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Bilski M, Szklener K, Szklener S, Rudzińska A, Kluz N, Klas J, Rodzajewska A, Kuryło W, Korga M, Baranowska I, Mańdziuk S. Stereotactic radiosurgery in the treatment of essential tremor - a systematic review. Front Neurol 2024; 15:1370091. [PMID: 38633530 PMCID: PMC11021759 DOI: 10.3389/fneur.2024.1370091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Essential tremor (ET) is the most common movement disorder in adults, with an estimated incidence of up to 1% of the population and 5% of people older than 65 years of age. ET is manifested primarily by bilateral postural and kinetic tremor of the upper limbs with or without neurological symptoms and cognitive deficits. ET disrupts daily tasks and significantly lowers quality of life. Currently available medications alone are often insufficient to control severe symptoms. Several surgical treatment options are available, including stereotactic radiosurgery (SRS)-a minimally invasive treatment option aimed at relieving and controlling tremors. Methods We conducted a systematic review of the scientific literature on the use of SRS in the treatment of ET using PubMed, Scopus, Web of Science, Cochrane, ScienceDirect, and ClinicalTrials.gov registry and adhered to the PRISMA guidelines. Results The results obtained confirm the high efficacy and safety of the SRS procedure in treating drug-resistant intention tremor. The study results present high response rate reaching 80% and achievement of manual task improvement, lessening of the tremor and increase in the quality of life of the majority of the operated patients. The method also stands out for its favorable balance between efficiency and cost. Disscusion Stereotactic radiosurgery is a favourable, safe, efficient and cost-effective method in treatment of the essential tremor. Ongoing research is crucial to refine patient selection criteria for this procedure and further improve the effectiveness of the technique.
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Affiliation(s)
- Mateusz Bilski
- Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
- Brachytherapy Department, Saint John’s Cancer Center, Lublin, Poland
- Radiotherapy Department, Saint John’s Cancer Center, Lublin, Poland
| | - Katarzyna Szklener
- Department of Clinical Oncology and Chemotherapy, Medical University of Lublin, Lublin, Poland
| | | | - Anna Rudzińska
- Department of Clinical Oncology and Chemotherapy, Medical University of Lublin, Lublin, Poland
| | - Natalia Kluz
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Jakub Klas
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Anna Rodzajewska
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Weronika Kuryło
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Mateusz Korga
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Izabela Baranowska
- Department of Medical Physics, Saint John’s Cancer Center, Lublin, Poland
- Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Sławomir Mańdziuk
- Department of Clinical Oncology and Chemotherapy, Medical University of Lublin, Lublin, Poland
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Bolton TAW, Van De Ville D, Régis J, Witjas T, Girard N, Levivier M, Tuleasca C. Morphometric features of drug-resistant essential tremor and recovery after stereotactic radiosurgical thalamotomy. Netw Neurosci 2022; 6:850-869. [PMID: 36605417 PMCID: PMC9810368 DOI: 10.1162/netn_a_00253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/02/2022] [Indexed: 01/09/2023] Open
Abstract
Essential tremor (ET) is the most common movement disorder. Its neural underpinnings remain unclear. Here, we quantified structural covariance between cortical thickness (CT), surface area (SA), and mean curvature (MC) estimates in patients with ET before and 1 year after ventro-intermediate nucleus stereotactic radiosurgical thalamotomy, and contrasted the observed patterns with those from matched healthy controls. For SA, complex rearrangements within a network of motion-related brain areas characterized patients with ET. This was complemented by MC alterations revolving around the left middle temporal cortex and the disappearance of positive-valued covariance across both modalities in the right fusiform gyrus. Recovery following thalamotomy involved MC readjustments in frontal brain centers, the amygdala, and the insula, capturing nonmotor characteristics of the disease. The appearance of negative-valued CT covariance between the left parahippocampal gyrus and hippocampus was another recovery mechanism involving high-level visual areas. This was complemented by the appearance of negative-valued CT/MC covariance, and positive-valued SA/MC covariance, in the right inferior temporal cortex and bilateral fusiform gyrus. Our results demonstrate that different morphometric properties provide complementary information to understand ET, and that their statistical cross-dependences are also valuable. They pinpoint several anatomical features of the disease and highlight routes of recovery following thalamotomy.
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Affiliation(s)
- Thomas A. W. Bolton
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,Connectomics Laboratory, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,* Corresponding Author:
| | - Dimitri Van De Ville
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland,Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Tatiana Witjas
- Neurology Department, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Nadine Girard
- Department of Diagnostic and Interventional Neuroradiology, Centre de Résonance Magnétique Biologique et Médicale, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland,Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Bolton TAW, Van De Ville D, Régis J, Witjas T, Girard N, Levivier M, Tuleasca C. Graph Theoretical Analysis of Structural Covariance Reveals the Relevance of Visuospatial and Attentional Areas in Essential Tremor Recovery After Stereotactic Radiosurgical Thalamotomy. Front Aging Neurosci 2022; 14:873605. [PMID: 35677202 PMCID: PMC9168220 DOI: 10.3389/fnagi.2022.873605] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Essential tremor (ET) is the most common movement disorder. Its pathophysiology is only partially understood. Here, we leveraged graph theoretical analysis on structural covariance patterns quantified from morphometric estimates for cortical thickness, surface area, and mean curvature in patients with ET before and one year after (to account for delayed clinical effect) ventro-intermediate nucleus (Vim) stereotactic radiosurgical thalamotomy. We further contrasted the observed patterns with those from matched healthy controls (HCs). Significant group differences at the level of individual morphometric properties were specific to mean curvature and the post-/pre-thalamotomy contrast, evidencing brain plasticity at the level of the targeted left thalamus, and of low-level visual, high-level visuospatial and attentional areas implicated in the dorsal visual stream. The introduction of cross-correlational analysis across pairs of morphometric properties strengthened the presence of dorsal visual stream readjustments following thalamotomy, as cortical thickness in the right lingual gyrus, bilateral rostral middle frontal gyrus, and left pre-central gyrus was interrelated with mean curvature in the rest of the brain. Overall, our results position mean curvature as the most relevant morphometric feature to understand brain plasticity in drug-resistant ET patients following Vim thalamotomy. They also highlight the importance of examining not only individual features, but also their interactions, to gain insight into the routes of recovery following intervention.
