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Kim SH, Han JY, Song MK, Choi IS, Park HK. Orthostatic tremor after knee contusion without head trauma: A rare case report. Turk J Phys Med Rehabil 2023; 69:111-115. [PMID: 37201017 PMCID: PMC10186025 DOI: 10.5606/tftrd.2023.8718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/08/2021] [Indexed: 05/20/2023] Open
Abstract
Orthostatic tremor (OT) is an uncommon progressive movement disorder that involves a leg tremor when standing or weight bearing. Additionally, OT can accompany other medical or neurodegenerative disorders. In this article, we report an unusual case of OT after trauma in an 18-year-old male patient whose symptoms of OT have been resolved after a multimodal therapeutic approach, including botulinum toxin injection. Surface electromyography, including a tremor recording, was used for the diagnosis of OT. The patient completely recovered after the rehabilitation. A comprehensive rehabilitative treatment is required in the management of OT as the patient's quality of life is greatly affected.
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Affiliation(s)
- San-Ha Kim
- Department of Physical & Rehabilitation Medicine, Chonnam National University Hospital, Gwangju City, Republic of Korea
| | - Jae-Young Han
- Department of Physical & Rehabilitation Medicine, Regional Cardiocerebrovascular Center, Center for Aging and Geriatrics, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - Min-Keun Song
- Department of Physical & Rehabilitation Medicine, Regional Cardiocerebrovascular Center, Center for Aging and Geriatrics, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - In Sung Choi
- Department of Physical & Rehabilitation Medicine, Chonnam National University Hospital, Gwangju City, Republic of Korea
| | - Hyeng-Kyu Park
- Department of Physical & Rehabilitation Medicine, Regional Cardiocerebrovascular Center, Center for Aging and Geriatrics, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
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2
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Deuschl G, Becktepe JS, Dirkx M, Haubenberger D, Hassan A, Helmich R, Muthuraman M, Panyakaew P, Schwingenschuh P, Zeuner KE, Elble RJ. The clinical and electrophysiological investigation of tremor. Clin Neurophysiol 2022; 136:93-129. [DOI: 10.1016/j.clinph.2022.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 01/18/2023]
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3
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Alonso CCG, Silva FG, Costa LOP, Freitas SMSF. Smell tests can discriminate Parkinson's disease patients from healthy individuals: A meta-analysis. Clin Neurol Neurosurg 2021; 211:107024. [PMID: 34823156 DOI: 10.1016/j.clineuro.2021.107024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/20/2021] [Accepted: 11/03/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Olfactory impairment is common in Parkinson's disease (PD). The authors aimed to identify the clinical tests used to assess olfactory function and examine their ability to distinguish PD with different disease duration from healthy individuals with physiological aging. METHODS Cross-sectional studies published until May 2020 that assessed the olfaction of individuals with PD using search terms related to PD, olfactory function, and assessment were searched on PubMed, PsycInfo, Cinahl, and Web of Science databases. RESULTS Twelve smell tests were identified from the reviewed studies (n = 125) that assessed 8776 individuals with PD. Data of 6593 individuals with PD and 8731 healthy individuals were included in the meta-analyses. Individuals with PD presented worse performance than healthy individuals, regardless of the smell test used. The University of Pennsylvania Smell Identification Test (UPSIT) was used by most studies (n = 2310 individuals with PD) and presented smaller heterogeneity. When the studies were subclassified according to the years of PD duration, there were no significant differences. CONCLUSION All smell tests were able to discriminate the olfactory function of PD from that of healthy individuals, although the UPSIT was widely used. The abnormal olfaction was not related to the disease duration. Systematic review protocol registration (PROSPERO/2020-CRD42020160878).
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Affiliation(s)
- Cintia C G Alonso
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Fernanda G Silva
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Leonardo O P Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Sandra M S F Freitas
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
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4
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Alonso CCG, Silva FG, Costa LOP, Freitas SMSF. Smell tests to distinguish Parkinson's disease from other neurological disorders: a systematic review and meta-analysis. Expert Rev Neurother 2021; 21:365-379. [PMID: 33546569 DOI: 10.1080/14737175.2021.1886925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: Olfactory impairment has been considered for differential diagnosis in Parkinson's disease (PD) patients. The authors aimed to identify the tests used to assess the olfactory function in PD patients and examine these tests' ability to distinguish them from other neurological disorders.Areas covered: Cross-sectional studies published until May 2020 comparing the olfactory function of PD patients to other neurological disorders were searched on PubMed, PsycInfo, Cinahl, and Web of Science databases using search terms related to PD, olfactory function, and assessment. Five thousand three hundred and four studies were screened, and 35 were included in the systematic review. Six smell tests that evaluated a total of 1,544 PD patients were identified. Data of 1,144 patients included in the meta-analyses revealed worse smell performance than individuals with other neurological disorders, such as progressive supranuclear palsy and essential tremor, but not with idiopathic rapid eye movement sleep behavior disorder.Expert opinion: The University of Pennsylvania Smell Identification Test was the most used test to assess the olfactory function of PD. Smell loss was worse in PD than in some neurological disorders. The smell tests' ability in differentiating PD from other neurological disorders still deserves more attention in future studies. Protocol register (PROSPERO/2018-CRD42018107009).
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Affiliation(s)
- Cintia C G Alonso
- Graduate Program in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
| | - Fernanda G Silva
- Graduate Program in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
| | - Leonardo O P Costa
- Graduate Program in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
| | - Sandra M S F Freitas
- Graduate Program in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
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5
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Park S, Lim JG, Chang HJ, Oh E. What Shall We Do for the Patients with Shaky Leg Syndrome? A Review of 23 Patients. NEURODEGENER DIS 2020; 20:46-54. [PMID: 32911473 DOI: 10.1159/000509411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
Orthostatic tremor (OT) is not an uncommon symptom in various neurodegenerative diseases. However, the nature and pathophysiology of OT involve a complex network of tremors and dopaminergic pathways. We assessed patients who complained of prominent leg tremors described as "shaky leg." We analyzed their characteristics and evaluated them with neuroimaging and electrophysiological tools. A total of 23 patients who experienced an uncomfortable symptom of leg tremor were retrospectively enrolled from April 2014 to October 2019. Previous medical history, brain MRI, and surface electromyography (EMG) data were analyzed. The [18F]-FP-CIT brain positron emission tomography (PET) and the Unified Parkinson's Disease Rating Scale (UPDRS) were assessed for patients who showed parkinsonism. The causes of OT varied: parkinsonism (n = 5), idiopathic causes (n = 4), secondary causes (n = 3, trauma, brain lesion, arteriovenous malformation), drug reactions (n = 3, valproate, perphenazine, haloperidol), other neurological disorders (n = 5, essential tremor, dystonia, restless leg syndrome, REM sleep behavior disorder, dementia), alcohol withdrawal (n = 1), functional movement disorder (n = 1), and an unknown cause (n = 1). The frequency range varied (2.6-15 Hz) and according to the new consensus statement on the classification of OT, 4 patients had primary OT, 2 had "primary OT plus," 12 had slow OT, and 5 had orthostatic myoclonus. The prognosis associated with the use of medication was generally poor; however, clonazepam and levodopa were the most effective drugs. In conclusion, we found that different types of OT and orthostatic myoclonus were diagnosed by electrophysiological evaluation and neuroimaging tools even if they showed the same symptoms as "shaky leg." In addition, it is possible to roughly estimate the response to medication according to the type of OT and the cause. To clarify the pathophysiology of OT, a large number of longitudinal cohort studies and detailed neuroimaging and electrophysiological evaluations are needed.
