Motor Control Lab at NNI
- providing quantitative measurements for Parkinson’s
Parkinson’s disease is one of the most common neurodegenerative diseases, affecting 3 per 1000 individuals aged 50 and above in Singapore. It is a chronic debilitating illness, presenting with slowing of movement (bradykinesia), stiffness (rigidity), shaking of limbs (tremor), and falls (postural instability). Of these symptoms, bradykinesia is the most consistent and disabling symptom. Fortunately, there are effective medications to control these symptoms so that patients may remain active in the community.
One of the challenges in the management of parkinsonism is to determine the level of response to treatment, which is used as a supportive criteria to diagnose Parkinson’s disease. The specialist uses a clinical rating scale which is subjective and requires training of raters to ensure inter-rater consistency. Since Parkinson’s disease may be managed by general practitioners, internists, and geriatricians, who may not be familiar with these rating scales, there is thus a need for objective quantitative measures to document disease severity in Parkinson’s disease.
The Motor Control Laboratory at NNI uses various techniques to quantitate motor disability so that physicians may have objective markers to monitor disease progression and treatment response in parkinsonism. The laboratory is run by a team of movement disorders specialists, nurse clinicians and technicians. Three services are currently offered:
a. Motor-time testing
b. On-off evaluation
c. Deep Brain Stimulation (DBS) programming and evaluation
These services are open to all physicians managing Parkinson’s disease and related disorders.
Motor-Time Testing
By using simple ‘motor-time testing’ parameters, the Motor Control Laboratory is able to provide objective quantitative measures that correlate well to disease severity in Parkinson’s disease. Subjects will perform a set of upper limb movements and a 7-metre walking test. These movements will be timed to provide a quantitative score that correlated to disease severity (bradykinesia) in Parkinson’s disease. Physicians may use this objective marker to monitor disease progression and treatment response. The test takes approximately 30 – 45 minutes to complete.
On-off Evaluation
Under the supervision of nurse clinicians and movement disorders specialists, the Motor Control Laboratory provides ‘on-off testing’ to evaluate levodopa responsiveness. Improvement in quantitative scores after levodopa challenge will provide physicians an objective marker to further aid in their diagnosis and management of parkinsonism. Levodopa responsiveness is also one of the prerequisite for good outcome in DBS surgery for Parkinson’s disease. On-off evaluation will help to determine patient suitability for DBS operation, thereby further optimising the limited resources available.
The test takes approximately 90 – 140 minutes to complete, including waiting time for the medication effects to turn on. Subjects will need to withdraw anti-Parkinson medications overnight for at least 12 hours before the test. The test is scheduled in the morning. Subjects will need to bring along their usual anti- Parkinson medications to the laboratory on the day of the test. If at any time subjects are not able to tolerate being off anti-Parkinson medications overnight, they are advised to take their usual dose of anti-Parkinson medication immediately, and to call the laboratory the soonest possible during office hours to reschedule or to arrange for alternative tests.
Referring physicians may also discuss with specialists at the Motor Control Laboratory for alternative tests, if they think the patients are not likely to tolerate being off anti-Parkinson medications overnight for 12 hours.
Deep Brain Stimulation (DBS) Programming and Evaluation
The Laboratory provides the expertise to perform post-operative DBS programming and evaluation, which is integral to the success of DBS surgery in Parkinson’s disease. Subjects will be evaluated in the ‘offstimulator, off-medication’ state, the ‘on-stimulator, off-medication’ state, and the ‘on-stimulator, on-medication’ state. The test will take approximately half a day to complete, including DBS programming time. As in on-off evaluation, subjects will need to withdraw anti-Parkinson medications overnight for 12 hours before the test. The requirements and precautions as stated under the ‘On-off evaluation’ section apply.
Indications for referral:
• Motor-Time Testing:
1. Quantification of disease severity in parkinsonism
2. Monitoring of disease progression and treatment response in parkinsonism
• On-off evaluation:
1. To determine levodopa responsiveness in parkinsonism
2. Pre-operative evaluation for DBS surgery in Parkinson’s disease
• DBS programming and evaluation:
1. Post-operative DBS programming and evaluation for Parkinson’s disease
Subject requirements:
1. Ability to follow simple verbal instructions
2. Ability to sit upright
3. Without upper limb disability (other than due to parkinsonism)
4. For on-off evaluation and DBS programming and evaluation,
a. Subject to withdraw all anti-Parkinson medications for at least 12 hours before the test.
b. Subject to bring along all anti-Parkinson medications to the Motor Control Laboratory on the
day of the test.
Precautions (for ‘On-off evaluation’ and ‘DBS programming and evaluation’):
- If subject is not able to tolerate being off anti-Parkinson medications overnight, he/she is advised to take his/her usual dose of anti-Parkinson medication immediately, and to call the Motor Control Laboratory the soonest possible during office hours to reschedule or to arrange for alternative tests.
- Referring physicians to discuss with specialists at the Motor Control Laboratory for alternative tests, if they think the subjects are not likely to tolerate being off anti-Parkinson medications for 12 hours.
How to Order The Tests:
For appointment and enquiry, please call the Motor Control Laboratory at 65-6357 7070 or fax the Neurodiagnostic Service Request Form to 65-6357 7069.
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The Motor Control Laboratory was set up in National Neuroscience Institute (NNI) in February 2008, with the aim of providing diagnostic evaluation of Parkinson’s disease and movement disorders through various methods of quantitative measures and electrophysiological studies. This service is provided by the Parkinson’s Disease and Movement Disorders Centre of NNI, as part of its continuing effort to improve the care and management of Parkinson’s disease.
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Contact Information:
Enquiry and Appointment:
Tel : 65-6357 7070 during office hours
Fax: 65-6357 7069
Opening Hours
8:00am to 5:30pm (Mon-Wed, Fri)
8:00am to 5:00pm (Thurs)