1
|
|
2
|
Bhatti D, Thompson R, Hellman A, Penke C, Bertoni JM, Torres-Russotto D. Smartphone Apps Provide a Simple, Accurate Bedside Screening Tool for Orthostatic Tremor. Mov Disord Clin Pract 2017; 4:852-857. [PMID: 30363432 DOI: 10.1002/mdc3.12547] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/23/2017] [Accepted: 08/18/2017] [Indexed: 11/07/2022] Open
Abstract
Background Orthostatic Tremor (OT) is characterized by the presence of a sensation of instability while standing, associated with high frequency (13-18 Hz) lower extremity tremor. Diagnosis is confirmed with surface electromyography (EMG). An accurate screening tool that could be used in the routine clinical setting, without any specialized equipment, would be useful in earlier detection of OT and judicial use of additional testing. Objective The objective of this study was to evaluate OT diagnostic test characteristics at bedside using iPhone's built-in accelerometer and available applications for tremor recordings. Methods We obtained recordings using iPhones (Model 5, 5s, and 6) and free Applications ("LiftPulse" by LiftLabs [App1] and "iSeismometer" by ObjectGraph LLC [App2]) at default settings. Results 24 EMG-confirmed OT subjects (mostly females, 22/24) and 15 age-matched controls (mostly males, 11/15) were evaluated. App1 detected OT range tremor in 22/24 patients and none of the controls. (Sensitivity = 92%, Specificity = 100%, NPV = 88%). App2 detected OT range tremor in 21/24 patients and in 1/13 controls (Sensitivity = 88%, Specificity = 92%, NPV = 80%). When combined, 24/24 patients and 1/13 controls had OT range tremor (Sensitivity = 100%, Specificity = 92%, NPV = 100%). Conclusions Smartphone apps that use the built-in accelerometer provide a simple, accurate and inexpensive bedside screening diagnostic tool for patients with OT.
Collapse
Affiliation(s)
- Danish Bhatti
- Department of Neurological Sciences University of Nebraska Medical Center Omaha Nebraska
| | - Rebecca Thompson
- Department of Neurological Sciences University of Nebraska Medical Center Omaha Nebraska
| | - Amy Hellman
- Department of Neurological Sciences University of Nebraska Medical Center Omaha Nebraska
| | - Cynthia Penke
- Department of Neurological Sciences University of Nebraska Medical Center Omaha Nebraska
| | - John M Bertoni
- Department of Neurological Sciences University of Nebraska Medical Center Omaha Nebraska
| | - Diego Torres-Russotto
- Department of Neurological Sciences University of Nebraska Medical Center Omaha Nebraska
| |
Collapse
|
3
|
Chokroverty S. Differential Diagnoses of Restless Legs Syndrome/Willis-Ekbom Disease. Sleep Med Clin 2015; 10:249-62, xii. [DOI: 10.1016/j.jsmc.2015.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
4
|
Phielipp NM, Chen R. Neurophysiologic Assessment of Movement Disorders in Humans. Mov Disord 2015. [DOI: 10.1016/b978-0-12-405195-9.00010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
5
|
|
6
|
Trocello JM, Zanotti-Fregonara P, Roze E, Apartis E, Legrand AP, Habert MO, Devaux JY, Vidailhet M. Dopaminergic deficit is not the rule in orthostatic tremor. Mov Disord 2008; 23:1733-8. [DOI: 10.1002/mds.22224] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
7
|
Bacsi AM, Fung VSC, Colebatch JG. Sway patterns in orthostatic tremor: impairment of postural control mechanisms. Mov Disord 2006; 20:1469-75. [PMID: 16037916 DOI: 10.1002/mds.20600] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Sway parameters in orthostatic tremor (OT) patients were compared with age-matched controls. The effects of vision (eyes open or closed), stance width (feet apart or together), and external support (with or without) on sway and 14-18 Hz energy were measured. Sway in OT patients decreased in the presence of each of the stabilizing factors but the extent of benefit obtained by OT patients was significantly less than controls for support for the sagittal plane (22% vs. 42% decrease; P < 0.01) and feet apart in the mediolateral plane (38% vs. 65% decrease; P < 0.01). Three patients with proprioceptive loss also had a reduced response to these factors. Energy in the 14-18 Hz range did not always change in parallel with sway levels. Vision suppresses activity at the OT frequency in patients. Postural control mechanisms in OT remain responsive to postural conditions, but patients differ significantly from normals in the degree of their responsiveness. OT appears to have disruption of the normal generation or processing of proprioceptive signals as one of its important components.
