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Silsby M, Yiannikas C, Fois AF, Kennerson ML, Kiernan MC, Fung VSC, Vucic S. Upper and lower limb tremor in Charcot-Marie-Tooth neuropathy type 1A and the implications for standing balance. J Neurol 2024; 271:1776-1786. [PMID: 38051345 PMCID: PMC10972941 DOI: 10.1007/s00415-023-12124-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/17/2023] [Accepted: 11/18/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Neuropathic tremor occurs in Charcot-Marie-Tooth neuropathy type 1A (CMT1A; hereditary motor and sensory neuropathy, HMSN), although the pathophysiological mechanisms remain to be elucidated. Separately, lower limb tremor has not been explored in CMT1A and could be associated with imbalance as in other neuropathies. The present study aimed to determine tremor characteristics in the upper and lower limbs in CMT1A and relate these findings to clinical disability, particularly imbalance. METHODS Tremor and posturography studies were undertaken in phenotyped and genotyped CMT1A patients. Participants underwent detailed clinical assessment, tremor study recordings, and nerve conduction studies. Tremor stability index was calculated for upper limb tremor and compared to essential tremor. RESULTS Seventeen patients were enrolled. Postural and kinetic upper limb tremors were evident in 65%, while postural and orthostatic lower limb tremors were seen in 35% of CMT1A patients. Peak upper limb frequencies were lower distally (~ 6 Hz) and higher proximally (~ 9 Hz), were unchanged by weight-loading, and not impacted by fatigue. The tremor stability index was significantly higher in CMT1A than in essential tremor. A 5-6 Hz lower limb tremor was recorded which did not vary along the limb and was unaffected by fatigue. Balance was impaired in patients with postural lower limb tremor. A high frequency peak on posturography was associated with 'good' balance. CONCLUSIONS Tremor is a common clinical feature in CMT1A, distinct from essential tremor, mediated by a complex interaction between peripheral and central mechanisms. Postural lower limb tremor is associated with imbalance; strategies aimed at tremor modulation could be of therapeutic utility.
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Affiliation(s)
- Matthew Silsby
- Neurology Department, Westmead Hospital, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
- Brain and Nerve Research Centre, University of Sydney, Concord, NSW, Australia
- Neurology Department, Concord Hospital, Sydney, NSW, Australia
| | - Con Yiannikas
- Neurology Department, Concord Hospital, Sydney, NSW, Australia
- Neurology Department, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Alessandro F Fois
- Neurology Department, Westmead Hospital, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Marina L Kennerson
- Northcott Neuroscience Laboratory, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
- Molecular Medicine Laboratory, Concord Hospital, Concord, NSW, Australia
| | - Matthew C Kiernan
- Neurology Department, Royal Prince Alfred Hospital Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Victor S C Fung
- Neurology Department, Westmead Hospital, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Steve Vucic
- Brain and Nerve Research Centre, University of Sydney, Concord, NSW, Australia.
- Neurology Department, Concord Hospital, Sydney, NSW, Australia.
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Tankus A, Lustig-Barzelay Y, Gurevitch G, Faust-Socher A, Strauss I. Neuronal Encoding of Speech Features in the Human Thalamus in Parkinson's Disease and Essential Tremor Patients. Neurosurgery 2024; 94:307-316. [PMID: 37695053 DOI: 10.1227/neu.0000000000002665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/10/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The human thalamus is known, from stimulation studies and functional imaging, to participate in high-level language tasks. The goal of this study is to find whether and how speech features, in particular, vowel phonemes, are encoded in the neuronal activity of the thalamus, and specifically of the left ventralis intermediate nucleus (Vim), during speech production, perception, and imagery. METHODS In this cross-sectional study, we intraoperatively recorded single neuron activity in the left Vim of eight neurosurgical patients with Parkinson's disease (PD) (n = 4) or essential tremor (n = 4) undergoing implantation of deep brain stimulation (n = 3) or radiofrequency lesioning (n = 5) while patients articulated the five monophthongal vowel sounds. RESULTS In this article, we report that single neurons in the left Vim encode individual vowel phonemes mainly during speech production but also during perception and imagery. They mainly use one of two encoding schemes: broad or sharp tuning, with a similar percentage of units each. Sinusoidal tuning has been demonstrated in almost half of the broadly tuned units. Patients with PD had a lower percentage of speech-related units in each aspect of speech (production, perception, and imagery), a significantly lower percentage of broadly tuned units, and significantly lower median firing rates during speech production and perception, but significantly higher rates during imagery, than patients with essential tremor. CONCLUSION The results suggest that the left Vim uses mixed encoding schemes for speech features. Our findings explain, at the single neuron level, why deep brain stimulation and radiofrequency lesioning of the left Vim are likely to cause speech side effects. Moreover, they may indicate that speech-related units in the left Vim of patients with PD may be degraded even in the subclinical phase.
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Affiliation(s)
- Ariel Tankus
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
- Department of Neurology and Neurosurgery, Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv , Israel
| | - Yael Lustig-Barzelay
- Department of Neurology and Neurosurgery, Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Guy Gurevitch
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv , Israel
- Department of Physiology and Pharmacology, Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Achinoam Faust-Socher
- Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
| | - Ido Strauss
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv , Israel
- Department of Neurology and Neurosurgery, Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
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Sharifi S, Buijink AWG, Luft F, Scheijbeler EP, Potters WV, van Wingen G, Heida T, Bour LJ, van Rootselaar AF. Differences in Olivo-Cerebellar Circuit and Cerebellar Network Connectivity in Essential Tremor: a Resting State fMRI Study. CEREBELLUM (LONDON, ENGLAND) 2023; 22:1123-1136. [PMID: 36214998 PMCID: PMC10657290 DOI: 10.1007/s12311-022-01486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
The olivo-cerebellar circuit is thought to play a crucial role in the pathophysiology of essential tremor (ET). Whether olivo-cerebellar circuit dysfunction is also present at rest, in the absence of clinical tremor and linked voluntary movement, remains unclear. Assessing this network in detail with fMRI is challenging, considering the brainstem is close to major arteries and pulsatile cerebrospinal fluid-filled spaces obscuring signals of interest. Here, we used methods tailored to the analysis of infratentorial structures. We hypothesize that the olivo-cerebellar circuit shows altered intra-network connectivity at rest and decreased functional coupling with other parts of the motor network in ET. In 17 ET patients and 19 healthy controls, we investigated using resting state fMRI intracerebellar functional and effective connectivity on a dedicated cerebellar atlas. With independent component analysis, we investigated data-driven cerebellar motor network activations during rest. Finally, whole-brain connectivity of cerebellar motor structures was investigated using identified components. In ET, olivo-cerebellar pathways show decreased functional connectivity compared with healthy controls. Effective connectivity analysis showed an increased inhibitory influence of the dentate nucleus towards the inferior olive. Cerebellar independent component analyses showed motor resting state networks are less strongly connected to the cerebral cortex compared to controls. Our results indicate the olivo-cerebellar circuit to be affected at rest. Also, the cerebellum is "disconnected" from the rest of the motor network. Aberrant activity, generated within the olivo-cerebellar circuit could, during action, spread towards other parts of the motor circuit and potentially underlie the characteristic tremor of this patient group.
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Affiliation(s)
- Sarvi Sharifi
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Arthur W G Buijink
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Frauke Luft
- Department of Biomedical Signals and Systems, University of Twente, TechMed Centre, Enschede, The Netherlands
| | - Elliz P Scheijbeler
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Wouter V Potters
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Tjitske Heida
- Department of Biomedical Signals and Systems, University of Twente, TechMed Centre, Enschede, The Netherlands
| | - Lo J Bour
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Anne-Fleur van Rootselaar
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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Rajan R, Anandapadmanabhan R, Vishnoi A, Vishnu VY, Latorre A, Agarwal H, Ghosh T, Mangat N, Biswas D, Gupta A, Radhakrishnan DM, Singh MB, Bhatia R, Srivastava A, Srivastava MVP, Bhatia KP. Neuropathic Tremor in Guillain-Barré Syndrome. Mov Disord Clin Pract 2023; 10:1333-1340. [PMID: 37772292 PMCID: PMC10525049 DOI: 10.1002/mdc3.13807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/12/2023] [Accepted: 05/24/2023] [Indexed: 09/30/2023] Open
Abstract
Background Neuropathic Tremor (NT) is a postural/kinetic tremor of the upper extremity, often encountered in patients with chronic neuropathies such as paraprotein-associated and hereditary neuropathies. Objectives To describe the clinical and electrophysiological features of NT in a previously underrecognized setting- during recovery from Guillain-Barré Syndrome (GBS). Methods Patients with a documented diagnosis of GBS in the past, presenting with tremor were identified from review of clinical records. Participants underwent structured, videotaped neurological examination, and electrophysiological analysis using tri-axial accelerometry-surface electromyography. Tremor severity was assessed using the Fahn-Tolosa-Marin Tremor Rating Scale. Results We describe the clinical and electrophysiological features of 5 patients with GBS associated NT. Our cohort had a fine, fast, and slightly jerky postural tremor of frequency ranging from 8 to 10 Hz. Dystonic posturing and overflow movements were noted in 4/5 patients. Tremor appeared 3 months-5 years after the onset of GBS, when patients had regained near normal muscle strength and deep tendon jerks were well elicitable. Electrophysiological analysis of tremor strongly suggested the presence of a central oscillator in all patients. Conclusion NT is not limited to chronic inflammatory or hereditary neuropathies and may occur in the recovery phase of GBS. The tremor is characterized by a high frequency, jerky postural tremor with dystonic posturing. Electrophysiological evaluation suggests the presence of a central oscillator, hypothetically the cerebellum driven by impaired sensorimotor feedback.