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Affiliation(s)
- Sangmin Park
- Department of Neurology and Neurosurgery Center, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Jung Geol Lim
- Department of Neurology, Daejeon Veterans Hospital, Daejeon, Republic of Korea
| | - Hee Jin Chang
- Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea,
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6
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Yoshii F, Takahashi W, Aono K. Levodopa-Responsive Primary Slow Orthostatic Tremor: A Premotor Sign of Parkinson's Disease? Case Rep Neurol 2020; 12:1-6. [PMID: 32009929 PMCID: PMC6984156 DOI: 10.1159/000504798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 11/23/2022] Open
Abstract
We present a case of primary orthostatic tremor (OT) responsive to dopaminergic medication. The patient was a 62-year-old woman, who had leg tremor on standing for 2 years. No parkinsonian or other neurological signs were observed. Surface electromyography of the quadriceps muscles showed regular 5–6 Hz muscle discharges. [<sup>123</sup>I]-FP-CIT DAT-SPECT imaging revealed decreased specific binding ratio values in the striatum compared with age-matched controls. Her leg tremor almost completely disappeared following administration of levodopa 200 mg and pramipexole 0.75 mg. Since her OT with low-frequency discharge was responsive to dopaminergic medication, we speculate that it may be a premotor sign of Parkinson's disease.
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Affiliation(s)
- Fumihito Yoshii
- Department of Neurology, Saiseikai Shonan Hiratsuka Hospital, Hiratsuka, Japan.,Department of Neurology, Tokai University Oiso Hospital, Naka-gun, Japan
| | - Wakoh Takahashi
- Department of Neurology, Tokai University Oiso Hospital, Naka-gun, Japan
| | - Koji Aono
- Department of Rehabilitation, Isehara Kyodo Hospital, Isehara, Japan
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León Ruiz M, Benito-León J. The Top 50 Most-Cited Articles in Orthostatic Tremor: A Bibliometric Review. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 9:tre-09-679. [PMID: 31413901 PMCID: PMC6691913 DOI: 10.7916/tohm.v0.679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/06/2019] [Indexed: 12/20/2022]
Abstract
Background Article-level citation count is a hallmark indicating scientific impact. We aimed to pinpoint and evaluate the top 50 most-cited articles in orthostatic tremor (OT). Methods The ISI Web of Knowledge database and 2017 Journal Citation Report Science Edition were used to retrieve the 50 top-cited OT articles published from 1984 to April 2019. Information was collected by the Analyze Tool on the Web of Science, including number of citations, publication title, journal name, publication year, and country and institution of origin. Supplementary analyses were undertaken to clarify authorship, study design, level of evidence, and category. Results Up to 66% of manuscripts were recovered from five journals: Movement Disorders (n = 18), Brain (n = 4), Journal of Clinical Neurophysiology (n = 4), Neurology (n = 4), and Clinical Neurophysiology (n = 3). Articles were published between 1984 and 2018, with expert opinion as the predominant design (n = 22) and review as category (n = 17). Most articles had level 5 evidence (n = 26). According to their countries of origin, 34% of articles belonged to the United States (n = 17) leading the list, followed by United Kingdom (n = 15). University College London yielded the greater number of articles (n = 12), followed by the University of Kiel (n = 9). Most popular authors were G. Deuschl (n = 10), C.D. Marsden (n = 6), J. Jankovic (n = 5), P.D. Thompson (n = 5), J.C. Rothwell (n = 5), L.J. Findley (n = 4), and P. Brown (n = 4), who together accounted for 48% of them. All papers were in English. Discussion Publishing high-cited OT articles could be facilitated by source journal, study design, category, publication language, and country and institution of origin.
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Affiliation(s)
| | - Julián Benito-León
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, ES.,Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, ES.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, ES
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9
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Abstract
Tremor is clinically defined as a rhythmic, oscillating movement of parts of the body, which functionally leads to impairment of the coordination and execution of targeted movements. It can be a symptom of a primary disease, such as resting tremor in Parkinson's disease or occur as an independent disease, such as essential or orthostatic tremor. For the development of tremor, cerebral components as well as mechanisms at the spinal and muscular level play an important role. This review presents the results of new imaging and electrophysiological studies that have led to important advances in our understanding of the pathophysiology of tremor. We discuss pathophysiological models for the development of resting tremor in Parkinson's disease, essential and orthostatic tremor. We describe recent developments starting from the classical generator model, with an onset of pathological oscillations in distinct cerebral regions, to a network perspective in which tremor arises and spreads through existing anatomical or newly emerged pathological brain networks. In particular translational approaches are presented and discussed. These could serve in the future as a basis for the development of new therapeutic strategies.
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Affiliation(s)
- M Muthuraman
- Sektion für Bewegungsstörungen und Neurostimulation, Biomedizinische Statistik und multimodale Signalverarbeitung, Klinik und Poliklinik für Neurologie, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - A Schnitzler
- Klinik für Neurologie, Universitätsklinik Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - S Groppa
- Sektion für Bewegungsstörungen und Neurostimulation, Biomedizinische Statistik und multimodale Signalverarbeitung, Klinik und Poliklinik für Neurologie, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
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Lenka A, Pal PK, Bhatti DE, Louis ED. Pathogenesis of Primary Orthostatic Tremor: Current Concepts and Controversies. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:513. [PMID: 29204315 PMCID: PMC5712672 DOI: 10.7916/d8w66zbh] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/31/2017] [Indexed: 12/01/2022]
Abstract
Background Orthostatic tremor (OT), a rare and complex movement disorder, is characterized by rapid tremor of both legs and the trunk while standing. These disappear while the patient is either lying down or walking. OT may be idiopathic/primary or it may coexist with several neurological conditions (secondary OT/OT plus). Primary OT remains an enigmatic movement disorder and its pathogenesis and neural correlates are not fully understood. Methods A PubMed search was conducted in July 2017 to identify articles for this review. Results Structural and functional neuroimaging studies of OT suggest possible alterations in the cerebello-thalamo-cortical network. As with essential tremor, the presence of a central oscillator has been postulated for OT; however, the location of the oscillator within the tremor network remains elusive. Studies have speculated a possible dopaminergic deficit in the pathogenesis of primary OT; however, the evidence in favor of this concept is not particularly robust. There is also limited evidence favoring the concept that primary OT is a neurodegenerative disorder, as a magnetic resonance spectroscopic imaging study revealed significant reduction in cerebral and cerebellar N-acetyl aspartate (NAA) levels, a marker of neuronal compromise or loss. Discussion Based on the above, it is clear that the pathogenesis of primary OT still remains unclear. However, the available evidence most strongly favors the existence of a central oscillatory network, and involvement of the cerebellum and its connections.
