AM (1998) Stereotactic pallidotomy and thalamotomy using individual variations of anatomic landmarks for localization. Neurosurgery 42(1):56–65CrossRefGoogle Scholar
  21. 21.
    Niranjan A, Kondziolka D, Baser S, Heyman R, Lunsford LD (2000) Functional outcomes after gamma knife thalamotomy for essential tremor and MS-related tremor. Neurology 55(3):443–446CrossRefGoogle Scholar
  22. 22.
    Young RF, Jacques S, Mark R, Kopyov O, Copcutt B, Posewitz A, Li F (2000) Gamma knife thalamotomy for treatment of tremor: long-term results. J Neurosurg 93(S3):128–135Google Scholar
  23. 23.
    Hossen A, Muthuraman M, Al-Hakim Z, Raethjen J, Deuschl G, Heute U (2013) Discrimination of Parkinsonian tremor from essential tremor using statistical signal characterization of the spectrum of accelerometer signal. Biomed Mater Eng 23(6):513–531Google Scholar
  24. 24.
    LeMoyne R, Mastroianni T (2017) Smartphone and portable media device: a novel pathway toward the diagnostic characterization of human movement. In: Smartphones from an applied research perspective. InTech, Rijeka, Croatia, pp 1–24Google Scholar
  25. 25.
    LeMoyne R, Mastroianni T (2017) Wearable and wireless gait analysis platforms: smartphones and portable media devices. In: Wireless MEMS networks and applications. Elsevier, New York, pp 129–152CrossRefGoogle Scholar
  26. 26.
    LeMoyne R, Mastroianni T (2016) Telemedicine perspectives for wearable and wireless applications serving the domain of neurorehabilitation and movement disorder treatment. In: Telemedicine SMGroup, Dover, Delaware, pp 1–10Google Scholar
  27. 27.
    LeMoyne R, Mastroianni T (2015) Use of smartphones and portable media devices for quantifying human movement characteristics of gait, tendon reflex response, and Parkinson’s disease hand tremor. In: Mobile health technologies, methods and protocols. Springer, New York, pp 335–358Google Scholar
  28. 28.
    LeMoyne R, Coroian C, Cozza M, Opalinski P, Mastroianni T, Grundfest W (2009) The merits of artificial proprioception, with applications in biofeedback gait rehabilitation concepts and movement disorder characterization. In: Biomedical engineering. InTech, Vienna, pp 165–198Google Scholar
  29. 29.
    LeMoyne R, Mastroianni T, Cozza M, Coroian C, Grundfest W (2010) Implementation of an iPhone for characterizing Parkinson’s disease tremor through a wireless accelerometer application. In: 32nd Annual international conference of the IEEE, Engineering in Medicine and Biology Society (EMBS), pp 4954–4958Google Scholar
  30. 30.
    LeMoyne R, Mastroianni T, Grundfest W (2013) Wireless accelerometer configuration for monitoring Parkinson’s disease hand tremor. Adv Park Dis 2(2):62–67CrossRefGoogle Scholar
  31. 31.
    LeMoyne R, Tomycz N, Mastroianni T, McCandless C, Cozza M, Peduto D (2015) Implementation of a smartphone wireless accelerometer platform for establishing deep brain stimulation treatment efficacy of essential tremor with machine learning. In: 37th Annual international conference of the IEEE, Engineering in Medicine and Biology Society (EMBS), pp 6772–6775Google Scholar
  32. 32.
    LeMoyne R, Mastroianni T, Tomycz N, Whiting D, Oh M, McCandless C, Currivan C, Peduto D (2017) Implementation of a multilayer perceptron neural network for classifying deep brain stimulation in ‘On’ and ‘Off’ modes through a smartphone representing a wearable and wireless sensor application. In: 47th Society for Neuroscience annual meeting (featured in Hot Topics; top 1% of abstracts)Google Scholar
  33. 33.
    LeMoyne R, Mastroianni T, McCandless C, Currivan C, Whiting D, Tomycz N (2018) Implementation of a smartphone as a wearable and wireless accelerometer and gyroscope platform for ascertaining deep brain stimulation treatment efficacy of Parkinson’s disease through machine learning classification. Adv Park Dis 7(2):19–30Google Scholar
  34. 34.
    Hariz GM, Lindberg M, Bergenheim AT (2002) Impact of thalamic deep brain stimulation on disability and health-related quality of life in patients with essential tremor. J Neurol Neurosurg Psychiatry 72(1):47–52CrossRefGoogle Scholar
  35. 35.
    Benabid AL, Pollak P, Louveau A, Henry S, de Rougemont J (1987) Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson’s disease. Appl Neurophysiol 50(1–6):344–346Google Scholar
  36. 36.
    Volkmann J, Moro E, Pahwa R (2006) Basic algorithms for the programming of deep brain stimulation in Parkinson’s disease. Mov Disord 21(S14):S284–S289CrossRefGoogle Scholar
  37. 37.
    Amon A, Alesch F (2017) Systems for deep brain stimulation: review of technical features. J Neural Transm 124(9):1083–1091CrossRefGoogle Scholar
  38. 38.
    Isaias IU, Tagliati M (2008) Deep brain stimulation programming for movement disorders. In: Deep brain stimulation in neurological and psychiatric disorders. Springer, New York, pp 361–397CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Robert LeMoyne
    • 1
  • Timothy Mastroianni
    • 2
  • Donald Whiting
    • 3
  • Nestor Tomycz
    • 3
  1. 1.Department of Biological Sciences and Center for Bioengineering InnovationNorthern Arizona UniversityFlagstaffUSA
  2. 2.IndependentPittsburghUSA
  3. 3.Department of Neurosurgery Allegheny General HospitalAllegheny Health Network Neuroscience InstitutePittsburghUSA

Personalised recommendations