Collapse
Affiliation(s)
- Ann M Bacsi
- Institute of Neurological Sciences and University of New South Wales Clinical School, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | | | | |
Collapse
|
8
|
Spiegel J, Krick C, Fuss G, Sood D, Becker G, Dillmann U. Orthostatic tremor during modification of standing. Mov Disord 2006; 21:173-8. [PMID: 16149097 DOI: 10.1002/mds.20684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Primary orthostatic tremor (OT) occurs only during standing. We studied whether modification of the condition standing influences OT. In seven patients with OT, surface EMG was recorded from both tibialis anterior and gastrocnemius muscles during two maneuvers: relief, whereby the patient was gradually lifted by a crane, and tilting, whereby the patient was tilted by a tilting table to positions of 90 degrees (upright standing), 45 degrees (diagonal position), and 0 degrees (lying position). We determined the parameters tremor frequency, tremor intensity, coherence, and phase shift between the different muscles. Relief did not influence OT. In contrast, tilting modified significantly tremor intensity and phase shifts; tremor frequencies and coherences were not influenced. We chose both these maneuvers because of their different impact on the standing condition: relief modifies the factors afferent input and muscle forcing but not the factor postural set, whereas tilting modifies all three factors. The fact that tilting modifies OT, whereas relief does not, suggests an important role of postural set in OT generation. Afferent input and muscle forcing seem to play less important role.
Collapse
Affiliation(s)
- Jörg Spiegel
- Department of Neurology, Saarland University, Homburg/Saar, Germany.
| | | | | | | | | | | |
Collapse
|
9
|
Spiegel J, Fuss G, Dillmann U. Is primary orthostatic tremor associated with an autochthonous immunoglobulin synthesis in the cerebrospinal fluid? Mov Disord 2005; 20:1079-80. [PMID: 16007656 DOI: 10.1002/mds.20597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
10
|
Garosi LS, Rossmeisl JH, Lahunta A, Shelton GD, Lennox G. Primary Orthostatic Tremor in Great Danes. J Vet Intern Med 2005. [DOI: 10.1111/j.1939-1676.2005.tb02736.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
11
|
Piboolnurak P, Yu QP, Pullman SL. Clinical and neurophysiologic spectrum of orthostatic tremor: Case series of 26 subjects. Mov Disord 2005; 20:1455-61. [PMID: 16037915 DOI: 10.1002/mds.20588] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Orthostatic tremor (OT) is a condition described as high-frequency tremors predominantly in the legs and trunk, which are present not only in the standing position but also during isometric contraction of the limb muscles. This report is one of the largest OT series describing clinical and neurophysiologic findings in 26 subjects with OT. The main findings included 13.0 to 18.6 Hz leg tremors while standing with varied patterns of phase relationships between the antagonists of the ipsilateral leg and between the homologous muscles of the contralateral leg, short latency tremor onset upon standing with abrupt cessation after sitting, coexistence of tremors in the cranial structures and the arms, and sense of unsteadiness without actual falls. Although the oscillator of OT is most likely located in the brainstem, cerebral cortex, basal ganglia, and cerebellum may also be involved in its pathogenesis.
