A Series of 211 Children with Probable Essential Tremor

Clinical and Electrophysiological Characterization of Essential Tremor in 18 Children and Adolescents

Background

Essential tremor (ET) is considered the most frequent abnormal movement in the general population, with childhood onset in 5 to 30% of the patients.

Methods

A multicenter, descriptive cross-sectional study enrolled patients ⩽18 years with a definite diagnosis of ET according to the International Parkinson and Movement Disorders Society criteria. Demographic data, clinical and electrophysiological characteristics of the tremor, neurological examination and impact on quality of life were collected.

Results

9 males and 9 females were included (mean age of 13.9 years). Tremor was characterized by : upper limb onset at a mean age of 6.5 years; at enrollment, upper limbs localization, and involvement of an additional body region in 28% of the patients; kinetic tremor in all of the patients combined with postural tremor in 17 and rest tremor in 3; tremor mean frequency of 7.6 Hz, mean burst duration of 82.7 ms; identification of mild myoclonic jerks on the polymyographic recordings in 7 patients; altered quality of life with worse emotional outcomes in girls and when a disease duration >5 years was suggested.

Discussion

Childhood-onset ET is associated with delayed diagnosis and remarkable functional impact. Electromyographic identification of additional mild myoclonus is a new finding whose significance is discussed.

Highlights

ET onset involved upper limbs and at inclusion, 28% of the patients exhibited involvement of an additional body region.ET impacted quality of life for all patients.Girls and patients affected for >5 years reported worse emotional outcomes.Mild myoclonic jerks were identified on 7/17 polymyographic recordings.

Prevalence of Potential Essential Tremor Cases in Turkish Adolescents According to The WHIGET Classification

OBJECTIVE

Essential tremor is the most common movement disorder diagnosed during adolescence. However, there are insufficient data about its prevalence among adolescents. This study aims to determine the prevalence of potential essential tremor cases in Turkish adolescents.

MATERIALS AND METHODS

This cross-sectional study was carried out in Istanbul, Turkey. A total of 5 high schools were visited. In the first step, the authors provided 5559 students (aged 14-18) with clinical information about tremors and essential tremors in their classrooms. After that, a 12-item questionnaire filled by adolescents and parental consent forms were collected. The response rate was 78% (n = 4330). According to the questionnaire answers, adolescents who complained of experiencing tremors in any part of their body were clinically evaluated in the second step of the study. Lastly, a neurological examination to classify essential tremors based on the Washington Heights Inwood Genetic Study of Essential Tremor (1998) diagnostic criteria was conducted by a specialist.

RESULTS

The prevalence of tremor in the respondents aged 14-18 (median = 15) years was 1.2 % (n = 52/4330), and the prevalence of essential tremor was 0.41% (n = 18/4330). Male to female ratio for essential tremor was 5 : 1 (male = 15 and female = 1). Essential tremor cases were subclassified as following: 10 (55.5%) definite essential tremor, 3 (16.6%) probable essential tremor, and 5 (27.7%) possible essential tremor.

CONCLUSION

The data support the claim that essential tremor is a prevalent movement disorder in Turkish adolescents.

Epidemiology of pediatric essential tremor in the United States: a systematic literature review from 2010 to 2020

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Clinical and laboratory features of children with tremor: a single-center experience

AIM

Tremor is an involuntary, rhythmic, oscillatory movement of body parts around a central point or plane which arises from contraction of antagonist muscles. Evaluation of pediatric patients with tremor can be challenging due to limited population-based studies in children. The aim of this study is to evaluate the demographic, clinical and laboratory features of childhood tremor, retrospectively.

MATERIALS AND METHODS

Patients under the age of 18 years presenting with tremor (n = 111) to the Pediatric Neurology Unit of Kecioren Research and Training Hospital between January 2014 and December 2019 were included in the study. Patients with neuromuscular disease, vertebral pathology or incomplete data in hospital records were not included. Also, benign tremor causes (jitteriness, shuddering attack, etc.) seen in the neonatal and infancy period were excluded from the study as the number of patients was insufficient. Demographic data, type and duration of tremor, accompanying symptoms, chronic diseases and medications, family history, physical and neurological examination, laboratory findings, neuroimaging findings were retrospectively analyzed and recorded.