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Affiliation(s)
- Abhishek Lenka
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India.,Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Danish Ejaz Bhatti
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
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11
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Hassan A, van Gerpen JA. Orthostatic Tremor and Orthostatic Myoclonus: Weight-bearing Hyperkinetic Disorders: A Systematic Review, New Insights, and Unresolved Questions. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 6:417. [PMID: 28105385 PMCID: PMC5233784 DOI: 10.7916/d84x584k] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/25/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Orthostatic tremor (OT) and orthostatic myoclonus (OM) are weight-bearing hyperkinetic movement disorders most commonly affecting older people that induce "shaky legs" upon standing. OT is divided into "classical" and "slow" forms based on tremor frequency. In this paper, the first joint review of OT and OM, we review the literature and compare and contrast their demographic, clinical, electrophysiological, neuroimaging, pathophysiological, and treatment characteristics. METHODS A PubMed search up to July 2016 using the phrases "orthostatic tremor," "orthostatic myoclonus," "shaky legs," and "shaky legs syndrome" was performed. RESULTS OT and OM should be suspected in older patients reporting unsteadiness with prolonged standing and/or who exhibit cautious, wide-based gaits. Surface electromyography (SEMG) is necessary to verify the diagnoses. Functional neuroimaging and electrophysiology suggest the generator of classical OT lies within the cerebellothalamocortical network. For OM, and possibly slow OT, the frontal, subcortical cerebrum is the most likely origin. Clonazepam is the most useful medication for classical OT, and levetiracetam for OM, although results are often disappointing. Deep brain stimulation appears promising for classical OT. Rolling walkers reliably improve gait affected by these disorders, as both OT and OM attenuate when weight is transferred from the legs to the arms. DISCUSSION Orthostatic hyperkinesias are likely underdiagnosed, as SEMG is often unavailable in clinical practice, and thus may be more frequent than currently recognized. The shared weight-bearing induction of OT and OM may indicate a common pathophysiology. Further research, including use of animal models, is necessary to better define the prevalence and pathophysiology of OT and OM, in order to improve their treatment, and provide additional insights into basic balance and gait mechanisms.
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Affiliation(s)
- Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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12
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Benito-León J, Domingo-Santos Á. Orthostatic Tremor: An Update on a Rare Entity. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:411. [PMID: 27713855 PMCID: PMC5039949 DOI: 10.7916/d81n81bt] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/22/2016] [Indexed: 12/01/2022]
Abstract
Background Orthostatic tremor (OT) remains among the most intriguing and poorly understood of movement disorders. Compared to Parkinson’s disease or even essential tremor, there are very few articles addressing more basic science issues. In this review, we will discuss the findings of main case series on OT, including data on etiology, pathophysiology, diagnostic approach, treatment strategies, and outcome. Methods Data for this review were identified by searching PUBMED (January 1966 to August 2016) for the terms “orthostatic tremor” or “shaky leg syndrome,” which yielded 219 entries. We did not exclude papers on the basis of language, country, or publication date. The electronic database searches were supplemented by articles in the authors’ files that pertained to this topic. Results Owing to its rarity, the current understanding of OT is limited and is mostly based on small case series or case reports. Despite this, a growing body of evidence indicates that OT might be a progressive condition that is clinically heterogeneous (primary vs. secondary cases) with a broader spectrum of clinical features, mainly cerebellar signs, and possible cognitive impairment and personality disturbances. Along with this, advanced neuroimaging techniques are now demonstrating distinct anatomical and functional changes, some of which are consistent with neuronal loss. Discussion OT might be a family of diseases, unified by the presence of leg tremor, but further characterized by etiological and clinical heterogeneity. More work is needed to understand the pathogenesis of this condition.
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Affiliation(s)
- Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain
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Benito-León J, Louis ED, Mato-Abad V, Dydak U, Álvarez-Linera J, Hernández-Tamames JA, Molina-Arjona JA, Malpica N, Matarazzo M, Romero JP, Sánchez-Ferro Á. In vivo neurometabolic profiling in orthostatic tremor. Medicine (Baltimore) 2016; 95:e4848. [PMID: 27631243 PMCID: PMC5402586 DOI: 10.1097/md.0000000000004848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/17/2016] [Accepted: 08/22/2016] [Indexed: 11/29/2022] Open
Abstract
The pathogenesis of orthostatic tremor (OT) remains unclear, although some evidence points to dysfunction in the brainstem or cerebellum. We used single voxel proton magnetic resonance spectroscopy (1H-MRS) (3 T) to investigate whether neurochemical changes underlie abnormal cerebellar or cortical function in OT. Fourteen OT patients and 14 healthy controls underwent 1H-MRS studies with voxels placed in midparietal gray matter and cerebellum (vermis and central white matter). Spectral analysis was analyzed using the software package LCModel (version 6.3). The absolute metabolite concentrations and ratios of total N-acetylaspartate + N-acetylaspartyl glutamate (NAA), choline-containing compounds, myoinositol, and glutamate + glutamine to creatine were calculated. In midparietal gray matter spectra, we found a significant decrease in the absolute concentration of NAA in OT patients versus healthy controls (7.76 ± 0.25 vs 8.11 ± 0.45, P = 0.017). A similar decrease in NAA was seen in the cerebellar vermis (7.33 ± 0.61 vs 8.55 ± 1.54, P = 0.014) and cerebellar white matter (8.54 ± 0.79 vs 9.95 ± 1.57, P = 0.010). No differences in the other metabolites or their ratios were observed. Reductions in both cerebral cortical and cerebellar NAA suggest that there is neuronal damage or loss in OT, raising the intriguing question as to whether OT is a neurodegenerative disease. Along with clinical history and electrophysio0logical examination, 1H-MRS could serve as a useful diagnostic aid for OT.
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Affiliation(s)
- Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)
- Department of Medicine, Complutense University, Madrid, Spain
| | - Elan D. Louis
- Department of Neurology, Yale School of Medicine
- Department of Chronic Disease Epidemiology, Yale School of Public Health
- Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine and Yale School of Public Health, New Haven, CT
| | - Virginia Mato-Abad
- Neuroimaging Laboratory, Center for Biomedical Technology, Rey Juan Carlos University, Madrid, Spain
| | - Ulrike Dydak
- School of Health Sciences, Purdue University, West Lafayette
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
| | | | | | | | - Norberto Malpica
- Neuroimaging Laboratory, Center for Biomedical Technology, Rey Juan Carlos University, Madrid, Spain
| | | | - Juan Pablo Romero
- Department of Neurology, University Hospital “12 de Octubre”
- Faculty of Biosanitary Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
| | - Álvaro Sánchez-Ferro
- Department of Neurology, University Hospital “12 de Octubre”
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA
- HM CINAC, HM Hospitales, Madrid, Spain
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Adebayo PB. Orthostatic tremor: current challenges and future prospects. Degener Neurol Neuromuscul Dis 2016; 6:17-24. [PMID: 30050365 PMCID: PMC6053087 DOI: 10.2147/dnnd.s84742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This review provides an outlook of orthostatic tremor (OT), a rare adult-onset tremor characterized by subjective unsteadiness during standing that is relieved by sitting or walking. Recent case series with a long-time follow-up have shown that the disease is slowly progressive, spatially spreads to the upper limbs, and other neurological disorders may develop in about one-third of the patients. The diagnosis of OT hinges on the typical history of unsteadiness during standing, which is confirmed by electromyographic findings of a 13–18 Hz tremor that is typically absent during tonic activation while the patient is sitting and lying. Although the tremor is generated by a central oscillator, cerebellar and/or basal ganglia dysfunction are needed for its manifestation (double lesion hypothesis). However, functional neuroimaging findings have not consistently implicated the dopaminergic system in its pathogenesis. Drug treatments have been largely disappointing with no sustained benefits, although thalamic deep brain stimulation has helped some patients. Large-scale follow-up studies, more drug trials, and novel therapies are urgently needed.