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Affiliation(s)
- Roopa Rajan
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Aayushi Vishnoi
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Anna Latorre
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London (UCL) Institute of NeurologyLondonUnited Kingdom
| | - Harsh Agarwal
- All Indian Institute of Medical SciencesNew DelhiIndia
| | | | - Navtej Mangat
- All Indian Institute of Medical SciencesNew DelhiIndia
| | - Deblina Biswas
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Anu Gupta
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Mamta Bhushan Singh
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Rohit Bhatia
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Achal Srivastava
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London (UCL) Institute of NeurologyLondonUnited Kingdom
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Silsby M, Fois AF, Yiannikas C, Ng K, Kiernan MC, Fung VSC, Vucic S. Chronic inflammatory demyelinating polyradiculoneuropathy-associated tremor: Phenotype and pathogenesis. Eur J Neurol 2023; 30:1059-1068. [PMID: 36692234 DOI: 10.1111/ene.15693] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/16/2022] [Accepted: 12/29/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Tremor in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is underrecognized, and the pathophysiology remains incompletely understood. This study evaluated tremor in CIDP and tested the hypothesis, established in other demyelinating neuropathies, that tremor occurs due to mistimed peripheral inputs affecting central motor processing. Additionally, the tremor stability index (TSI) was calculated with the hypothesis that CIDP-related tremor is more variable than other tremor disorders. METHODS Consecutive patients with typical CIDP were prospectively recruited from neuromuscular clinics. Alternative causes of neuropathy and tremor were excluded. Cross-sectional clinical assessment and extensive tremor study recordings were undertaken. Pearson correlation coefficient was used to compare nerve conduction studies and tremor characteristics, and t-test was used for comparisons between groups. RESULTS Twenty-four patients with CIDP were included. Upper limb postural and action tremor was present in 66% and was mild according to the Essential Tremor Rating Assessment Scale. Tremor did not significantly impact disability. Surface electromyography (EMG) found high-frequency spectral peaks in deltoid (13.73 ± 0.66 Hz), biceps brachii (11.82 ± 0.91 Hz), and extensor carpi radialis (11.87 ± 0.91 Hz) muscles, with lower peaks in abductor pollicis brevis EMG (6.07 ± 0.45 Hz) and index finger accelerometry (6.53 ± 0.42 Hz). Tremor was unchanged by weight loading but correlated with ulnar nerve F-wave latency and median nerve sensory amplitude. TSI (2.3 ± 0.1) was significantly higher than essential tremor. CONCLUSIONS Postural tremor is a common feature in CIDP. Tremor was unaffected by weight loading, typical of centrally generated tremors, although there was a correlation with peripheral nerve abnormalities. The high beat-to-beat variability on TSI and gradation of peak frequencies further suggest a complex pathophysiology. These findings may assist clinicians with the diagnosis of neuropathic tremor.
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Affiliation(s)
- Matthew Silsby
- Neurology Department, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Brain and Nerve Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Neurology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Alessandro F Fois
- Neurology Department, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Con Yiannikas
- Neurology Department, Concord Hospital, Sydney, New South Wales, Australia
- Neurology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Karl Ng
- Neurology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Brain and Mind Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Victor S C Fung
- Neurology Department, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Steve Vucic
- Brain and Nerve Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Neurology Department, Concord Hospital, Sydney, New South Wales, Australia
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Paoli D, Mills R, Brechany U, Pavese N, Nicholson C. DBS in tremor with dystonia: VIM, GPi or both? A review of the literature and considerations from a single-center experience. J Neurol 2023; 270:2217-2229. [PMID: 36680569 PMCID: PMC10025201 DOI: 10.1007/s00415-023-11569-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is an established treatment for dystonia and tremor. However, there is no consensus about the best surgical targeting strategy in patients with concomitant tremor and dystonia. Both the thalamic ventral intermediate nucleus (VIM) and the globus pallidus pars interna (GPi) have been proposed as targets. Few cases using them together in a double-target approach have also been reported. METHODS We reviewed the literature on this topic, summarizing results of different target choices. Additionally, we retrospectively report a case series of nine patients with sporadic dystonia and severe tremor treated with a double-target strategy at our center. Outcome measures were the Burke-Fahn-Marsden Dystonia Rating Scale (BFM) and Eq-5d scale. RESULTS In published studies of patients with dystonia and tremor, VIM-DBS is highly effective on tremor but raise some concerns about dystonia's control, while GPi-DBS is more effective on dystonia but does not always relieve tremor. GPi + VIM-DBS shows good efficacy but is rarely reported and reserved for selected patients. In our patients, the double-target strategy obtained a significant and durable improvement in tremor, dystonia, and quality of life. Additionally, compared with a cohort of patients with tremor treated with VIM-DBS only, significantly lower frequency and intensity of VIM stimulation were required to control tremor. CONCLUSION Our findings and published evidence seem to support the double-targeting approach as a safe and effective option in selected patients with tremor-dominant dystonia. This strategy appears to provide a more extensive control of either dystonia or tremor and may have a potential for limiting stimulation-related side effects.
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Affiliation(s)
- Davide Paoli
- Clinical Ageing Research Unit, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Santa Chiara, 56126, Pisa, Italy
| | - Russell Mills
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - Una Brechany
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
- Newcastle Magnetic Resonance Centre and Positron Emission Tomography Centre - Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark.
| | - Claire Nicholson
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
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Kurtin DL, Giunchiglia V, Vohryzek J, Cabral J, Skeldon AC, Violante IR. Moving from phenomenological to predictive modelling: Progress and pitfalls of modelling brain stimulation in-silico. Neuroimage 2023; 272:120042. [PMID: 36965862 DOI: 10.1016/j.neuroimage.2023.120042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/06/2023] [Accepted: 03/16/2023] [Indexed: 03/27/2023] Open
Abstract
Brain stimulation is an increasingly popular neuromodulatory tool used in both clinical and research settings; however, the effects of brain stimulation, particularly those of non-invasive stimulation, are variable. This variability can be partially explained by an incomplete mechanistic understanding, coupled with a combinatorial explosion of possible stimulation parameters. Computational models constitute a useful tool to explore the vast sea of stimulation parameters and characterise their effects on brain activity. Yet the utility of modelling stimulation in-silico relies on its biophysical relevance, which needs to account for the dynamics of large and diverse neural populations and how underlying networks shape those collective dynamics. The large number of parameters to consider when constructing a model is no less than those needed to consider when planning empirical studies. This piece is centred on the application of phenomenological and biophysical models in non-invasive brain stimulation. We first introduce common forms of brain stimulation and computational models, and provide typical construction choices made when building phenomenological and biophysical models. Through the lens of four case studies, we provide an account of the questions these models can address, commonalities, and limitations across studies. We conclude by proposing future directions to fully realise the potential of computational models of brain stimulation for the design of personalized, efficient, and effective stimulation strategies.
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Affiliation(s)
- Danielle L Kurtin
- Neuromodulation Laboratory, School of Psychology, University of Surrey, Guildford, GU2 7XH, United Kingdom; Department of Brain Sciences, Imperial College London, London, United Kingdom.
| | | | - Jakub Vohryzek
- Centre for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain; Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, UK
| | - Joana Cabral
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Anne C Skeldon
- Department of Mathematics, Centre for Mathematical and Computational Biology, University of Surrey, Guildford, United Kingdom
| | - Ines R Violante
- Neuromodulation Laboratory, School of Psychology, University of Surrey, Guildford, GU2 7XH, United Kingdom
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Agarwal K, Biswas R, Kumar V. Wernekink Commissure Syndrome With Bilateral Cerebellar Signs and Holmes Tremor in a Patient With a Preexisting Movement Disorder. Cureus 2023; 15:e35674. [PMID: 37009377 PMCID: PMC10065355 DOI: 10.7759/cureus.35674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Wernekink commissure syndrome (WCS) is an extremely rare midbrain syndrome, in which there is the selective destruction of the decussation of the superior cerebellar peduncle, which commonly presents with bilateral cerebellar signs. We describe a case of WCS with Holmes tremor in a patient having an undiagnosed involuntary movement disorder since childhood following an undocumented case of meningitis. The patient presented with sudden onset gait instability with bilateral cerebellar signs (more prominent on the left side), Holmes tremor in bilateral limbs, slurred speech, and marked dysarthria. No ophthalmoplegia or palatal tremors were noted. The patient was conservatively managed along the lines of a stroke, and there was a marked improvement in cerebellar signs and Holmes tremor with time but no evolution (improvement or worsening) was observed in the involuntary movements of limbs and face that were present before the onset of WCS.
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9
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Pyrgelis ES, Agapiou E, Angelopoulou E. Holmes tremor: an updated review. Neurol Sci 2022; 43:6731-6740. [DOI: 10.1007/s10072-022-06352-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
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Chang SJ, Mitchell R, Hukin J, Singhal A. Treatment-responsive Holmes tremor in a child with low-pressure hydrocephalus: video case report and systematic review of the literature. J Neurosurg Pediatr 2022; 29:520-527. [PMID: 35148507 DOI: 10.3171/2021.12.peds21539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Holmes tremor (HT) is a rare and debilitating movement disorder comprising both rest and action tremor, and it is known for its resistance to treatment. Its most common causes include ischemic or hemorrhagic insults and trauma. Mechanistically, the combined rest and action tremor is thought to require a double lesion of both the dopaminergic nigrostriatal system and the dentatorubrothalamic pathways, often near the midbrain where both pathways converge. The aim of this study was to characterize HT as a presenting sign in cases of hydrocephalus and to discuss potential pathomechanisms, clinical presentations, and treatment options. METHODS MEDLINE and Web of Science were searched for cases of HT with hydrocephalus from database inception to August 2021, and these were compiled along with the authors' own unique case of treatment-responsive HT in a child with low-pressure obstructive hydrocephalus secondary to a tectal tumor. Patient characteristics, presenting signs/symptoms, potential precipitating factors, interventions, and patient outcomes were recorded. RESULTS Nine patients were identified including the authors' video case report. All patients had a triventriculomegaly pattern with at least a component of obstructive hydrocephalus, and 4 patients were identified as having low-pressure hydrocephalus. Parinaud's syndrome and bradykinesia were the most commonly associated signs. Levodopa and CSF diversion were the most commonly used and effective treatments for HT in this population. This review was not registered and did not receive any funding. CONCLUSIONS HT is a poorly understood and probably underrecognized presentation of hydrocephalus that is difficult to treat, limiting the strength of the evidence in this review. Treatment options include CSF diversion, antiparkinsonian agents, antiepileptic agents, deep brain stimulation, and MR-guided focused ultrasound, and aim toward the nigrostriatal and dentatorubrothalamic pathways hypothesized to be involved in its pathophysiology.