Collapse
Affiliation(s)
- Panida Piboolnurak
- Department of Neurology, Clinical Motor Physiology Laboratory, Columbia University Medical Center, New York, New York, USA
| | | | | |
Collapse
|
12
|
Gerschlager W, Münchau A, Katzenschlager R, Brown P, Rothwell JC, Quinn N, Lees AJ, Bhatia KP. Natural history and syndromic associations of orthostatic tremor: a review of 41 patients. Mov Disord 2004; 19:788-795. [PMID: 15254936 DOI: 10.1002/mds.20132] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Orthostatic tremor (OT) is a rare condition characterized by unsteadiness when standing still that is relieved when sitting or walking and is thought to arise from a central generator in the cerebellum or brainstem. OT is considered to be a distinct, discrete condition, and little is known about its demographic characteristics, natural history, associated features, and treatment response. We have reviewed these aspects in 41 OT patients fulfilling current diagnostic criteria, seen at our institution between 1986 and 2001. We classified 31 (75%) as having idiopathic "primary OT" either with (n = 24) or without an associated postural arm tremor. We found that 10 of 41 (25%) cases had additional neurological features, and we defined this group as having "OT plus" syndrome. Of these 10, 6 had parkinsonism; 4 of these had typical Parkinson's disease (PD), 1 had vascular and 1 had drug-induced parkinsonism. Among the remaining 4 patients, 2 had restless legs syndrome (RLS), 1 had tardive dyskinesia, and 1 orofacial dyskinesias of uncertain etiology. One patient with PD and the patient with vascular parkinsonism also had RLS. Age at onset was significantly earlier in the "primary OT" (mean +/- SD, 50.4 +/- 15.1) than in the "OT plus" (61.8 +/- 6.4; z = 2.7; P =.006) group. In 7 of the 10 "OT plus" patients, OT leg symptoms preceded the onset of additional neurological features. OT appeared to be underdiagnosed, and on average, it took 5.7 years from the initial complaints until a diagnosis was made. In general, treatment response to a variety of drugs such as clonazepam, primidone, and levodopa was poor. In most cases, OT symptoms remain relatively unchanged over the years, but in 6 of 41 cases (15%), the condition gradually worsened over the years, and in some of these cases, symptoms spread proximally to involve the trunk and arms. OT may not be a discrete disorder as commonly believed and associated features like parkinsonism present in nearly 25% of cases. Dopaminergic dysfunction may have a role in the pathophysiology of this disorder.
Collapse
Affiliation(s)
- Willibald Gerschlager
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom
- Department of Neurology, Krankenhaus der Barmherzigen Brüder, Vienna, Austria
| | | | - Regina Katzenschlager
- National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
- Reta Lila Weston Institute of Neurological Studies, Royal Free and University College London Medical School, United Kingdom
| | - Peter Brown
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom
| | - Niall Quinn
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Andrew J Lees
- National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
- Reta Lila Weston Institute of Neurological Studies, Royal Free and University College London Medical School, United Kingdom
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| |
Collapse
|
13
|
Spiegel J, Fuss G, Krick C, Dillmann U. Impact of different stimulation types on orthostatic tremor. Clin Neurophysiol 2004; 115:569-75. [PMID: 15036052 DOI: 10.1016/j.clinph.2003.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Primary orthostatic tremor (OT) is thought to be generated by a unique supraspinal tremor generator. Here we studied the effect of ipsi- and contralateral stimulation of the central and peripheral nervous system on OT. METHODS In 7 patients with primary OT, surface EMG was recorded from both tibialis anterior muscles. We performed transcranial magnetic stimulation (TMS) over the vertex, and lumbar magnetic stimulation (LMS) over the lumbar spine. Supramaximal electrical nerve stimuli were applied to the tibial or peroneal nerve at the knee. Proprioceptive input was evoked by rhythmical submaximal stimulation of the tibial, peroneal or sural nerve at the ankle. RESULTS TMS reset OT significantly in the contralateral as well as the ipsilateral tibialis anterior muscle. The resetting in both muscles was identical. In contrast, peripheral input by means of LMS, supra- or submaximal nerve stimulation had no impact on OT. CONCLUSIONS Transcranial magnetic stimulation of one cortical leg area resets OT in both legs whereas OT is not modified by any peripheral stimuli applied in this study. SIGNIFICANCE Our results support the hypothesis of n unique supraspinal OT generator. This generator receives a modulating input from the motor cortex.