RESULTS

A total of 111 children (59 girls and 52 boys) were included in our study and the female to male ratio was 1.1. The mean age at tremor onset and age at admission to hospital were 13.2 ± 2.8 years (range 4-17 years), and 14.8 ± 2.0 years (range 6-17 years), respectively. The most common type of tremor was essential tremor (62.2%), followed by enhanced physiologic (18.9%). None of the patients had acute metabolic disorder. Diagnostic tests revealed the etiology in 12 patients. These were vitamin B12 deficiency in 11 patients and multiple sclerosis in one patient. Drug-induced and task-specific tremors were determined in 4 patients each. It was determined that in patients with a positive family history, tremor appeared or was noticed at a younger age.

CONCLUSIONS

Most of the cases with tremor can be diagnosed accurately by a detailed medical history, physical and neurological examination. Essential tremor is the most common type of tremor in children. Laboratory tests and imaging methods have limited additional yield in elucidating the etiology. Early recognition of tremor and related signs and symptoms in childhood is important for the detection and treatment of the possible underlying cause.

Transitional Care for Young People with Neurological Disorders: A Scoping Review with A Focus on Patients with Movement Disorders

Childhood-onset movement disorders represent a heterogenous group of conditions. Given the complexity of these disorders, the transition of care from pediatric to adult medicine is an important consideration. We performed a scoping review of the literature on transitional care in chronic neurological disease, exploring key transitional issues and proposed transitional care models. Our aim was to describe the current knowledge and gaps about the transition process of young adults with chronic neurological disorders, paying special attention to childhood onset movement disorders. A total of 64 articles were included in the qualitative synthesis; 56 articles reported on transitional care issues, and 8 articles reported on transitional care models. Only 2 articles included patients with movement disorders. The following 4 main transitional issues were identified following synthesis of the available literature: (1) inadequate preparation for the transition process, (2) inappropriate and inconsistent transition practices, (3) inadequate adult services, and (4) heightened emotional response surrounding transition. Of the reported transitional care models, multidisciplinary ambulatory care was the most common approach. In studies evaluating patient-related outcomes, positive health, educational, and vocational outcomes were found. The available literature provides insights on issues that can arise during transition that should be addressed to improve patient and caregiver comfort and satisfaction with care. Further research is needed to evaluate how transitional care programs affect outcomes and their cost effectiveness. More studies are required to determine the needs and outcomes specific to patients with childhood onset movement disorders. © 2020 International Parkinson and Movement Disorder Society.

Essential tremor: diagnosis and management

Essential tremor is one of the most common movement disorders in adults and can affect both children and adults. An updated consensus statement in 2018 redefined essential tremor as an isolated action tremor present in bilateral upper extremities for at least three years. Tremor may also be present in other locations, commonly the neck or the vocal cords. Patients with additional neurologic symptoms are now categorized as "essential tremor plus." Additional clinical features associated with the condition include but are not limited to cognitive impairment, psychiatric disorders, and hearing loss. When treatment is needed, propranolol and primidone are considered first line treatments. Patients who are severely affected are often offered deep brain stimulation. Although the ventral intermediate nucleus of the thalamus is the traditional surgical target, the caudal zona incerta is also being studied as a possible superior alternative. Magnetic resonance imaging guided high intensity focused ultrasound is a newer surgical alternative that may be ideal for patients with substantial medical comorbidities. Current research explores novel oral treatments, chemodenervation, and noninvasive neuromodulation for treatment of essential tremor.

Clinical Features of Essential Tremor in Children

Investigators from Cleveland Clinic Child Neurology Center reported the clinical features of essential tremor (ET) in the pediatric population.