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Affiliation(s)
- Stephano J Chang
- 1Division of Neurosurgery, Department of Surgery, University of British Columbia
| | - Ruth Mitchell
- 2Faculty of Medicine and the Division of Neurosurgery, University of British Columbia and British Columbia Children's Hospital; and
| | - Juliette Hukin
- 3Divisions of Neurology and Hematology/Oncology/Bone Marrow Transplant, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Ash Singhal
- 2Faculty of Medicine and the Division of Neurosurgery, University of British Columbia and British Columbia Children's Hospital; and
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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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Frey J, Hess CW, Kugler L, Wajid M, Wagle Shukla A. Transcranial Magnetic Stimulation in Tremor Syndromes: Pathophysiologic Insights and Therapeutic Role. Front Neurol 2021; 12:700026. [PMID: 34512517 PMCID: PMC8426899 DOI: 10.3389/fneur.2021.700026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a painless, non-invasive, and established brain stimulation technique to investigate human brain function. Over the last three decades, TMS has shed insight into the pathophysiology of many neurological disorders. Tremor is an involuntary, rhythmic oscillatory movement disorder commonly related to pathological oscillations propagated via the cerebello-thalamo-cortical pathway. Although tremor is the most common movement disorder and recent imaging studies have enhanced our understanding of the critical pathogenic networks, the underlying pathophysiology of different tremor syndromes is complex and still not fully understood. TMS has been used as a tool to further our understanding of tremor pathophysiology. In addition, repetitive TMS (rTMS) that can modulate brain functions through plasticity effects has been targeted to the tremor network to gain potential therapeutic benefits. However, evidence is available for only a few studies that included small patient samples with limited clinical follow-up. This review aims to discuss the role of TMS in advancing the pathophysiological understanding as well as emerging applications of rTMS for treating individual tremor syndromes. The review will focus on essential tremor, Parkinson's disease tremor, dystonic tremor syndrome, orthostatic tremor, and functional tremor.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Christopher W Hess
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Liam Kugler
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Manahil Wajid
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Aparna Wagle Shukla
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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13
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Bayramoglu B, Emre U, Erdal Y, Demirhan H, Yasak I, Yalin OO. Cervical vestibular-evoked myogenic potentials in patients with essential tremor. J Clin Neurosci 2021; 91:365-368. [PMID: 34373053 DOI: 10.1016/j.jocn.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
Although different neuroanatomical structures and pathways are emphasized as possible explanations for essential tremor (ET), there is still an ongoing debate. This study aimed to assess the role of brainstem and reflex pathways with cervical vestibular-evoked myogenic potentials (VEMP) in patients with ET. This prospective study included 34 patients with ET and 25 healthy controls. Cervical VEMP was performed in both groups and latencies, inter-peak latency intervals, peak-to-peak amplitudes and asymmetry ratios were recorded. There was statistically no significant difference between the groups in terms of age (38.9 ± 14.9 years vs. 38.9 ± 14.9 years, p = 0.673) and gender (female to male ratio: 14/11 vs. 20/14, p = 0.828). Right N1 latency and right N1-P1 interval were significantly longer in the patient group (p < 0.05). There was a significant positive correlation between the duration of disease and the right N1-P1 interval (p < 0.05). There was no significant difference between the patient and control groups in terms of bilateral P1 latency, left N1 latency, left N1-P1 interval, and bilateral N1 and P1 amplitudes (p˃0.05). Cervical VEMP may reveal the involvement of brainstem and associated reflex pathways in ET.
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Affiliation(s)
- Banu Bayramoglu
- Health Sciences University, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric and Neurologic Diseases, Neurology Department, Istanbul, Turkey.
| | - Ufuk Emre
- Health Sciences University, Istanbul Training and Research Hospital, Neurology Department, Istanbul, Turkey
| | - Yuksel Erdal
- Health Sciences University, Istanbul Training and Research Hospital, Neurology Department, Istanbul, Turkey
| | - Hasan Demirhan
- Istanbul Medipol University, Otorhinolaryngology Department, Istanbul, Turkey
| | - Ilknur Yasak
- Health Sciences University, Istanbul Training and Research Hospital, Neurology Department, Istanbul, Turkey
| | - Osman Ozgur Yalin
- Health Sciences University, Istanbul Training and Research Hospital, Neurology Department, Istanbul, Turkey
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Fénelon G, Walusinski O. The landmark contributions of Paul Blocq, Georges Marinesco, and Édouard Brissaud in Parkinson's disease. Rev Neurol (Paris) 2021; 177:1214-1220. [PMID: 34187692 DOI: 10.1016/j.neurol.2021.02.386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/09/2021] [Indexed: 11/25/2022]
Abstract
Two students of Jean-Martin Charcot, Paul Blocq and Georges Marinesco, presented a case of hemi-parkinsonism to the Société de Biologie on 27 May 1893. A tuberculoma was found at post-mortem in the cerebral peduncle contralateral to the side of the body affected by Parkinson's disease. A year later, in one of his lessons, Édouard Brissaud suggested that damage to the substantia nigra caused by the granuloma might have been responsible for the physical signs. This article provides brief biographical accounts of both Blocq and Marinesco and a detailed review of their seminal paper before going on to discuss how the substantia nigra was eventually established as the most consistent pathological substrate for Parkinson's disease and its role in the dopamine miracle which led to striatal dopamine replacement therapy in 1967.
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Affiliation(s)
- G Fénelon
- Service de neurologie, centre expert Parkinson, hôpital Henri-Mondor-Albert-Chenevier, AP-HP, 94010 Créteil, France; Département d'études cognitives, école normale supérieure, PSL University, 75005 Paris, France; Inserm U955, équipe neuro-psychologie interventionnelle, institut Mondor de recherche biomédicale, université Paris-Est Créteil, 94010 Créteil, France.
| | - O Walusinski
- Lauréat de l'Académie nationale de médecine, 20, rue de Chartres, 28160 Brou, France.
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15
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Cenzato M, Colistra D, Iacopino G, Raftopoulos C, Sure U, Tatagiba M, Spetzler RF, Konovalov AN, Smolanka A, Smolanka V, Stefini R, Bortolotti C, Ferroli P, Pinna G, Franzini A, Dammann P, Naros G, Boeris D, Mantovani P, Lizio D, Piano M, Fava E. Holmes tremor: a delayed complication after resection of brainstem cavernomas. J Neurosurg 2020; 135:693-703. [PMID: 33307533 DOI: 10.3171/2020.7.jns201352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this paper, the authors aimed to illustrate how Holmes tremor (HT) can occur as a delayed complication after brainstem cavernoma resection despite strict adherence to the safe entry zones (SEZs). METHODS After operating on 2 patients with brainstem cavernoma at the Great Metropolitan Hospital Niguarda in Milan and noticing a similar pathological pattern postoperatively, the authors asked 10 different neurosurgery centers around the world to identify similar cases, and a total of 20 were gathered from among 1274 cases of brainstem cavernomas. They evaluated the tremor, cavernoma location, surgical approach, and SEZ for every case. For the 2 cases at their center, they also performed electromyographic and accelerometric recordings of the tremor and evaluated the post-operative tractographic representation of the neuronal pathways involved in the tremorigenesis. After gathering data on all 1274 brainstem cavernomas, they performed a statistical analysis to determine if the location of the cavernoma is a potential predicting factor for the onset of HT. RESULTS From the analysis of all 20 cases with HT, it emerged that this highly debilitating tremor can occur as a delayed complication in patients whose postoperative clinical course has been excellent and in whom surgical access has strictly adhered to the SEZs. Three of the patients were subsequently effectively treated with deep brain stimulation (DBS), which resulted in complete or almost complete tremor regression. From the statistical analysis of all 1274 brainstem cavernomas, it was determined that a cavernoma location in the midbrain was significantly associated with the onset of HT (p < 0.0005). CONCLUSIONS Despite strict adherence to SEZs, the use of intraoperative neurophysiological monitoring, and the immediate success of a resective surgery, HT, a severe neurological disorder, can occur as a delayed complication after resection of brainstem cavernomas. A cavernoma location in the midbrain is a significant predictive factor for the onset of HT. Further anatomical and neurophysiological studies will be necessary to find clues to prevent this complication.
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Affiliation(s)
- Marco Cenzato
- 1Neurosurgery, Great Metropolitan Hospital Niguarda, Milan
| | | | - Giorgia Iacopino
- 2Neurosurgery, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Christian Raftopoulos
- 3Department of Neurosurgery, Saint-Luc University Clinic, Catholic University of Louvain, Brussels, Belgium
| | - Ulrich Sure
- 4Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen
| | - Marcos Tatagiba
- 5Department of Neurosurgery, University Hospital Tübingen, Germany
| | | | | | | | | | | | - Carlo Bortolotti
- 10Department of Neurologic Surgery, Bellaria Hospital, Institute of Neurological Sciences of Bologna
| | - Paolo Ferroli
- 11Department of Neurosurgery, Carlo Besta Neurological Institute, Milan
| | | | - Angelo Franzini
- 11Department of Neurosurgery, Carlo Besta Neurological Institute, Milan
| | - Philipp Dammann
- 4Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen
| | - Georgios Naros
- 5Department of Neurosurgery, University Hospital Tübingen, Germany
| | - Davide Boeris
- 1Neurosurgery, Great Metropolitan Hospital Niguarda, Milan
| | - Paolo Mantovani
- 10Department of Neurologic Surgery, Bellaria Hospital, Institute of Neurological Sciences of Bologna
| | | | - Mariangela Piano
- 14Neuroradiology, Great Metropolitan Hospital Niguarda, Milan; and
| | - Enrica Fava
- 1Neurosurgery, Great Metropolitan Hospital Niguarda, Milan
- 15Department of Medical Biotechnologies and Translational Medicine, University of Milan, Italy
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Wang KL, Wong JK, Eisinger RS, Carbunaru S, Smith C, Hu W, Shukla AW, Hess CW, Okun MS, Ramirez-Zamora A. Therapeutic Advances in the Treatment of Holmes Tremor: Systematic Review. Neuromodulation 2020; 25:796-803. [PMID: 32578304 DOI: 10.1111/ner.13220] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/22/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to formulate a practical clinical treatment algorithm for Holmes's tremor (HT) by reviewing currently published clinical data. MATERIALS AND METHODS We performed a systematic review of articles discussing the management of HT published between January 1990 and December 2018. We examined data from 89 patients published across 58 studies detailing the effects of pharmacological or surgical interventions on HT severity. Clinical outcomes were measured by a continuous 1-10 ranked scale. The majority of studies addressing treatment response were case series or case reports. No randomized control studies were identified. RESULTS Our review included 24 studies focusing on pharmacologic treatments of 25 HT patients and 34 studies focusing on the effect of deep brain stimulation (DBS) in 64 patients. In the medical intervention group, the most commonly used drugs were levetiracetam, trihexyphenidyl, and levodopa. In the surgically treated group, the thalamic ventralis intermedius nucleus (VIM) and globus pallidus internus (GPi) were the most common brain targets for neuromodulation. The two targets accounted for 57.8% and 32.8% of total cases, respectively. Overall, compared to the medically treated group, DBS provided greater tremor suppression (p = 0.025) and was more effective for the management of postural tremor in HT. Moreover, GPi DBS displayed greater benefit in the resting tremor component (p = 0.042) and overall tremor reduction (p = 0.022). CONCLUSIONS There is a highly variable response to different medical treatments in HT without randomized clinical trials available to dictate treatment decisions. A variety of medical and surgical treatment options can be considered for the management of HT. Collaborative reseach between different institutions and researchers are warranted and needed to improve our understanding of the pathophysiology and management of this condition. In this review, we propose a practical treatment algorithm for HT based on currently available evidence.