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Affiliation(s)
- Philip Babatunde Adebayo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, Ladoke Akintola University of Technology, Ogbomoşo, Oyo State, Nigeria,
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15
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Benito-León J, Louis ED, Puertas-Martín V, Romero JP, Matarazzo M, Molina-Arjona JA, Domínguez-González C, Sánchez-Ferro Á. Cognitive and neuropsychiatric features of orthostatic tremor: A case-control comparison. J Neurol Sci 2016; 361:137-43. [PMID: 26810532 PMCID: PMC5469211 DOI: 10.1016/j.jns.2015.12.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/30/2015] [Accepted: 12/20/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Evidence suggests that the cerebellum could play a role in the pathophysiology of orthostatic tremor. The link between orthostatic tremor and the cerebellum is of interest, especially in light of the role the cerebellum plays in cognition, and it raises the possibility that orthostatic tremor patients could have cognitive deficits consistent with cerebellar dysfunction. Our aim was to examine whether orthostatic tremor patients had cognitive deficits and distinct personality profiles when compared with matched controls. METHODS Sixteen consecutive orthostatic tremor patients (65.7 ± 13.3 years) and 32 healthy matched controls underwent a neuropsychological battery and the Personality Assessment Inventory. In linear regression models, the dependent variable was each one of the neuropsychological test scores or the Personality Assessment Inventory subscales and the independent variable was orthostatic tremor vs. RESULTS Adjusted for age in years, sex, years of education, comorbidity index, current smoker, and depressive symptoms, diagnosis (orthostatic tremor vs. healthy control) was associated with poor performance on tests of executive function, visuospatial ability, verbal memory, visual memory, and language tests, and on a number of the Personality Assessment Inventory subscales (somatic concerns, anxiety related disorders, depression, and antisocial features). Older-onset OT (>60 years) patients had poorer scores on cognitive and personality testing compared with their younger-onset OT counterparts. CONCLUSION Orthostatic tremor patients have deficits in specific aspects of neuropsychological functioning, particularly those thought to rely on the integrity of the prefrontal cortex, which suggests involvement of frontocerebellar circuits. Cognitive impairment and personality disturbances could be disease-associated nonmotor manifestations of orthostatic tremor.
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Affiliation(s)
- Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, (CIBERNED), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain.
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine and Yale School of Public Health, New Haven, CT, USA
| | | | - Juan Pablo Romero
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Faculty of Biosanitary Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
| | - Michele Matarazzo
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain
| | | | | | - Álvaro Sánchez-Ferro
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA; HM CINAC, HM Hospitales, Móstoles, Madrid, Spain
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Ganos C, Maugest L, Apartis E, Gasca-Salas C, Cáceres-Redondo MT, Erro R, Navalpotro-Gómez I, Batla A, Antelmi E, Degos B, Roze E, Welter ML, Mestre T, Palomar FJ, Isayama R, Chen R, Cordivari C, Mir P, Lang AE, Fox SH, Bhatia KP, Vidailhet M. The long-term outcome of orthostatic tremor. J Neurol Neurosurg Psychiatry 2016; 87:167-72. [PMID: 25770124 DOI: 10.1136/jnnp-2014-309942] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/16/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Orthostatic tremor is a rare condition characterised by high-frequency tremor that appears on standing. Although the essential clinical features of orthostatic tremor are well established, little is known about the natural progression of the disorder. We report the long-term outcome based on the largest multicentre cohort of patients with orthostatic tremor. METHODS Clinical information of 68 patients with clinical and electrophysiological diagnosis of orthostatic tremor and a minimum follow-up of 5 years is presented. RESULTS There was a clear female preponderance (76.5%) with a mean age of onset at 54 years. Median follow-up was 6 years (range 5-25). On diagnosis, 86.8% of patients presented with isolated orthostatic tremor and 13.2% had additional neurological features. At follow-up, seven patients who initially had isolated orthostatic tremor later developed further neurological signs. A total 79.4% of patients reported worsening of orthostatic tremor symptoms. These patients had significantly longer symptom duration than those without reported worsening (median 15.5 vs 10.5 years, respectively; p=0.005). There was no change in orthostatic tremor frequency over time. Structural imaging was largely unremarkable and dopaminergic neuroimaging (DaTSCAN) was normal in 18/19 cases. Pharmacological treatments were disappointing. Two patients were treated surgically and showed improvement. CONCLUSIONS Orthostatic tremor is a progressive disorder with increased disability although tremor frequency is unchanged over time. In most cases, orthostatic tremor represents an isolated syndrome. Drug treatments are unsatisfactory but surgery may hold promise.
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Affiliation(s)
- Christos Ganos
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Lucie Maugest
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France CRICM UPMC/INSERM UMR 1127 CNRS UMR7225 Brain and Spine Institute, Paris, France
| | - Emmanuelle Apartis
- CRICM UPMC/INSERM UMR 1127 CNRS UMR7225 Brain and Spine Institute, Paris, France Neurophysiology Unit, AP-HP, Saint-Antoine Hospital, Paris, France Pierre Marie Curie Paris-6 University, Paris, France
| | - Carmen Gasca-Salas
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Canada
| | - María T Cáceres-Redondo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Irene Navalpotro-Gómez
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK Department of Neurology, Hospital del Mar, Barcelona, Spain
| | - Amit Batla
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Elena Antelmi
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Bertrand Degos
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France Pierre Marie Curie Paris-6 University, Paris, France
| | - Emmanuel Roze
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France CRICM UPMC/INSERM UMR 1127 CNRS UMR7225 Brain and Spine Institute, Paris, France Pierre Marie Curie Paris-6 University, Paris, France
| | - Marie-Laure Welter
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France CRICM UPMC/INSERM UMR 1127 CNRS UMR7225 Brain and Spine Institute, Paris, France Pierre Marie Curie Paris-6 University, Paris, France
| | - Tiago Mestre
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Canada Parkinson's Disease and Movement Disorder Centre, division of Neurology, department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | - Francisco J Palomar
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Reina Isayama
- Department of Medicine, University of Toronto, Toronto, Canada Division of Brain, Imaging and Behavior-Systems Neuroscience, Toronto Western Research Institute, Toronto, Canada
| | - Robert Chen
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Canada Department of Medicine, University of Toronto, Toronto, Canada Division of Brain, Imaging and Behavior-Systems Neuroscience, Toronto Western Research Institute, Toronto, Canada
| | - Carla Cordivari
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Canada
| | - Susan H Fox
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Canada
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Marie Vidailhet
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France CRICM UPMC/INSERM UMR 1127 CNRS UMR7225 Brain and Spine Institute, Paris, France Pierre Marie Curie Paris-6 University, Paris, France
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Hassan A, Ahlskog JE, Matsumoto JY, Milber JM, Bower JH, Wilkinson JR. Orthostatic tremor: Clinical, electrophysiologic, and treatment findings in 184 patients. Neurology 2016; 86:458-64. [PMID: 26747880 DOI: 10.1212/wnl.0000000000002328] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 10/07/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the clinical, electrophysiologic, and treatment outcome features of orthostatic tremor (OT) in a large case series. METHODS We performed medical record review of 184 patients who met clinical and electrodiagnostic criteria for OT from 1976 to 2013 at the Mayo Clinic. Demographic, clinical, electrophysiologic, and treatment data were extracted. RESULTS The majority of OT cases were female (63.6%) and mean age at onset was 59.3 years (range 13-85 years). Diagnosis was delayed by a mean of 7.2 years (range 0-44 years). The average tremor frequency was 15.7 Hz (range 12.5-20 Hz), and transmitted to the arms on weight-bearing (95.5%). Patients reported a spectrum of progressive orthostatic leg symptoms, relieved by sitting or leaning. Falls were reported in 24.1%. Coexistent neurologic disorders included essential tremor (22.8%), other tremor (4.9%), and parkinsonism (8.7%). Family history of OT was noted in 4.9%. Of 46 medications trialed, 24 failed to provide any benefit. Benzodiazepines provided at least mild benefit in 55.9%, and moderate to marked benefit in 31.5%; β-blockers (31.0%) and anticonvulsants (25.0%) provided mild benefit, and the remainder were largely ineffective. Medication benefit waned over time. Deep brain stimulation (DBS) was effective in 2 cases. CONCLUSION OT predominantly affects female seniors, and the diagnosis should be considered with any orthostatic-induced leg symptoms, and confirmed by surface EMG. Benzodiazepines are the most efficacious treatment, followed by β-blockers and anticonvulsants. DBS should be further explored for treatment.