Collapse
Affiliation(s)
- J Spiegel
- Department of Neurology, University of the Saarland, Homburg/Saar, D-66421 Germany.
| | | | | | | |
Collapse
|
14
|
Abstract
Tremor is defined as rhythmic oscillatory activity of body parts. Four physiological basic mechanisms for such oscillatory activity have been described: mechanical oscillations; oscillations based on reflexes; oscillations due to central neuronal pacemakers; and oscillations because of disturbed feedforward or feedback loops. New methodological approaches with animal models, positron emission tomography, and mathematical analysis of electromyographic and electroencephalographic signals have provided new insights into the mechanisms underlying specific forms of tremor. Physiological tremor is due to mechanical and central components. Psychogenic tremor is considered to depend on a clonus mechanism and is thus believed to be mediated by reflex mechanisms. Symptomatic palatal tremor is most likely due to rhythmic activity of the inferior olive, and there is much evidence that essential tremor is also generated within the olivocerebellar circuits. Orthostatic tremor is likely to originate in hitherto unidentified brainstem nuclei. Rest tremor of Parkinson's disease is probably generated in the basal ganglia loop, and dystonic tremor may also originate within the basal ganglia. Cerebellar tremor is at least in part caused by a disturbance of the cerebellar feedforward control of voluntary movements, and Holmes' tremor is due to the combination of the mechanisms producing parkinsonian and cerebellar tremor. Neuropathic tremor is believed to be caused by abnormally functioning reflex pathways and a wide variety of causes underlies toxic and drug-induced tremors. The understanding of the pathophysiology of tremor has made significant progress but many hypotheses are not yet based on sufficient data. Modern neurology needs to develop and test such hypotheses, because this is the only way to develop rational medical and surgical therapies.
Collapse
Affiliation(s)
- G Deuschl
- Department of Neurology, Christian-Albrechts-Universität, Niemannsweg 147, D-24105 Kiel, Germany.
| | | | | | | |
Collapse
|
15
|
Abstract
Primary orthostatic tremor (OT) consists of rhythmical muscle contractions at a frequency of around 16 Hz, causing discomfort and/or unsteadiness while standing. Diagnosis has hitherto relied on recording Electromyography (EMG) from affected muscles. The main aim of this study was to see if the characteristic postural tremor in OT can be identified with force platforms. We also quantified postural sway in OT patients to assess their degree of objective unsteadiness. Finally, we investigated the time relations between bursts of activity in the various affected muscle groups. Subjects stood on a force platform with concurrent multichannel surface EMG recordings from the lower limbs. Seven patients with clinical and EMG diagnosis of OT were examined and the force platform data compared with those of 21 other neurological patients with postural tremor and eight normal controls. All OT patients had high frequency peaks in power spectra of posturography and EMG recordings (12--16 Hz). No such high frequency activity was evident in patients with Parkinson's disease, cerebellar degenerations, essential tremor or in healthy controls. Additionally, OT patients showed increased sway at low frequencies relative to normal controls, suggesting that the unsteadiness reported by OT patients is at least partly due to increased postural sway. Examination of EMG timing showed fixed patterns of muscle activation when maintaining a quiet stance within but not across OT patients. These data show a high correlation between EMG and posturography and confirm that OT may be diagnosed using short epochs of force platform recordings.
Collapse
Affiliation(s)
- K Yarrow
- MRC Human Movement and Balance Unit, National Hospital for Neurology and Neurosurgery, 8-11 Queen Square, London, WC1N 3BG, UK
| | | | | | | |
Collapse
|
16
|
Cavallazzi LO, Machado SN, Matosinho P, Pio FJ. [Primary orthostatic tremor: report of 4 cases]. ARQUIVOS DE NEURO-PSIQUIATRIA 2000; 58:146-9. [PMID: 10770880 DOI: 10.1590/s0004-282x2000000100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report on four cases of primary orthostatic tremor. The purpose of this study is the rarity of this type of tremor and the differential diagnosis with other tremors. The electrophysiological study showed a 15-20 Hz tremor frequency in our cases. There are clinical, electrophysiological and therapeutic differences of primary orthostatic tremor in report to other tremors of legs, according to the literature and characteristics of our cases.
Collapse
Affiliation(s)
- L O Cavallazzi
- Serviço de Residência de Neurologia, Hospital Governador Celso Ramos (HGCR), Florianópolis, SC
| | | | | | | |
Collapse
|