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Affiliation(s)
- Kai-Liang Wang
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA; Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Joshua K Wong
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA
| | - Robert S Eisinger
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA
| | - Samuel Carbunaru
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christine Smith
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA
| | - Wei Hu
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA
| | - Christopher W Hess
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA.
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17
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Bogdan ID, van Laar T, Oterdoom DM, Drost G, van Dijk JMC, Beudel M. Optimal Parameters of Deep Brain Stimulation in Essential Tremor: A Meta-Analysis and Novel Programming Strategy. J Clin Med 2020; 9:jcm9061855. [PMID: 32545887 PMCID: PMC7356338 DOI: 10.3390/jcm9061855] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 01/10/2023] Open
Abstract
The programming of deep brain stimulation (DBS) parameters for tremor is laborious and empirical. Despite extensive efforts, the end-result is often suboptimal. One reason for this is the poorly understood relationship between the stimulation parameters’ voltage, pulse width, and frequency. In this study, we aim to improve DBS programming for essential tremor (ET) by exploring a new strategy. At first, the role of the individual DBS parameters in tremor control was characterized using a meta-analysis documenting all the available parameters and tremor outcomes. In our novel programming strategy, we applied 10 random combinations of stimulation parameters in eight ET-DBS patients with suboptimal tremor control. Tremor severity was assessed using accelerometers and immediate and sustained patient-reported outcomes (PRO’s), including the occurrence of side-effects. The meta-analysis showed no substantial relationship between individual DBS parameters and tremor suppression. Nevertheless, with our novel programming strategy, a significantly improved (accelerometer p = 0.02, PRO p = 0.02) and sustained (p = 0.01) tremor suppression compared to baseline was achieved. Less side-effects were encountered compared to baseline. Our pilot data show that with this novel approach, tremor control can be improved in ET patients with suboptimal tremor control on DBS. In addition, this approach proved to have a beneficial effect on stimulation-related complications.
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Affiliation(s)
- I. Daria Bogdan
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (I.D.B.); (G.D.)
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (J.M.C.v.D.)
| | - Teus van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (I.D.B.); (G.D.)
- Correspondence:
| | - D.L. Marinus Oterdoom
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (J.M.C.v.D.)
| | - Gea Drost
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (I.D.B.); (G.D.)
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (J.M.C.v.D.)
| | - J. Marc C. van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (J.M.C.v.D.)
| | - Martijn Beudel
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, 1007 MB Amsterdam, The Netherlands;
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18
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Barcelos LB, Marinho MM, Barcellos I, Silva CCD, Silva SMA, Centeno RS, Borges V, Ferraz HB. Improvement of post-hypoxic cerebellar tremor with bilateral thalamic deep brain stimulation: A case report and review of the literature. Clin Neurol Neurosurg 2020; 195:105879. [PMID: 32502947 DOI: 10.1016/j.clineuro.2020.105879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Lorena Broseghini Barcelos
- Movement Disorders Unit, Universidade Federal de Sao Paulo, Brazil; Neurology Unit, Pontificia Universidade Catolica do Parana, Brazil
| | - Murilo Martinez Marinho
- Movement Disorders Unit, Universidade Federal de Sao Paulo, Brazil; Neurology Unit, Pontificia Universidade Catolica do Parana, Brazil.
| | - Igor Barcellos
- Movement Disorders Unit, Universidade Federal de Sao Paulo, Brazil; Neurology Unit, Pontificia Universidade Catolica do Parana, Brazil
| | - Carolina Candeias da Silva
- Movement Disorders Unit, Universidade Federal de Sao Paulo, Brazil; Neurology Unit, Pontificia Universidade Catolica do Parana, Brazil
| | - Sonia Maria Azevedo Silva
- Movement Disorders Unit, Universidade Federal de Sao Paulo, Brazil; Neurology Unit, Pontificia Universidade Catolica do Parana, Brazil
| | - Ricardo Silva Centeno
- Movement Disorders Unit, Universidade Federal de Sao Paulo, Brazil; Neurology Unit, Pontificia Universidade Catolica do Parana, Brazil
| | - Vanderci Borges
- Movement Disorders Unit, Universidade Federal de Sao Paulo, Brazil; Neurology Unit, Pontificia Universidade Catolica do Parana, Brazil
| | - Henrique Ballalai Ferraz
- Movement Disorders Unit, Universidade Federal de Sao Paulo, Brazil; Neurology Unit, Pontificia Universidade Catolica do Parana, Brazil
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19
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Wang Y, Guo S, Xu L, Geng Y, Shi Z, Lei B, Ma Y, Wang M. Tremor Caused by Dandy-Walker Syndrome Concomitant with Syringomyelia: Case Report and Review of the Literature Review. World Neurosurg 2020; 136:301-304. [PMID: 31954915 DOI: 10.1016/j.wneu.2020.01.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Dandy-Walker Syndrome (DWS) is a rare congenital brain malformation characterized by underdevelopment of cerebellar vermis and cystic enlargement of the fourth ventricle and enlargement of the posterior fossa. The cooccurrence of DWS and syringomyelia in adults is very rare. CASE DESCRIPTION We report a man aged 19 years who presented with a 2-year history of tremor. Magnetic resonance imaging showed cystic dilation of the fourth ventricle, hypoplasia of the cerebellar vermis, and syringomyelia. Posterior fossa decompression and spinal cord ostomy were performed. Tremor was markedly improved and the fourth ventricular and the syringomyelia were reduced in size postoperatively. CONCLUSIONS Tremor can be a clinical manifestation in patients of DWS concomitant with syringomyelia in adults. Spinal cord ostomy combined with posterior fossa decompression may be an effective approach for alleviation of symptoms and syringomyelia.
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Affiliation(s)
- Yiqi Wang
- Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical, Hangzhou, Zhejiang, China
| | - Shunyuan Guo
- Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical, Hangzhou, Zhejiang, China
| | - Liang'e Xu
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yu Geng
- Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical, Hangzhou, Zhejiang, China
| | - Zongjie Shi
- Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical, Hangzhou, Zhejiang, China
| | - Bing Lei
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical, Hangzhou, Zhejiang, China
| | - Yuyuan Ma
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical, Hangzhou, Zhejiang, China
| | - Meiping Wang
- Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical, Hangzhou, Zhejiang, China.
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20
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Joutsa J, Shih LC, Fox MD. Mapping holmes tremor circuit using the human brain connectome. Ann Neurol 2019; 86:812-820. [PMID: 31614012 PMCID: PMC6899700 DOI: 10.1002/ana.25618] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Holmes tremor is a debilitating movement disorder with limited treatment options. Lesions causing Holmes tremor can occur in multiple different brain locations, leaving the neuroanatomical substrate unclear. Here, we test whether lesion locations that cause Holmes tremor map to a connected brain circuit and whether this circuit might serve as a useful therapeutic target. METHODS Case reports of Holmes tremor caused by focal brain lesions were identified through a systematic literature search. Connectivity between each lesion location and the rest of the brain was computed using resting state functional connectivity magnetic resonance imaging data from 1,000 healthy volunteers. Commonalities across lesion locations were identified. This Holmes tremor circuit was then compared to neurosurgical treatment targets and clinical efficacy. RESULTS We identified 36 lesions causing Holmes tremor, which were scattered across multiple different brain regions. However, all lesion locations were connected to a common brain circuit with nodes in the red nucleus, thalamus, globus pallidus, and cerebellum. In cases with effective neurosurgical treatment, the treatment target was connected with the lesion location, indicating that a second hit to the same circuit might be beneficial. Commonly used deep brain stimulation targets such as the ventral intermediate nucleus and subthalamic nucleus fell outside our Holmes tremor circuit, whereas the globus pallidus target was close, consistent with published clinical response rates for these targets. INTERPRETATION Lesions causing Holmes tremor are part of a single connected brain circuit that may serve as an improved therapeutic target. ANN NEUROL 2019;86:812-820.
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Affiliation(s)
- Juho Joutsa
- Turku Brain and Mind Center and Department of Neurology, University of Turku, Turku, Finland.,Division of Clinical Neurosciences and Turku Positron Emission Tomography Center, Turku University Hospital, Turku, Finland.,Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ludy C Shih
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Neurology, Massachusetts General Hospital, Boston, MA
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21
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Lee J, Chang SY. Altered Primary Motor Cortex Neuronal Activity in a Rat Model of Harmaline-Induced Tremor During Thalamic Deep Brain Stimulation. Front Cell Neurosci 2019; 13:448. [PMID: 31680866 PMCID: PMC6803555 DOI: 10.3389/fncel.2019.00448] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/19/2019] [Indexed: 01/30/2023] Open
Abstract
Although deep brain stimulation (DBS) is a clinically effective surgical treatment for essential tremor (ET), and its neurophysiological mechanisms are not fully understood. As the motor thalamus is the most popular DBS target for ET, and it is known that the thalamic nucleus plays a key role in relaying information about the external environment to the cerebral cortex, it is important to investigate mechanisms of thalamic DBS in the context of the cerebello-thalamo-cortical neuronal network. To examine this, we measured single-unit neuronal activities in the resting state in M1 during VL thalamic DBS in harmaline-induced tremor rats and analyzed neuronal activity patterns in the thalamo-cortical circuit. Four activity patterns - including oscillatory burst, oscillatory non-burst, irregular burst, and irregular non-burst - were identified by harmaline administration; and those firing patterns were differentially affected by VL thalamic DBS, which seems to drive pathologic cortical signals to signals in normal status. As specific neuronal firing patterns like oscillation or burst are considered important for information processing, our results suggest that VL thalamic DBS may modify pathophysiologic relay information rather than simply inhibit the information transmission.
