Seeing the unseen: could Eulerian video magnification aid clinician detection of subclinical Parkinson’s tremor ?

Introduction Eulerian magnification amplifies very small movements in video, revealing otherwise invisible motion. This raises the possibility that it could enable clinician visualisation of subclinical tremor using a standard camera. We tested whether Eulerian magnification of apparently a tremulous hands reveals a Parkinsonian tremor more frequently in Parkinson’s than in controls. Method We applied Eulerian magnification to smartphone video of 48 hands that appeared a tremulous during recording (22 hands from 11 control participants, 26 hands from 17 idiopathic Parkinson’s participants). Videos were rated for Parkinsonian tremor appearance (yes/no) before and after Eulerian magnification by three movement disorder specialist neurologists. Results The proportion of hands correctly classified as Parkinsonian or not by clinicians was significantly higher after Eulerian magnification (OR = 2.67; CI = [1.39, 5.17]; p < 0.003). Parkinsonian-appearance tremors were seen after magnification in a number of control hands, but the proportion was greater in the Parkinson’s hands. Conclusion Eulerian magnification slightly improves clinician ability to identify apparently a tremulous hands as Parkinsonian. This suggests that some of the apparent tremor revealed may be subclinical Parkinson’s (pathological) tremor, and Eulerian magnification may represent a first step towards contactless visualisation of such tremor. However, the technique also reveals apparent tremor in control hands. Therefore, our method needs additional elaboration and would not be of direct clinical use in its current iteration.