Objective: To assess the feasibility of using movement energy heatmaps to detect troublesome dyskinesia in Parkinson’s disease (PD) during activities of daily living.

Background: Recently, ‘troublesome dyskinesia’ (TSD) has emerged as a key clinical trial outcome, yet its definition remains ambiguous, complicating treatment and data interpretation. Identifying objective markers for TSD is therefore imperative. We propose that TSD occurs when the signal-to-noise ratio—the amplitude of voluntary movement relative to dyskinesia—falls below a critical threshold, significantly impairing functional performance.

Method: We analyzed 61 PD patients with peak-dose dyskinesia (LID) compared to 72 healthy controls and 50 non-dyskinetic PD patients. Participants wore 17 inertial sensors while performing a Pegboard test and a 5-meter Timed-Up-and-Go (TUG) with a glass of water. Performance was measured by pins inserted, task time, and water spillage. To quantify movement intensity, we calculated the average Root Mean Square (RMS) acceleration (0.5–7 Hz bandpass filter) for each limb sensor in 3-second windows, neutralizing gravity. We hypothesized that LID patients would show elevated ‘energy’ levels before tasks. During movement, if dyskinesia is mitigated by voluntary action, limb heatmaps should resemble healthy controls; otherwise, persistent high-energy heatmaps—coupled with poor task performance—would identify ‘troublesome’ dyskinesia

Results: For the Pegboard test, upper limb energy was similar across groups, suggesting dyskinesia attenuation during movement. However, dyskinetic patients showed significantly higher energy in the lower limbs. In seven participants, ‘hotter’ heatmaps indicated dyskinesia overwhelming voluntary movement, which correlated with poorer performance (~6 ± 1 pins) compared to other groups (LID: ~12 ± 2; PD: ~10 ± 4; Controls: ~15 ± 4). A similar pattern emerged during TUG with water, where intense heatmaps were directly associated with water spillage.

Conclusion: These results support those published earlier where we demonstrated that patients with dyskinesia can counteract their involuntary movements, until dyskinesia overwhelms the voluntary movements behavior. The present methods could eventually be used to detect TSD during activities of daily living using wearable sensors.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/towards-the-detection-of-troublesome-dyskinesia-in-parkinsons-disease-using-wearable-sensors/