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Affiliation(s)
- Jihyun Lee
- Laboratory of Brain & Cognitive Sciences for Convergence Medicine, College of Medicine, Hallym University, Anyang, South Korea
| | - Su-Youne Chang
- Department of Neurologic Surgery, Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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22
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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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23
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Canepa C. Waldenstrom-associated anti-MAG paraprotein polyneuropathy with neurogenic tremor. BMJ Case Rep 2019; 12:12/3/e228376. [PMID: 30936346 DOI: 10.1136/bcr-2018-228376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 71-year-old female patient presented with a 14-year history of slowly progressive distal limb numbness, paraesthesia and reduced vibration perception, ataxic gait and intentional tremor. Examination revealed with a length-dependent sensory neuropathy. Nerve conduction studies showed a chronic sensorimotor inflammatory demyelinating polyneuropathy. Intravenous immunoglobulin treatment (on two occasions) proved ineffective. Serum electrophoresis showed increased monoclonal IgM with kappa light chains. Anti-myelin-associated glycoprotein (MAG) levels were extremely elevated, >70 000 BTU. Bone marrow biopsy revealed 15%-20% small B cells and positive MYD88 mutation, indicative of Waldenstrom macroglobulinaemia. A diagnosis of Waldenstrom-associated anti-MAG paraprotein neuropathy with intentional (neurogenic) tremor was made. Repeat nerve conduction study showed a severe sensory demyelinating neuropathy with no axonal lesion. Treatment with rituximab was given for 1 month with minimal improvement. Repeat anti-MAG levels dropped to 53 670 BTU, with minimal clinical improvement.
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Affiliation(s)
- Carlo Canepa
- Department of Neurology, James Paget University Hospital, Great Yarmouth, UK
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24
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He JM, He J, Lin HX, Wang N, Lin Y. Holmes tremor with impairment of the Guillain-Mollaret triangle following medullar hemorrhage. Neurol Sci 2018; 39:1305-1306. [PMID: 29502268 DOI: 10.1007/s10072-018-3289-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/13/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Jia-Ming He
- Department of Pharmacy, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jin He
- Department of Neurology, First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Hui-Xia Lin
- Department of Neurology, First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Ning Wang
- Department of Neurology, First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Yu Lin
- Department of Neurology, First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
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25
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Boonstra F, Florescu G, Evans A, Steward C, Mitchell P, Desmond P, Moffat B, Butzkueven H, Kolbe S, van der Walt A. Tremor in multiple sclerosis is associated with cerebello-thalamic pathology. J Neural Transm (Vienna) 2017; 124:1509-1514. [PMID: 29098451 PMCID: PMC5686246 DOI: 10.1007/s00702-017-1798-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/13/2017] [Indexed: 01/21/2023]
Abstract
Tremor in people with multiple sclerosis (MS) is a frequent and debilitating symptom with a relatively poorly understood pathophysiology. To determine the relationship between clinical tremor severity and structural magnetic resonance imaging parameters. Eleven patients with clinically definite MS and right-sided upper limb tremor were studied. Tremor severity was assessed using the Bain score (overall severity, writing, and Archimedes spiral drawing). Cerebellar dysfunction was assessed using the Scale for the Assessment and Rating of Ataxia. Dystonia was assessed using the Global Dystonia Scale adapted for upper limb. For all subjects, volume was calculated for the thalamus from T1-weighted volumetric scans using Freesurfer. Superior cerebellar peduncle (SCP) cross-sectional areas were measured manually. The presence of lesions was visually determined and the lesion volumes were calculated by the lesion growth algorithm as implemented in the Lesion Segmentation Toolbox. Right thalamic volume negatively correlated with Bain tremor severity score (ρ = - 0.65, p = 0.03). Left thalamic volume negatively correlated with general Bain tremor severity score (ρ = - 0.65, p = 0.03) and the Bain writing score (ρ = - 0.65, p = 0.03). Right SCP area negatively correlated with Bain writing score (ρ = - 0.69, p = 0.02). Finally, Bain Archimedes score was significantly higher in patients with lesions in the contralateral thalamus. Whole brain lesion load showed no relationship with tremor severity. These results implicate degeneration of key structures within the cerebello-thalamic pathway as pathological substrates for tremor in MS patients.
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Affiliation(s)
- Frederique Boonstra
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Australia
| | - Grace Florescu
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Andrew Evans
- Department of Neurology, The Royal Melbourne Hospital, Level 4 South, 300 Grattan Street, Parkville, VIC, 3052, Australia
| | - Chris Steward
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter Mitchell
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Patricia Desmond
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Brad Moffat
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neurology, The Royal Melbourne Hospital, Level 4 South, 300 Grattan Street, Parkville, VIC, 3052, Australia
- Melbourne Brain Centre at Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Melbourne, Australia
- Multiple Sclerosis Unit, Box Hill Hospital, Box Hill, Australia
- Department of Neuroscience, Alfred Central Clinical School, Monash University, Melbourne, Australia
| | - Scott Kolbe
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Australia
| | - Anneke van der Walt
- Department of Neurology, The Royal Melbourne Hospital, Level 4 South, 300 Grattan Street, Parkville, VIC, 3052, Australia.
- Melbourne Brain Centre at Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Melbourne, Australia.
- Department of Neuroscience, Alfred Central Clinical School, Monash University, Melbourne, Australia.
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26
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Roh E, Lee HB, Kim DI, Lee NE. A Solution-Processable, Omnidirectionally Stretchable, and High-Pressure-Sensitive Piezoresistive Device. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2017; 29:1703004. [PMID: 28960525 DOI: 10.1002/adma.201703004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/25/2017] [Indexed: 05/21/2023]
Abstract
The development of omnidirectionally stretchable pressure sensors with high performance without stretching-induced interference has been hampered by many challenges. Herein, an omnidirectionally stretchable piezoresistive pressure-sensing device is demonstrated by combining an omniaxially stretchable substrate with a 3D micropattern array and solution-printing of electrode and piezoresistive materials. A unique substrate structural design and materials mean that devices that are highly sensitive are rendered, with a stable out-of-plane pressure response to both static (sensitivity of 0.5 kPa-1 and limit of detection of 28 Pa) and dynamic pressures and the minimized in-plane stretching responsiveness (a small strain gauge factor of 0.17), achieved through efficient strain absorption of the electrode and sensing materials. The device can detect human-body tremors, as well as measure the relative elastic properties of human skin. The omnidirectionally stretchable pressure sensor with a high pressure sensitivity and minimal stretch-responsiveness yields great potential to skin-attachable wearable electronics, human-machine interfaces, and soft robotics applications.
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Affiliation(s)
- Eun Roh
- SKKU Advanced Institute of Nanotechnology (SAINT), Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea
| | - Han-Byeol Lee
- School of Advanced Materials Science & Engineering, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea
| | - Do-Il Kim
- School of Advanced Materials Science & Engineering, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea
| | - Nae-Eung Lee
- School of Advanced Materials Science & Engineering, SKKU Advanced Institute of Nanotechnology (SAINT), Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Kyunggi-do, 16419, South Korea
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27
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Elias GJB, Namasivayam AA, Lozano AM. Deep brain stimulation for stroke: Current uses and future directions. Brain Stimul 2017; 11:3-28. [PMID: 29089234 DOI: 10.1016/j.brs.2017.10.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/07/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Survivors of stroke often experience significant disability and impaired quality of life related to ongoing maladaptive responses and persistent neurologic deficits. Novel therapeutic options are urgently needed to augment current approaches. One way to promote recovery and ameliorate symptoms may be to electrically stimulate the surviving brain. Various forms of brain stimulation have been investigated for use in stroke, including deep brain stimulation (DBS). OBJECTIVE/METHODS We conducted a comprehensive literature review in order to 1) review the use of DBS to treat post-stroke maladaptive responses including pain, dystonia, dyskinesias, and tremor and 2) assess the use and potential utility of DBS for enhancing plasticity and recovery from post-stroke neurologic deficits. RESULTS/CONCLUSIONS A large variety of brain structures have been targeted in post-stroke patients, including motor thalamus, sensory thalamus, basal ganglia nuclei, internal capsule, and periventricular/periaqueductal grey. Overall, the reviewed clinical literature suggests a role for DBS in the management of several post-stroke maladaptive responses. More limited evidence was identified regarding DBS for post-stroke motor deficits, although existing work tentatively suggests DBS-particularly DBS targeting the posterior limb of the internal capsule-may improve paresis in certain circumstances. Substantial future work is required both to establish optimal targets and parameters for treatment of maladapative responses and to further investigate the effectiveness of DBS for post-stroke paresis.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Neuroscience Center, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Andrew A Namasivayam
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Neuroscience Center, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Neuroscience Center, University of Toronto, Toronto, ON M5T 2S8, Canada.
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28
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Filip P, Lungu OV, Manto MU, Bareš M. Linking Essential Tremor to the Cerebellum: Physiological Evidence. THE CEREBELLUM 2017; 15:774-780. [PMID: 26530223 DOI: 10.1007/s12311-015-0740-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Essential tremor (ET), clinically characterized by postural and kinetic tremors, predominantly in the upper extremities, originates from pathological activity in the dynamic oscillatory network comprising the majority of nodes in the central motor network. Evidence indicates dysfunction in the thalamus, the olivocerebellar loops, and intermittent cortical engagement. Pathology of the cerebellum, a structure with architecture intrinsically predisposed to oscillatory activity, has also been implicated in ET as shown by clinical, neuroimaging, and pathological studies. Despite electrophysiological studies assessing cerebellar impairment in ET being scarce, their impact is tangible, as summarized in this review. The electromyography-magnetoencephalography combination provided the first direct evidence of pathological alteration in cortico-subcortical communication, with a significant emphasis on the cerebellum. Furthermore, complex electromyography studies showed disruptions in the timing of agonist and antagonist muscle activation, a process generally attributed to the cerebellum. Evidence pointing to cerebellar engagement in ET has also been found in electrooculography measurements, cerebellar repetitive transcranial magnetic stimulation studies, and, indirectly, in complex analyses of the activity of the ventral intermediate thalamic nucleus (an area primarily receiving inputs from the cerebellum), which is also used in the advanced treatment of ET. In summary, further progress in therapy will require comprehensive electrophysiological and physiological analyses to elucidate the precise mechanisms leading to disease symptoms. The cerebellum, as a major node of this dynamic oscillatory network, requires further study to aid this endeavor.