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Affiliation(s)
- Anhar Hassan
- From the Department of Neurology (A.H., J.E.A., J.Y.M., J.H.B.), Mayo Clinic, Rochester, MN; SUNY Downstate College of Medicine (J.M.M.), Brooklyn, NY; University of Pennsylvania (J.R.W.), Philadelphia; and Parkinson's Disease Research, Education and Clinical Center (PADRECC) (J.R.W.), Philadelphia VA Medical Center, PA.
| | - J Eric Ahlskog
- From the Department of Neurology (A.H., J.E.A., J.Y.M., J.H.B.), Mayo Clinic, Rochester, MN; SUNY Downstate College of Medicine (J.M.M.), Brooklyn, NY; University of Pennsylvania (J.R.W.), Philadelphia; and Parkinson's Disease Research, Education and Clinical Center (PADRECC) (J.R.W.), Philadelphia VA Medical Center, PA
| | - Joseph Y Matsumoto
- From the Department of Neurology (A.H., J.E.A., J.Y.M., J.H.B.), Mayo Clinic, Rochester, MN; SUNY Downstate College of Medicine (J.M.M.), Brooklyn, NY; University of Pennsylvania (J.R.W.), Philadelphia; and Parkinson's Disease Research, Education and Clinical Center (PADRECC) (J.R.W.), Philadelphia VA Medical Center, PA
| | - Joshua M Milber
- From the Department of Neurology (A.H., J.E.A., J.Y.M., J.H.B.), Mayo Clinic, Rochester, MN; SUNY Downstate College of Medicine (J.M.M.), Brooklyn, NY; University of Pennsylvania (J.R.W.), Philadelphia; and Parkinson's Disease Research, Education and Clinical Center (PADRECC) (J.R.W.), Philadelphia VA Medical Center, PA
| | - James H Bower
- From the Department of Neurology (A.H., J.E.A., J.Y.M., J.H.B.), Mayo Clinic, Rochester, MN; SUNY Downstate College of Medicine (J.M.M.), Brooklyn, NY; University of Pennsylvania (J.R.W.), Philadelphia; and Parkinson's Disease Research, Education and Clinical Center (PADRECC) (J.R.W.), Philadelphia VA Medical Center, PA
| | - Jayne R Wilkinson
- From the Department of Neurology (A.H., J.E.A., J.Y.M., J.H.B.), Mayo Clinic, Rochester, MN; SUNY Downstate College of Medicine (J.M.M.), Brooklyn, NY; University of Pennsylvania (J.R.W.), Philadelphia; and Parkinson's Disease Research, Education and Clinical Center (PADRECC) (J.R.W.), Philadelphia VA Medical Center, PA
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18
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Yaltho TC, Ondo WG. Orthostatic tremor: A review of 45 cases. Parkinsonism Relat Disord 2014; 20:723-5. [PMID: 24736049 DOI: 10.1016/j.parkreldis.2014.03.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/04/2014] [Accepted: 03/15/2014] [Indexed: 10/25/2022]
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Erro R, Bhatia KP, Cordivari C. Shaking on Standing: A Critical Review. Mov Disord Clin Pract 2014; 1:173-179. [PMID: 30363785 DOI: 10.1002/mdc3.12053] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 04/19/2014] [Accepted: 04/24/2014] [Indexed: 11/06/2022] Open
Abstract
Orthostatic tremor is a rare condition, though its exact prevalence is unknown, which is clinically characterized by a feeling of unsteadiness or being about to fall on standing and which disappears on walking, sitting, or lying down. It is generally accepted that classic orthostatic tremor manifests with a high-frequency tremor (>13 Hz) of the legs when standing. However, a number of patients initially reported as orthostatic tremor did not actually have such electrophysiological features. It is our experience that there is a clinical spectrum of different conditions presenting as shaking on standing, and this highlights the importance of the electrophysiology to aid the differential diagnosis of these disorders. Here, we provide a critical review of the clinical spectrum of shaking on standing, along with demonstrative electrophysiological recordings of some of these conditions.
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Affiliation(s)
- Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology London United Kingdom.,Dipartimento di Scienze Neurologiche e del Movimento Università di Verona Verona Italy.,Department of Clinical Neurophysiology National Hospital for Neurology and Neurosurgery, Queen Square London United Kingdom
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology London United Kingdom
| | - Carla Cordivari
- Department of Clinical Neurophysiology National Hospital for Neurology and Neurosurgery, Queen Square London United Kingdom
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20
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Tatsch K, Poepperl G. Nigrostriatal dopamine terminal imaging with dopamine transporter SPECT: an update. J Nucl Med 2013; 54:1331-8. [PMID: 23864718 DOI: 10.2967/jnumed.112.105379] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This article gives an update on nigrostriatal dopamine terminal imaging, with emphasis on SPECT performed with the presynaptic dopamine transporter (DAT) ligand (123)I-FP-CIT. The paper covers the rational use of this technique in the diagnostic work-up of patients with known or suspected parkinsonian syndromes. In detail, it addresses the impact of the method for the proof or exclusion of neurodegenerative parkinsonism, for its early and preclinical diagnosis, and for the evaluation of disease progression. The importance of normal DAT binding for differentiating symptomatic parkinsonism and relevant tremor syndromes from neurodegeneration is highlighted. Particularly emphasized is the role of DAT SPECT for diagnosing Lewy body dementia and its separation from Alzheimer dementia. Finally, some remarks deal with the economic aspects of the use of these imaging techniques in the clinical setting.
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Affiliation(s)
- Klaus Tatsch
- Department of Nuclear Medicine, Municipal Hospital Karlsruhe, Inc, Karlsruhe, Germany.
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22
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Acoustic startle response in patients with orthostatic tremor. Neurosci Lett 2012; 525:100-4. [PMID: 22884645 DOI: 10.1016/j.neulet.2012.07.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/25/2012] [Accepted: 07/27/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIM Orthostatic tremor is a high frequency tremor predominantly on calf muscles during standing. Brainstem is the most probable generator in the pathogenesis since it comprises bilaterally projecting centers regulating stance or tone. We aimed to investigate the functional role of brainstem through the evaluation of acoustic startle response in primary orthostatic tremor patients. PATIENTS AND METHOD We included 7 (2 males) consecutive patients and 13 (5 males) healthy volunteers. Diagnosis was confirmed by polymyographic surface electromyography. All subjects underwent acoustic startle response and blink reflex investigations. RESULTS Presence rate (71.4% vs. 100%, p=0.042) and response rate (27.5% vs. 40.5%, p=0.047) of total acoustic startle response were lower in patient group. Similarly, probability over orbicularis oculi was lower among patients (p=0.003). However, blink reflex was observed in all patients and healthy volunteers and latencies of startle and blink reflexes were similar between groups. CONCLUSIONS In our patient group, normal response rate and latencies of R1 and R2 show structural integrity of at least blink reflex circuit at brainstem. On the other hand, suppressed response rates probably reflect decreased excitability of auditory startle reflex pathway.
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Abstract
Tremor is one of the most frequent movement disorders and covers a wide spectrum of entities summarized in the 1998 consensus statement of the Movement Disorder Society. Essential tremor and Parkinson tremor are most common and are also the most thoroughly studied. Major progress has occurred in the clinical semiology, neuroimaging, epidemiology, and pathophysiology of tremors. Pathology and genetic research are rapidly growing fields of study. Recently described tremor entities include orthostatic tremor, dystonic tremor, cortical tremor, and thalamic tremor. Treatment research methodology has improved substantially, but few double-blind controlled trials have been published. Deep brain stimulation is the most effective treatment for most tremors but is reserved for advanced cases.
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Affiliation(s)
- Rodger Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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24
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Transcranial sonography for the discrimination of idiopathic Parkinson's disease from the atypical parkinsonian syndromes. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2011. [PMID: 20692498 DOI: 10.1016/s0074-7742(10)90009-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
We reviewed eight studies on transcranial sonography (TCS) as a tool for differentiating idiopathic Parkinson's disease (IPD) from atypical parkinsonian syndromes (APS) and included some first data on TCS findings in the subforms of PSP. Changes of specific structures on TCS like the substantia nigra (SN), lenticular nucleus (LN), and the third ventricle are discussed as well as how they can contribute to differentiate between IPD, multiple system atrophy (MSA), progressive supranuclear palsy (PSP), Lewy body disease (LBD), and corticobasal degeneration (CBD). We finish with an algorithm that may be used to employ TCS as a diagnostic instrument delineating IPD from the APS and discerning among the APS themselves. As TCS is at present the most promising tool for this particular diagnostic problem, this algorithm might be a suitable hypothesis to study in future research.
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Abstract
Orthostatic tremor (OT) is a rare syndrome characterized by unsteadiness on standing due to a high-frequency tremor involving the legs. Symptoms usually start in the sixth decade. Typically, the symptoms rapidly improve on sitting or walking, and the need to sit down or to move can be so strong that patients avoid situations where they have to stand still. A polygraphic recording of a fast and synchronous tremor of the legs, between 13 and 18Hz, is mandatory to confirm the diagnosis of OT. Many patients also suffer from tremor, often involving lower frequencies, of the face, hands, or trunk. Recent studies suggest that this is perhaps due to subharmonics of the high-frequency tremor spreading through the body. Most cases of OT seem to be idiopathic, though symptomatic forms have been occasionally described. Several cases of OT have been reported in Parkinson's disease (PD), either preceding the onset of OT or developing in long-standing PD, suggesting a dopaminergic control of the central oscillator, possibly in the posterior fossa. The response to treatment is often disappointing. Clonazepam is widely used as a first-line agent, but gabapentin and dopaminergic drugs may be helpful in some patients.
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Abstract
The role for neuroimaging in the management of patients with tremor is gradually increasing, particularly with respect to stereotactic neurosurgery and deep brain stimulation where less than 2-mm tolerance is required for accurate electrode placement. The routine use of single photon emission CT technology to image the nigrostriatal dopaminergic system is proving helpful in distinguishing essential and dystonic tremors from neurodegenerative forms of parkinsonism and in improving our understanding of the pathophysiology of rarer tremors.
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In vivo imaging of synaptic function in the central nervous system. Behav Brain Res 2009; 204:1-31. [DOI: 10.1016/j.bbr.2009.06.008] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 05/27/2009] [Accepted: 06/02/2009] [Indexed: 01/07/2023]
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Raudino F, Muscia F, Osio M. Orthostatic tremor and I123-FP-CIT-SPECT: report of a case. Neurol Sci 2009; 30:365-6. [DOI: 10.1007/s10072-009-0105-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 05/27/2009] [Indexed: 11/24/2022]
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Intact serotonergic and dopaminergic systems in two cases of orthostatic tremor. J Neurol 2008; 255:1840-2. [PMID: 18821047 DOI: 10.1007/s00415-008-0023-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 05/06/2008] [Accepted: 06/26/2008] [Indexed: 10/21/2022]
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Trocello JM, Zanotti-Fregonara P, Roze E, Apartis E, Legrand AP, Habert MO, Devaux JY, Vidailhet M. Dopaminergic deficit is not the rule in orthostatic tremor. Mov Disord 2008; 23:1733-8. [DOI: 10.1002/mds.22224] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Leu-Semenescu S, Roze E, Vidailhet M, Legrand AP, Trocello JM, Cochen V, Sangla S, Apartis E. Myoclonus or tremor in orthostatism: an under-recognized cause of unsteadiness in Parkinson's disease. Mov Disord 2008; 22:2063-9. [PMID: 17674413 DOI: 10.1002/mds.21651] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Patients with Parkinson's disease (PD) often complain of unsteadiness. This can occur as the result of various neurological dysfunctions, including changes in postural adjustments, loss of postural reflexes, axial akinesia and rigidity, freezing and/or postural hypotension. In some cases these symptoms remain unexplained, and rare cases of unsteadiness have been attributed to tremor on standing. To delineate this condition, we investigated 11 consecutive PD patients with unexplained unsteadiness because of tremor on standing, seen in our department over a 6-year period. All the patients had detailed clinical and electrophysiological investigations based on surface polygraphic electromyographic recordings. Four patients had fast orthostatic tremor (13-18 Hz), one had intermediate orthostatic tremor (8-9 Hz), and three had slow orthostatic tremor (4-6 Hz). The remaining 3 patients had orthostatic myoclonus, a condition that has not previously been reported in PD. Patients with fast tremor improved on clonazepam. Patients with slow tremor and myoclonus improved on levodopa and sometimes benefited further when clonazepam was added. These observations show the usefulness of neurophysiological investigations for diagnosing and treating unexplained unsteadiness in Parkinson's disease.
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Thomas A, Bonanni L, Antonini A, Barone P, Onofrj M. Dopa-responsive pseudo-orthostatic tremor in parkinsonism. Mov Disord 2007; 22:1652-6. [PMID: 17579364 DOI: 10.1002/mds.21621] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In four patients an inabilitating standing tremor appeared years before that parkinsonian symptoms were evidenced. This tremor was refractory to gabapentin and dramatically responded to Levodopa administration. Its dominant frequency was 6.2 to 6.9 Hz with sporadic subharmonics at 8 to 18 Hz. Three patients were affected by different genetic mutations (Park 2, Park 6, mtDNA deletion) in one no genetic or metabolic alterations could be evidenced. All patients had dopamine transporter abnormalities. We suggest that the term "Pseudo-Orthostatic Tremor" could be used to define this Dopa responsive, 6 to 7 Hz standing tremor.
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Affiliation(s)
- Astrid Thomas
- Department of Oncology and Neuroscience, Neurophysiopathology, University G. D'Annunzio Chieti-Pescara, Italy
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Abstract
Patients with orthostatic tremor (OT) can be classified as having "primary OT," with or without postural arm tremor but no other abnormal neurological features, or "OT plus." We describe a patient with OT, with postural tremor of the arms and restless legs syndrome (RLS), who developed features typical of progressive supranuclear palsy (PSP). PSP can be accompanied by OT.
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Affiliation(s)
- Rob M A de Bie
- Movement Disorders Center, Division of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
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Zijlmans J, Evans A, Fontes F, Katzenschlager R, Gacinovic S, Lees AJ, Costa D. [123I] FP-CIT spect study in vascular parkinsonism and Parkinson's disease. Mov Disord 2007; 22:1278-85. [PMID: 17486613 DOI: 10.1002/mds.21479] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
There is substantial evidence to support a role for small vessel disease (SVD) as a cause for vascular parkinsonism (VP). Using [(123)I] FP-CIT SPECT (single photon emission computed tomography), we have tried to determine whether VP patients have pre-synaptic dopaminergic function similar to PD patients, and whether the severity of parkinsonian symptoms as well as the levodopa response in VP patients are correlated with pre-synaptic dopaminergic dysfunction. Thirteen patients fulfilling operational clinical criteria for VP had [(123)I] FP-CIT scans. Mean [(123)I] FP-CIT uptake in the basal ganglia was significantly lower in VP patients than in healthy controls, and the asymmetry index was not significantly different between these groups. In contrast, compared with the PD group, only the mean asymmetry index was significantly lower in VP patients. None of the parameters measured was significantly different between VP patients who had an insidious onset of parkinsonism (VPi) and those who had an acute onset (VPa). There was a significant correlation between the bilateral basal ganglia FP-CIT uptake reduction in the VP patients and UPDRS motor scores, but not with the mean % reduction in motor UPDRS after levodopa. We suggest that in the majority of VP patients, pre-synaptic dopaminergic function is reduced. The presence of a rather symmetrical FP-CIT uptake in the basal ganglia may help to distinguish VP from PD and could therefore be used as a criterion for the clinical diagnosis of VP.