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Affiliation(s)
- Pavel Filip
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's Teaching Hospital, Pekařská 53, 656 91, Brno, Czech Republic.,Central European Institute of Technology, CEITEC MU, Behavioral and Social Neuroscience Research Group, Masaryk University, Brno, Czech Republic
| | - Ovidiu V Lungu
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada.,Functional Neuroimaging Unit, Research Center of the Geriatric Institute Affiliated with the Université de Montréal, Montréal, Québec, Canada
| | | | - Martin Bareš
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's Teaching Hospital, Pekařská 53, 656 91, Brno, Czech Republic. .,Central European Institute of Technology, CEITEC MU, Behavioral and Social Neuroscience Research Group, Masaryk University, Brno, Czech Republic. .,Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, MN, USA.
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29
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Gajos A, Budrewicz S, Koszewicz M, Bieńkiewicz M, Dąbrowski J, Kuśmierek J, Sławek J, Bogucki A. Is nigrostriatal dopaminergic deficit necessary for Holmes tremor to develop? The DaTSCAN and IBZM SPECT study. J Neural Transm (Vienna) 2017; 124:1389-1393. [PMID: 28836067 PMCID: PMC5653710 DOI: 10.1007/s00702-017-1780-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/14/2017] [Indexed: 12/28/2022]
Abstract
Holmes’s tremor (HT) is assumed to be the result of coexistence of nigrostriatal dopaminergic system impairment and the lesion of cerebello-thalamic pathways. It was suggested that dopaminergic deficiency is responsible for rest tremor, and lack of compensatory cerebellar function leads to spill of tremor into voluntary movements. Cases of HT with and without abnormalities of the presynaptic part of dopaminergic nigrostriatal were published and these findings raised the question of possibility of the postsynaptic lesion. Three patients with HT diagnosed according to criteria of Consensus Statement on Tremor were studied. In all of them SPECT imaging with ligands of presynaptic (I 123-FP CIT—DaTSCAN) and postsynaptic (I 123-iodobenzamide—IBZM) nigrostriatal dopaminergic neurons was performed. Indices of uptake in caudate and putamen normalized to nonspecific uptake in occipital cortex and indices of asymmetry for each whole striatum as well as for putamen and caudate separately were calculated. SPECT studies did not reveal asymmetry of DaTSCAN and IBZM binding in striatum in all studied subjects. The current clinical diagnostic criteria of HT are presumably insufficiently specific and when using them we identify patients both with and without the involvement of dopaminergic system. These two groups may represent tremor disorders of similar phenomenology but of different pathomechanism.
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Affiliation(s)
- Agata Gajos
- Department of Extrapyramidal Diseases, Central University Hospital, Medical University of Łódź, Pomorska 251 Str, 92-213, Łódź, Poland
| | | | | | - Małgorzata Bieńkiewicz
- Department of Quality Control and Radiological Protection, Medical University of Łódź, Łódź, Poland
| | - Janusz Dąbrowski
- Department of Nuclear Medicine, Medical University of Łódź, Łódź, Poland
| | - Jacek Kuśmierek
- Department of Nuclear Medicine, Medical University of Łódź, Łódź, Poland
| | - Jarosław Sławek
- Department of Neurological and Psychiatric Nursing, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Bogucki
- Department of Extrapyramidal Diseases, Central University Hospital, Medical University of Łódź, Pomorska 251 Str, 92-213, Łódź, Poland.
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30
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Iyer RS, Wattamwar P, Thomas B. Reversible Holmes' tremor due to spontaneous intracranial hypotension. BMJ Case Rep 2017; 2017:bcr-2017-220348. [PMID: 28754752 DOI: 10.1136/bcr-2017-220348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Holmes' tremor is a low-frequency hand tremor and has varying amplitude at different phases of motion. It is usually unilateral and does not respond satisfactorily to drugs and thus considered irreversible. Structural lesions in the thalamus and brainstem or cerebellum are usually responsible for Holmes' tremor. We present a 23-year-old woman who presented with unilateral Holmes' tremor. She also had hypersomnolence and headache in the sitting posture. Her brain imaging showed brain sagging and deep brain swelling due to spontaneous intracranial hypotension (SIH). She was managed conservatively and had a total clinical and radiological recovery. The brain sagging with the consequent distortion of the midbrain and diencephalon was responsible for this clinical presentation. SIH may be considered as one of the reversible causes of Holmes' tremor.
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Affiliation(s)
| | - Pandurang Wattamwar
- Department of Neurology, United CIIGMA Hospitals, Aurangabad, Maharashtra, India
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional R, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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31
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Aydın S, Canaz H, Erdogan ET, Durmaz N, Topcular B. Holmes' Tremor with Shoulder Pain Treated by Deep Brain Stimulation of Unilateral Ventral Intermediate Thalamic Nucleus and Globus Pallidus Internus. J Mov Disord 2017; 10:92-95. [PMID: 28415166 PMCID: PMC5435830 DOI: 10.14802/jmd.16051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/28/2016] [Accepted: 12/07/2016] [Indexed: 11/24/2022] Open
Abstract
A 21-year-old male was admitted with severe right arm and hand tremors after a thalamic hemorrhage caused by a traffic accident. He was also suffering from agonizing pain in his right shoulder that manifested after the tremor. Neurologic examination revealed a disabling, severe, and irregular kinetic and postural tremor in the right arm during target-directed movements. There was also an irregular ipsilateral rest tremor and dystonic movements in the distal part of the right arm. The amplitude was moderate at rest and extremely high during kinetic and intentional movements. The patient underwent left globus pallidum internus and ventral intermediate thalamic nucleus deep brain stimulation. The patient improved by more than 80% as rated by the Fahn-Tolosa-Marin Tremor Rating Scale and Visual Analog Scale six months after surgery.
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Affiliation(s)
- Sabri Aydın
- Department of Neurosurgery, Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Huseyin Canaz
- Department of Neurosurgery, Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Ezgi Tuna Erdogan
- Department of Physiology, Istanbul Bilim University, Istanbul, Turkey
| | - Nazlı Durmaz
- Department of Neurology, Ankara University, Ankara, Turkey
| | - Barıs Topcular
- Department of Neurology, Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
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Cabañes-Martínez L, Del Álamo de Pedro M, de Blas Beorlegui G, Bailly-Bailliere IR. Long-Term Effective Thalamic Deep Brain Stimulation for Neuropathic Tremor in Two Patients with Charcot-Marie-Tooth Disease. Stereotact Funct Neurosurg 2017; 95:102-106. [PMID: 28297702 DOI: 10.1159/000457963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 01/18/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND It has been described that many Charcot-Marie-Tooth syndrome type 2 patients are affected by a very disabling type of tremor syndrome, the pathophysiology of which remains unclear. Deep brain stimulation (DBS) has been successfully applied to treat most types of tremors by implanting electrodes in the ventral intermediate nucleus of the thalamus (Vim). METHODS We used DBS applied to the Vim in 2 patients with severe axonal inherited polyneuropathies who developed a disabling tremor. RESULTS Both patients responded positively to stimulation, with a marked reduction of the tremor and with an improvement of their quality of life. CONCLUSION We report 2 cases of tremor associated with a hereditary neuropathy with a good response to DBS.
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Simultaneous Classical and Holmes' Tremor in Parkinson's Disease: Involvement of the Cerebellum. Can J Neurol Sci 2017; 44:436-440. [PMID: 28162102 DOI: 10.1017/cjn.2016.451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Cagnan H, Pedrosa D, Little S, Pogosyan A, Cheeran B, Aziz T, Green A, Fitzgerald J, Foltynie T, Limousin P, Zrinzo L, Hariz M, Friston KJ, Denison T, Brown P. Stimulating at the right time: phase-specific deep brain stimulation. Brain 2017; 140:132-145. [PMID: 28007997 PMCID: PMC5226063 DOI: 10.1093/brain/aww286] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/30/2016] [Accepted: 09/18/2016] [Indexed: 11/13/2022] Open
Abstract
SEE MOLL AND ENGEL DOI101093/AWW308 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: Brain regions dynamically engage and disengage with one another to execute everyday actions from movement to decision making. Pathologies such as Parkinson's disease and tremor emerge when brain regions controlling movement cannot readily decouple, compromising motor function. Here, we propose a novel stimulation strategy that selectively regulates neural synchrony through phase-specific stimulation. We demonstrate for the first time the therapeutic potential of such a stimulation strategy for the treatment of patients with pathological tremor. Symptom suppression is achieved by delivering stimulation to the ventrolateral thalamus, timed according to the patient's tremor rhythm. Sustained locking of deep brain stimulation to a particular phase of tremor afforded clinically significant tremor relief (up to 87% tremor suppression) in selected patients with essential tremor despite delivering less than half the energy of conventional high frequency stimulation. Phase-specific stimulation efficacy depended on the resonant characteristics of the underlying tremor network. Selective regulation of neural synchrony through phase-locked stimulation has the potential to both increase the efficiency of therapy and to minimize stimulation-induced side effects.