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Affiliation(s)
- Jan Zijlmans
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
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36
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Krauss JK, Weigel R, Blahak C, Bäzner H, Capelle HH, Grips E, Rittmann M, Wöhrle JC. Chronic spinal cord stimulation in medically intractable orthostatic tremor. J Neurol Neurosurg Psychiatry 2006; 77:1013-6. [PMID: 16735398 PMCID: PMC2077764 DOI: 10.1136/jnnp.2005.086132] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Orthostatic tremor with its sense of unsteadiness when standing may have a devastating effect on affected persons. Currently, there are no other treatment options in those who do not respond or who do not tolerate medical treatment. OBJECTIVES To report on a pilot study on spinal cord stimulation in medically intractable orthostatic tremor. METHODS Chronic spinal cord stimulation (SCS) was performed in two patients with medically-intractable orthostatic tremor via quadripolar plate electrodes implanted at the lower thoracic spine. The electrodes were connected to implantable pulse generators. RESULTS Subjective and objective improvement of unsteadiness was achieved within a frequency range of 50 to 150 Hz, and occurred in the presence of stimulation-induced paraesthesia. With optimized stimulation settings polygraphic electromyelogram (EMG) recordings continued to show the typical 14-16 Hz EMG activity. The beneficial effect of SCS was maintained at long-term follow-up. CONCLUSIONS The results of this pilot study indicate that SCS may be an option in patients with otherwise intractable orthostatic tremor.
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Affiliation(s)
- J K Krauss
- Department of Neurosurgery, Medical University, MHH, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Bacsi AM, Fung VSC, Colebatch JG. Sway patterns in orthostatic tremor: impairment of postural control mechanisms. Mov Disord 2006; 20:1469-75. [PMID: 16037916 DOI: 10.1002/mds.20600] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Sway parameters in orthostatic tremor (OT) patients were compared with age-matched controls. The effects of vision (eyes open or closed), stance width (feet apart or together), and external support (with or without) on sway and 14-18 Hz energy were measured. Sway in OT patients decreased in the presence of each of the stabilizing factors but the extent of benefit obtained by OT patients was significantly less than controls for support for the sagittal plane (22% vs. 42% decrease; P < 0.01) and feet apart in the mediolateral plane (38% vs. 65% decrease; P < 0.01). Three patients with proprioceptive loss also had a reduced response to these factors. Energy in the 14-18 Hz range did not always change in parallel with sway levels. Vision suppresses activity at the OT frequency in patients. Postural control mechanisms in OT remain responsive to postural conditions, but patients differ significantly from normals in the degree of their responsiveness. OT appears to have disruption of the normal generation or processing of proprioceptive signals as one of its important components.
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Affiliation(s)
- Ann M Bacsi
- Institute of Neurological Sciences and University of New South Wales Clinical School, Prince of Wales Hospital, Sydney, New South Wales, Australia
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38
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Garosi LS, Rossmeisl JH, Lahunta A, Shelton GD, Lennox G. Primary Orthostatic Tremor in Great Danes. J Vet Intern Med 2005. [DOI: 10.1111/j.1939-1676.2005.tb02736.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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39
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García Vicente AM, Vaamonde Cano J, Poblete García VM, Rodado Marina S, Cortés Romera M, Ruiz Solís S, Ibáñez Alonso R, Soriano Castrejón A. [Utility of dopamine transporter imaging (123-I Ioflupane SPECT) in the assessment of movement disorders]. ACTA ACUST UNITED AC 2005; 23:245-52. [PMID: 15207208 DOI: 10.1016/s0212-6982(04)72294-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of our work was to assess the diagnostic impact of 123-I Ioflupane SPECT in patients with tremor and some other sign of Parkinsonisms in regards to its categorization in Parkinsonisms with involvement/indemnity of presynaptic dopaminergic neurons as well as to establish a differential diagnosis between essential tremor (ET) and degenerative Parkinsonism. METHODS 105 patients were included, 45 for differential diagnosis between Parkinsonism and ET, 52 to determine the origin of their Parkinsonism (degenerative vs secondary) and 8 with an established diagnosis, 5 Parkinson's disease and 3 ET. A dose of 185 MBq of Ioflupane 1-123 was administered and tomographic study acquired at 5 hours. After reconstruction, transaxial views were assessed by three observers. In all the patients, the diagnosis was established by a neurologist specialized in movement disorders, according to the symptoms, course, response to treatment and result of Ioflupane I-123. RESULTS 42 patients were diagnosed of degenerative Parkinsonism (PD or Parkinsonism plus) and 63 of ET or secondary Parkinsonism. We obtained a values of sensitivity, specificity, PPV, NPV and accuracy of 93 %, 100 %, 100 %, 97 % and 97 % respectively. 123-I Ioflupane SPECT changed the treatment in 18 % of our patients. CONCLUSIONS 123-I Ioflupane SPECT is a test of great value to establish the differential diagnosis between Parkinsonism vs ET and secondary vs degenerative Parkinsonism.
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Affiliation(s)
- A M García Vicente
- Servicio de Medicina Nuclear, Complejo Hospitalario Nuestra Sra. de Alarcos, Ciudad Real.
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40
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Piboolnurak P, Yu QP, Pullman SL. Clinical and neurophysiologic spectrum of orthostatic tremor: Case series of 26 subjects. Mov Disord 2005; 20:1455-61. [PMID: 16037915 DOI: 10.1002/mds.20588] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Orthostatic tremor (OT) is a condition described as high-frequency tremors predominantly in the legs and trunk, which are present not only in the standing position but also during isometric contraction of the limb muscles. This report is one of the largest OT series describing clinical and neurophysiologic findings in 26 subjects with OT. The main findings included 13.0 to 18.6 Hz leg tremors while standing with varied patterns of phase relationships between the antagonists of the ipsilateral leg and between the homologous muscles of the contralateral leg, short latency tremor onset upon standing with abrupt cessation after sitting, coexistence of tremors in the cranial structures and the arms, and sense of unsteadiness without actual falls. Although the oscillator of OT is most likely located in the brainstem, cerebral cortex, basal ganglia, and cerebellum may also be involved in its pathogenesis.
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Affiliation(s)
- Panida Piboolnurak
- Department of Neurology, Clinical Motor Physiology Laboratory, Columbia University Medical Center, New York, New York, USA
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41
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Gerschlager W, Münchau A, Katzenschlager R, Brown P, Rothwell JC, Quinn N, Lees AJ, Bhatia KP. Natural history and syndromic associations of orthostatic tremor: a review of 41 patients. Mov Disord 2004; 19:788-795. [PMID: 15254936 DOI: 10.1002/mds.20132] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Orthostatic tremor (OT) is a rare condition characterized by unsteadiness when standing still that is relieved when sitting or walking and is thought to arise from a central generator in the cerebellum or brainstem. OT is considered to be a distinct, discrete condition, and little is known about its demographic characteristics, natural history, associated features, and treatment response. We have reviewed these aspects in 41 OT patients fulfilling current diagnostic criteria, seen at our institution between 1986 and 2001. We classified 31 (75%) as having idiopathic "primary OT" either with (n = 24) or without an associated postural arm tremor. We found that 10 of 41 (25%) cases had additional neurological features, and we defined this group as having "OT plus" syndrome. Of these 10, 6 had parkinsonism; 4 of these had typical Parkinson's disease (PD), 1 had vascular and 1 had drug-induced parkinsonism. Among the remaining 4 patients, 2 had restless legs syndrome (RLS), 1 had tardive dyskinesia, and 1 orofacial dyskinesias of uncertain etiology. One patient with PD and the patient with vascular parkinsonism also had RLS. Age at onset was significantly earlier in the "primary OT" (mean +/- SD, 50.4 +/- 15.1) than in the "OT plus" (61.8 +/- 6.4; z = 2.7; P =.006) group. In 7 of the 10 "OT plus" patients, OT leg symptoms preceded the onset of additional neurological features. OT appeared to be underdiagnosed, and on average, it took 5.7 years from the initial complaints until a diagnosis was made. In general, treatment response to a variety of drugs such as clonazepam, primidone, and levodopa was poor. In most cases, OT symptoms remain relatively unchanged over the years, but in 6 of 41 cases (15%), the condition gradually worsened over the years, and in some of these cases, symptoms spread proximally to involve the trunk and arms. OT may not be a discrete disorder as commonly believed and associated features like parkinsonism present in nearly 25% of cases. Dopaminergic dysfunction may have a role in the pathophysiology of this disorder.
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Affiliation(s)
- Willibald Gerschlager
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom
- Department of Neurology, Krankenhaus der Barmherzigen Brüder, Vienna, Austria
| | | | - Regina Katzenschlager
- National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
- Reta Lila Weston Institute of Neurological Studies, Royal Free and University College London Medical School, United Kingdom
| | - Peter Brown
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom
| | - Niall Quinn
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Andrew J Lees
- National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
- Reta Lila Weston Institute of Neurological Studies, Royal Free and University College London Medical School, United Kingdom
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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Evans AH, Costa DC, Gacinovic S, Katzenschlager R, O'sullivan JD, Heales S, Lee P, Lees AJ. L-dopa-responsive Parkinson's syndrome in association with phenylketonuria: In vivo dopamine transporter and D2 receptor findings. Mov Disord 2004; 19:1232-6. [PMID: 15390012 DOI: 10.1002/mds.20146] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Reports of parkinsonism in phenylketonuria are exceedingly rare. We report on a patient who had received a delayed diagnosis of phenylketonuria as an infant and subsequently developed levodopa-responsive parkinsonism at the age of 33. Single-photon emission computed tomography (SPECT) using (123)I-FP-CIT ([(123))I]-2 beta-carbomethoxy-3beta-(-4-iodophenyl)-N-(3-fluoropropyl)-nortropane) used to measure dopamine transporter levels on two occasions, 7 and 9 years after the onset of neurological symptoms, were normal. Iodine-123-iodo-lisuride SPECT (IBZM) imaging, however, showed reduced caudate over putamen binding. This combination of imaging findings indicates a possible upregulation of postsynaptic D2 receptors in the context of intact presynaptic dopamine nerve terminal density.
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Affiliation(s)
- Andrew H Evans
- Reta Lila Weston Institute of Neurological Studies, University College London, United Kingdom
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Abstract
PURPOSE OF REVIEW Functional imaging such as positron emission tomography and single-photon emission computed tomography provide sensitive tools to assess functional brain abnormalities associated with neurodegenerative disease. This review discusses recent findings in this field, with a focus on the detection and characterization of receptor binding and presynaptic dopamine changes in movement disorders. RECENT FINDINGS The classical role of positron emission tomography and radioligands such as F-dopa and C-raclopride for investigating abnormalities of the presynaptic and postsynaptic dopaminergic system underlying Parkinson's disease, Parkinsonism and Huntington's disease has recently been made more powerful by the application of statistical mapping to localize changes in dopamine storage capacity and receptor binding across the whole brain at a voxel level. C-raclopride positron emission tomography provides an indirect marker of changes in levels of dopamine in the synaptic cleft. The application of this model in assessing dopamine changes in response to pharmacological, behavioural, motor task and magnetic stimulation in normal individuals and Parkinson's disease patients is reviewed. Recent studies using positron emission tomography and single-photon emission computed tomography to discriminate Parkinson's disease from essential tremor and Parkinsonism, the involvement of non-dopaminergic systems in Parkinson's disease and the role of cell transplantation in Parkinson's disease and Huntington's disease are also discussed. SUMMARY Functional imaging techniques provide insight into the pathophysiology of Parkinson's disease, Parkinsonism, and Huntington's disease and the mechanisms of the progression of these diseases. They also play a role in assessing the efficacy of putative neuroprotective and restorative therapy, such as striatal infusions of neurotrophic factors and implants of fetal cells.
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Affiliation(s)
- Paola Piccini
- MRC Clinical Sciences Centre and Division of Neuroscience, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, UK.
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Abstract
PURPOSE OF REVIEW Marked olfactory dysfunction (hyposmia) is a frequent and early abnormality in Parkinson's disease. We review recent advances related to its cause and its clinical relevance with respect to the differential diagnosis of Parkinsonian syndromes. RECENT FINDINGS Marked olfactory dysfunction occurs in Parkinson's disease and dementia with Lewy bodies but is not found in progressive supranuclear palsy and corticobasal degeneration. In multiple system atrophy, the deficit is mild and indistinguishable from cerebellar syndromes of other aetiologies, including the spino-cerebllar ataxias. This is in keeping with evidence of cerebellar involvement in olfactory processing, which may also help to explain recent findings of mild olfactory dysfunction in essential tremor. Smell testing remains, however, a clinically relevant tool in the differential diagnosis of indeterminate tremors. Intact olfaction has also been reported recently in Parkin disease (PARK 2) and vascular Parkinsonism. The relevance of sniffing ability to olfaction and a possible role of increased tyrosine hydroxylase and dopamine in parts of the olfactory bulb are issues of current interest with respect to pathophysiology. The early or 'pre-clinical' detection of Parkinson's disease is increasingly recognized as an area in which olfactory testing may be of value. SUMMARY Research findings have confirmed a role for olfactory testing in the differential diagnosis of movement disorders, and suggest that this approach is currently underused in clinical practice. Validated test batteries are now available that may prove to be of practical use in the differential diagnosis of Parkinsonian syndromes and indeterminate tremors.
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Marshall V, Grosset DG. Role of dopamine transporter imaging in the diagnosis of atypical tremor disorders. Mov Disord 2003; 18 Suppl 7:S22-7. [PMID: 14531042 DOI: 10.1002/mds.10574] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Dopamine transporter (DAT) imaging detects presynaptic dopamine neuronal dysfunction and thereby assists differentiation of conditions with and without dopamine deficit. In atypical tremor disorders, DAT imaging can differentiate between Parkinson's disease (PD), where dopamine deficit is demonstrated on DAT imaging, and essential tremor, where no dopamine deficit is found. DAT imaging may be particularly informative in monosymptomatic rest tremors, benign tremulous Parkinson's syndrome, and in the elderly in whom essential tremor may be accompanied by pseudoparkinsonism.
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Affiliation(s)
- Vicky Marshall
- Institute of Neurological Sciences, Southern General Hospital, Glasgow, United Kingdom.
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