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Affiliation(s)
- Hayriye Cagnan
- 1 Institute of Neurology, University College London, London, UK
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- 3 Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - David Pedrosa
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- 3 Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Simon Little
- 1 Institute of Neurology, University College London, London, UK
| | - Alek Pogosyan
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- 3 Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Binith Cheeran
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Tipu Aziz
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alexander Green
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - James Fitzgerald
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Thomas Foltynie
- 1 Institute of Neurology, University College London, London, UK
| | | | - Ludvic Zrinzo
- 1 Institute of Neurology, University College London, London, UK
| | - Marwan Hariz
- 1 Institute of Neurology, University College London, London, UK
| | - Karl J Friston
- 1 Institute of Neurology, University College London, London, UK
| | | | - Peter Brown
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- 3 Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
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Abstract
Introduction: Deep brain stimulation (DBS) has become a standard therapy for the treatment of select cases of medication refractory essential tremor and Parkinson’s disease however the effectiveness and long-term outcomes of DBS in other uncommon and complex tremor syndromes has not been well established. Traditionally, the ventralis intermedius nucleus (VIM) of the thalamus has been considered the main target for medically intractable tremors; however alternative brain regions and improvements in stereotactic techniques and hardware may soon change the horizon for treatment of complex tremors. Areas covered: In this article, we conducted a PubMed search using different combinations between the terms ‘Uncommon tremors’, ‘Dystonic tremor’, ‘Holmes tremor’ ‘Midbrain tremor’, ‘Rubral tremor’, ‘Cerebellar tremor’, ‘outflow tremor’, ‘Multiple Sclerosis tremor’, ‘Post-traumatic tremor’, ‘Neuropathic tremor’, and ‘Deep Brain Stimulation/DBS’. Additionally, we examined and summarized the current state of evolving interventions for treatment of complex tremor syndromes. Expertcommentary: Recently reported interventions for rare tremors include stimulation of the posterior subthalamic area, globus pallidus internus, ventralis oralis anterior/posterior thalamic subnuclei, and the use of dual lead stimulation in one or more of these targets. Treatment should be individualized and dictated by tremor phenomenology and associated clinical features.
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Affiliation(s)
| | - Michael S Okun
- b Department of Neurology , University of Florida Center for Movement Disorders and Neurorestoration , Gainesville FL , USA
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Picillo M, Lozano AM, Kou N, Munhoz RP, Fasano A. Programming Deep Brain Stimulation for Tremor and Dystonia: The Toronto Western Hospital Algorithms. Brain Stimul 2016; 9:438-452. [DOI: 10.1016/j.brs.2016.02.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/02/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022] Open
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Miletić V, Bažadona D, Kuliš T, Bilić E. Neuropathic tremor associated with anti-MAG IgM-monoclonal gammopathy and prostate adenocarcinoma: Which one is the culprit? Parkinsonism Relat Disord 2016; 27:109-10. [PMID: 27036215 DOI: 10.1016/j.parkreldis.2016.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/11/2016] [Accepted: 03/13/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Vladimir Miletić
- Referral Center for Movement Disorders, Department of Neurology, University Hospital Center Zagreb, Kispatićeva 12, 10000 Zagreb, Croatia.
| | - Danira Bažadona
- Referral Center for Movement Disorders, Department of Neurology, University Hospital Center Zagreb, Kispatićeva 12, 10000 Zagreb, Croatia
| | - Tomislav Kuliš
- Department of Urology, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - Ervina Bilić
- Referral Center for Neuromuscular Diseases and Clinical Electromyoneurography, Department of Neurology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kispatićeva 12, 10000 Zagreb, Croatia
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Olszewska DA, Walsh R, Lynch T. SCA 6 with Writer's Cramp: The Phenotype Expanded. Mov Disord Clin Pract 2015; 3:83-86. [PMID: 30713900 DOI: 10.1002/mdc3.12222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 12/27/2022] Open
Abstract
Spinocerebellar ataxia type 6 (SCA6) presents typically with a pure cerebellar syndrome. Only 1 SCA 6 patient with writer's cramp has been reported on and a family history of ataxia and writer's cramp has never been reported on. Two other SCA6 patients with a shoulder girdle/hand dystonia and unspecified upper-limb dystonia with a family history of ataxia have been reported on. We report on the largest family with SCA6 and writer's cramp. The proband developed dysarthria, ataxia, and writer's cramp by age 37. His father presented with ataxia at 55, followed by writer's cramp and dysarthria. The proband's brother developed ataxia at 41, followed by dysarthria and writer's cramp. A paternal uncle (deceased; not examined) and 58-yr-old brother both developed pure ataxia (genetic testing is pending). This large family with complex movement disorder demonstrates that it is important to consider SCA6 in a patient presenting with an ataxia and writer's cramp and supports cerebellum involvement in dystonia.
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Affiliation(s)
- Diana Angelika Olszewska
- Department of Neurology at the Dublin Neurological Institute Mater Misericordiae University Hospital Dublin Ireland
| | - Richard Walsh
- Department of Neurology at the Dublin at the Adelaide and Meath Hospital, Dublin National Children's Hospital Tallaght, Dublin Ireland
| | - Tim Lynch
- Department of Neurology at the Dublin Neurological Institute Mater Misericordiae University Hospital Dublin Ireland
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Latino P, Pontieri FE, Orzi F, Giovannelli M. Botulinum toxin type A for Holmes tremor secondary to thalamic hemorrhage. Neurol Sci 2015; 36:1935-6. [PMID: 26118788 DOI: 10.1007/s10072-015-2285-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Pamela Latino
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy.,Unit of Neurology, Sant'Andrea Hospital, Via di Grottarossa, 1035-00189, Rome, Italy
| | - Francesco E Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy.,Unit of Neurology, Sant'Andrea Hospital, Via di Grottarossa, 1035-00189, Rome, Italy.,IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesco Orzi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy.,Unit of Neurology, Sant'Andrea Hospital, Via di Grottarossa, 1035-00189, Rome, Italy
| | - Morena Giovannelli
- Unit of Neurology, Sant'Andrea Hospital, Via di Grottarossa, 1035-00189, Rome, Italy.
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Kilbane C, Ramirez-Zamora A, Ryapolova-Webb E, Qasim S, Glass GA, Starr PA, Ostrem JL. Pallidal stimulation for Holmes tremor: clinical outcomes and single-unit recordings in 4 cases. J Neurosurg 2015; 122:1306-14. [DOI: 10.3171/2015.2.jns141098] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECT
Holmes tremor (HT) is characterized by irregular, low-frequency (< 4.5 Hz) tremor occurring at rest, with posture, and with certain actions, often affecting proximal muscles. Previous reports have tended to highlight the use of thalamic deep brain stimulation (DBS) in cases of medication-refractory HT. In this study, the authors report the clinical outcome and analysis of single-unit recordings in patients with medication-refractory HT treated with globus pallidus internus (GPi) DBS.
METHODS
The authors retrospectively reviewed the medical charts of 4 patients treated with pallidal DBS for medication-refractory HT at the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center. Clinical outcomes were measured at baseline and after surgery using an abbreviated motor-severity Fahn-Tolosa-Marin (FTM) tremor rating scale. Intraoperative microelectrode recordings were performed with patients in the awake state. The neurophysiological characteristics identified in HT were then also compared with characteristics previously described in Parkinson's disease (PD) studied at the authors' institution.
RESULTS
The mean percentage improvement in tremor motor severity was 78.87% (range 59.9%–94.4%) as measured using the FTM tremor rating scale, with an average length of follow-up of 33.75 months (range 18–52 months). Twenty-eight GPi neurons were recorded intraoperatively in the resting state and 13 of these were also recorded during contralateral voluntary arm movement. The mean firing rate at rest in HT was 56.2 ± 28.5 Hz, and 63.5 ± 19.4 Hz with action, much lower than the GPi recordings in PD. GPi unit oscillations of 2–8 Hz were prominent in both patients with HT and those with PD, but in HT, unlike PD, these oscillations were not suppressed by voluntary movement.
CONCLUSIONS
The efficacy of GPi DBS exceeded that reported in prior studies of ventrolateral thalamus DBS and suggest GPi may be a better target for treating HT. These clinical and neurophysiological findings help illuminate evolving models of HT and highlight the importance of cerebellar–basal ganglia interactions.
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Affiliation(s)
- Camilla Kilbane
- 1Department of Neurology, Stanford University Medical Center, Stanford;
| | | | | | - Salman Qasim
- 3Neurosurgery, University of California, San Francisco
| | - Graham A. Glass
- 4Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California; and
| | - Philip A. Starr
- 3Neurosurgery, University of California, San Francisco
- 4Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California; and
| | - Jill L. Ostrem
- Departments of 2Neurology and
- 4Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California; and
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41
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Van der Walt A, Buzzard K, Sung S, Spelman T, Kolbe SC, Marriott M, Butzkueven H, Evans A. The occurrence of dystonia in upper-limb multiple sclerosis tremor. Mult Scler 2015; 21:1847-55. [PMID: 26014602 DOI: 10.1177/1352458515577690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/18/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The pathophysiology of multiple sclerosis (MS) tremor is uncertain with limited phenotypical studies available. OBJECTIVE To investigate whether dystonia contributes to MS tremor and its severity. METHODS MS patients (n = 54) with and without disabling uni- or bilateral upper limb tremor were recruited (39 limbs per group). We rated tremor severity, writing and Archimedes spiral drawing; cerebellar dysfunction (SARA score); the Global Dystonia Scale (GDS) for proximal and distal upper limbs, dystonic posturing, mirror movements, geste antagoniste, and writer's cramp. RESULTS Geste antagoniste, mirror dystonia, and dystonic posturing were more frequent and severe (p < 0.001) and dystonia scores were correlated with tremor severity in tremor compared to non-tremor patients. A 1-unit increase in distal dystonia predicted a 0.52-Bain unit (95% confidence interval (CI) 0.08-0.97), p = 0.022) increase in tremor severity and a 1-unit (95% CI 0.48-1.6, p = 0.001) increase in drawing scores. A 1-unit increase in proximal dystonia predicted 0.93-Bain unit increase (95% CI 0.45-1.41, p < 0.001) in tremor severity and 1.5-units (95% CI 0.62-2.41, p = 0.002) increase in the drawing score. Cerebellar function in the tremor limb and tremor severity was correlated (p < 0.001). CONCLUSIONS Upper limb dystonia is common in MS tremor suggesting that MS tremor pathophysiology involves cerebello-pallido-thalamo-cortical network dysfunction.
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Affiliation(s)
- A Van der Walt
- Department of Neurology, Royal/Melbourne Hospital, Australia Melbourne Brain Centre, Department of Medicine at RMH, University of Melbourne, Australia/Centre for Neuroscience, Department of Anatomy and Neuroscience, University of Melbourne, Australia
| | - K Buzzard
- Department of Neurology, Royal Melbourne Hospital, Australia
| | - S Sung
- Department of Neurology, Royal Melbourne Hospital, Australia
| | - T Spelman
- Department of Neurology, Royal Melbourne Hospital, Australia
| | - S C Kolbe
- Centre for Neuroscience, Department of Anatomy and Neuroscience, University of Melbourne, Australia
| | - M Marriott
- Department of Neurology, Royal Melbourne Hospital, Australia/Department of Neurology, Box Hill Hospital, Melbourne, Australia
| | - H Butzkueven
- Department of Neurology, Royal Melbourne Hospital, Australia/Melbourne Brain Centre, Department of Medicine at RMH, University of Melbourne, Australia
| | - A Evans
- Department of Neurology, Royal Melbourne Hospital, Australia
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Deep brain stimulation of the globus pallidus internus or ventralis intermedius nucleus of thalamus for Holmes tremor. Neurosurg Rev 2015; 38:753-63. [DOI: 10.1007/s10143-015-0636-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 10/06/2014] [Accepted: 01/19/2015] [Indexed: 10/23/2022]
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43
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News and controversies regarding essential tremor. Rev Neurol (Paris) 2015; 171:415-25. [DOI: 10.1016/j.neurol.2015.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/01/2015] [Accepted: 02/02/2015] [Indexed: 01/08/2023]
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Vim thalamotomy in a patient with Holmes' tremor and palatal tremor - Pathophysiological considerations. BMC Neurol 2015; 15:26. [PMID: 25879699 PMCID: PMC4357054 DOI: 10.1186/s12883-015-0277-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/20/2015] [Indexed: 11/19/2022] Open
Abstract
Background We peformed a ventral intermediate nucleus (Vim) thalamotomy in a patient with Holmes’ tremor and palatal tremor. The frequencies of these movement disorders were 4 Hz and 3 Hz, respectively. Vim thalamotomy stopped the Holmes’ tremor but not the palatal tremor. Our observations suggest different mechanisms for these two involuntary movements. Case presentation A 57-arm 11 months after a pontine hemorrhage. Transoral carotid ultrasonography revealed periodic motion of her posterior pharyngeal wall with a frequency of 3 Hz. Recording of neuronal activities in the thalamus revealed a 4Hz rhythmic discharge time that was associated with her tremor in the contralateral arm. A left Vim thalamotomy was performed. The resting tremor of the upper limb stopped, but the kinetic tremor recurred 6 months after the thalamotomy. No effect was observed on her palatal tremor. Conclusions The different effects of Vim thalamotomy on the Holmes’ tremor and palatal tremor suggest different oscillation sources for these two involuntary movements.
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Maki F, Sato S, Watanabe K, Yanagisawa T, Hagiwara Y, Shimizu T, Hasegawa Y. Vim thalamotomy in a patient with Holmes' tremor and palatal tremor - Pathophysiological considerations. BMC Neurol 2015. [PMID: 25879699 DOI: 10.1186/s12883-015-0277-5.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We peformed a ventral intermediate nucleus (Vim) thalamotomy in a patient with Holmes' tremor and palatal tremor. The frequencies of these movement disorders were 4 Hz and 3 Hz, respectively. Vim thalamotomy stopped the Holmes' tremor but not the palatal tremor. Our observations suggest different mechanisms for these two involuntary movements. CASE PRESENTATION A 57-arm 11 months after a pontine hemorrhage. Transoral carotid ultrasonography revealed periodic motion of her posterior pharyngeal wall with a frequency of 3 Hz. Recording of neuronal activities in the thalamus revealed a 4Hz rhythmic discharge time that was associated with her tremor in the contralateral arm. A left Vim thalamotomy was performed. The resting tremor of the upper limb stopped, but the kinetic tremor recurred 6 months after the thalamotomy. No effect was observed on her palatal tremor. CONCLUSIONS The different effects of Vim thalamotomy on the Holmes' tremor and palatal tremor suggest different oscillation sources for these two involuntary movements.
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Affiliation(s)
- Futaba Maki
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Sumito Sato
- Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, Japan.
| | - Katsushige Watanabe
- Department of Neurosurgery, Tokyo Metropolitan Matsuzawa hospital, Tokyo, Japan.
| | - Toshiyuki Yanagisawa
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Yuta Hagiwara
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Takahiro Shimizu
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Yasuhiro Hasegawa
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, 216-8511, Japan.
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46
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Cerebellar Continuous Theta Burst Stimulation in Essential Tremor. THE CEREBELLUM 2014; 14:133-41. [DOI: 10.1007/s12311-014-0621-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Ahn SY, Kim DA, Park YO, Shin JH. Effect of ultrasonography-guided botulinum toxin type a injection in holmes' tremor secondary to pontine hemorrhage: case report. Ann Rehabil Med 2014; 38:694-7. [PMID: 25379500 PMCID: PMC4221399 DOI: 10.5535/arm.2014.38.5.694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 10/28/2013] [Indexed: 11/16/2022] Open
Abstract
Holmes' tremor is a low-frequency rest and intentional tremor secondary to various insults, including cerebral ischemia, hemorrhage, trauma, or neoplasm. Pharmacologic treatment is usually unsuccessful, and some cases require surgical intervention. We report a rare case of Holmes' tremor secondary to left pontine hemorrhage in a 29-year-old Asian male patient who developed 1.6-Hz postural and rest tremor of the right hand. He responded markedly to ultrasonography-guided botulinum toxin type A injection. To our knowledge, this is the first report of Homes' tremor treated with ultrasonography-guided botulinum toxin type A injection with favorable results.
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Affiliation(s)
- So-Yeon Ahn
- Department of Rehabilitation Medicine, Rehabilitation Hospital, National Rehabilitation Center, Seoul, Korea
| | - Dong-A Kim
- Department of Rehabilitation Medicine, Rehabilitation Hospital, National Rehabilitation Center, Seoul, Korea
| | - Youn-Ok Park
- Division of Education & Public Relations, National Rehabilitation Center, Seoul, Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, Rehabilitation Hospital, National Rehabilitation Center, Seoul, Korea
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48
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Bolen RD, Balakrishnan M D N. Palatal myoclonus, eight-and-a-half syndrome, and Holmes tremor in a patient from a single brainstem lesion. J Neurol Sci 2014; 347:411-2. [PMID: 25466698 DOI: 10.1016/j.jns.2014.10.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 10/22/2014] [Accepted: 10/27/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Robert D Bolen
- Department of Neurology, Wake Forest Baptist Hospital, Winston Salem, NC, United States.
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Lee A, Schoonderwaldt E, Chadde M, Altenmüller E. Movement induced tremor in musicians and non-musicians reflects adaptive brain plasticity. Front Psychol 2014; 5:824. [PMID: 25120522 PMCID: PMC4114260 DOI: 10.3389/fpsyg.2014.00824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 07/10/2014] [Indexed: 11/16/2022] Open
Abstract
Evidence exists that motor dexterity is associated with a higher tremor amplitude of physiological tremor. Likewise, lower frequencies are associated with motor control. So far only case reports of a higher amplitude of physiological tremor in musicians exist. Moreover, no study has investigated lower frequencies during a finger movement task in musicians who can be regarded as a model of motor expertise. We developed a model and derived three hypotheses which we investigated in this study: (1) Tremor amplitude is higher in the range of physiological tremor and (2) higher for frequency ranges of dystonic tremor in musicians compared to non-musicians; (3) there is no difference in tremor amplitude at frequencies below 4 Hz. We measured tremor during a finger flexion-extension movement in 19 musicians (age 26.5 ± 8.2 years) and 24 age matched non-musicians (age 26.5 ± 8.7). By using empirical mode decomposition in combination with a Hilbert transform we obtained the instantaneous frequency and amplitude, allowing to compare tremor amplitudes throughout the movement at various frequency ranges. We found a significantly higher tremor amplitude in musicians for physiological tremor and a tendency toward a higher amplitude during most of the movement in the frequency range of 4-8 Hz, which, however, was not significant. No difference was found in the frequency range below 4 Hz for the flexion and for almost the entire extension movement. Our results corroborate findings that the 8-12 Hz oscillatory activity plays a role in motor dexterity. However, our results do not allow for the conclusion that tremor at the frequency range of 4-8 Hz is related to either plasticity induced changes that are beneficial for motor skill development nor to maladaptive changes as, e.g., focal dystonia.
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Affiliation(s)
- André Lee
- Institute for Music Physiology and Musicians’ Medicine, University of Music, Drama and Media HannoverHannover, Germany
| | - Erwin Schoonderwaldt
- Institute for Music Physiology and Musicians’ Medicine, University of Music, Drama and Media HannoverHannover, Germany
| | - Mareike Chadde
- Institute for Music Physiology and Musicians’ Medicine, University of Music, Drama and Media HannoverHannover, Germany
- Hannover Medical UniversityHannover, Germany
| | - Eckart Altenmüller
- Institute for Music Physiology and Musicians’ Medicine, University of Music, Drama and Media HannoverHannover, Germany
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50
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Lee A, Tominaga K, Furuya S, Miyazaki F, Altenmüller E. Electrophysiological characteristics of task-specific tremor in 22 instrumentalists. J Neural Transm (Vienna) 2014; 122:393-401. [PMID: 25056709 DOI: 10.1007/s00702-014-1275-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/14/2014] [Indexed: 11/30/2022]
Abstract
Our aim was to address three characteristics of task-specific tremor in musicians (TSTM): First, we quantified muscular activity of flexor and extensor muscles, of coactivation as well as tremor acceleration. Second, we compared muscular activity between task-dependent and position-dependent tremor. Third, we investigated, whether there is an overflow of muscular activity to muscles adjacent to the affected muscles in TSTM. Tremor acceleration and muscular activity were measured in the affected muscles and the muscles adjacent to the affected muscles in 22 patients aged 51.5 ± 11.4 years with a task-specific tremor. We assessed power of muscular oscillatory activity and calculated the coherence between EMG activity of affected muscles and tremor acceleration as well as between adjacent muscles and tremor acceleration. This was done for task-dependent and position-dependent tremor. We found the highest power and coherence of muscular oscillatory activity in the frequency range of 3-8 Hz for affected and adjacent muscles. No difference was found between task-dependent and position-dependent tremor in neither power nor coherence measures. Our results generalize previous results of a relation between coactivation and tremor among a variety of musicians. Furthermore, we found coherence of adjacent muscles and TSTM. This indicates that overflow exists in TSTM and suggests an association of TST with dystonia.
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Affiliation(s)
- André Lee
- Institute of Music Physiology and Musicians' Medicine, Hannover University of Music, Drama and Media, Hannover, Germany,
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