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Affiliation(s)
- Thomas A. W. Bolton
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Connectomics Laboratory, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Dimitri Van De Ville
- Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Tatiana Witjas
- Neurology Department, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Nadine Girard
- Department of Diagnostic and Interventional Neuroradiology, Centre de Résonance Magnétique Biologique et Médicale, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, Álvarez I, Pastor P, Agúndez JAG. Genomic Markers for Essential Tremor. Pharmaceuticals (Basel) 2021; 14:ph14060516. [PMID: 34072005 PMCID: PMC8226734 DOI: 10.3390/ph14060516] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 12/13/2022] Open
Abstract
There are many reports suggesting an important role of genetic factors in the etiopathogenesis of essential tremor (ET), encouraging continuing the research for possible genetic markers. Linkage studies in families with ET have identified 4 genes/loci for familial ET, although the responsible gene(s) have not been identified. Genome-wide association studies (GWAS) described several variants in LINGO1, SLC1A2, STK32B, PPARGC1A, and CTNNA3, related with ET, but none of them have been confirmed in replication studies. In addition, the case-control association studies performed for candidate variants have not convincingly linked any gene with the risk for ET. Exome studies described the association of several genes with familial ET (FUS, HTRA2, TENM4, SORT1, SCN11A, NOTCH2NLC, NOS3, KCNS2, HAPLN4, USP46, CACNA1G, SLIT3, CCDC183, MMP10, and GPR151), but they were found only in singular families and, again, not found in other families or other populations, suggesting that some can be private polymorphisms. The search for responsible genes for ET is still ongoing.
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Affiliation(s)
- Félix Javier Jiménez-Jiménez
- Section of Neurology, Hospital Universitario del Sureste, E28500 Arganda del Rey, Spain;
- Correspondence: ; Tel.: +34-636-96-83-95; Fax: +34-913-28-07-04
| | | | - Elena García-Martín
- ARADyAL Instituto de Salud Carlos III, University Institute of Molecular Pathology Biomarkers, University of Extremadura, E10071 Caceres, Spain; (E.G.-M.); (J.A.G.A.)
| | - Ignacio Álvarez
- Movement Disorders Unit, Department of Neurology, University Hospital Mútua de Terrassa, Fundació Docencia i Recerça Mútua de Terrassa, E08221 Terrassa, Spain; (I.Á.); (P.P.)
| | - Pau Pastor
- Movement Disorders Unit, Department of Neurology, University Hospital Mútua de Terrassa, Fundació Docencia i Recerça Mútua de Terrassa, E08221 Terrassa, Spain; (I.Á.); (P.P.)
| | - José A. G. Agúndez
- ARADyAL Instituto de Salud Carlos III, University Institute of Molecular Pathology Biomarkers, University of Extremadura, E10071 Caceres, Spain; (E.G.-M.); (J.A.G.A.)
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Sleep disturbances in essential tremor: an investigation of associated brain microstructural changes using diffusion tensor imaging. Sleep Biol Rhythms 2021. [DOI: 10.1007/s41105-021-00328-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, Agúndez JAG. Sleep disorders in essential tremor: systematic review and meta-analysis. Sleep 2021; 43:5804186. [PMID: 32163585 DOI: 10.1093/sleep/zsaa039] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/19/2020] [Indexed: 12/20/2022] Open
Abstract
Sleep disorders are frequent in patients diagnosed with essential tremor (ET). The present review focuses on sleep disorders and the results of polysomnographic studies performed in patients with ET. For this purpose we performed a systematic review crossing the search term "essential tremor" with "sleep," "sleep disorders," "sleep disturbances" and "polysomnography," and with specific sleep disorders, according to the International Classification of the Sleep Disorders-Third Edition, using the PubMed, EMBASE, MEDLINE, and Web of Science Databases. The most frequent sleep problems reported by patients with ET were the bad quality of sleep and excessive daytime somnolence (the latter could be related to drugs commonly used for the treatment of ET). Probable rapid eye movement sleep behavior disorder, coexistent restless legs syndrome, insomnia, and nocturia were not infrequent complaints, while the presence of other sleep disorders in patients with ET was restricted to anecdotal reports or not described. Meta-analyses of previous reports showed that patients with ET (according to the PRISMA and MOOSE guidelines) showed higher scores in the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale than controls and lower scores than those of patients diagnosed with Parkinson's disease. Studies using polysomnography in patients with ET are scarce and do not permit to establish valid conclusions regarding polysomnographic features in this disorder.
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Affiliation(s)
| | | | - Elena García-Martín
- University Institute of Molecular Pathology Biomarkers, UNEx. ARADyAL Instituto de Salud Carlos III, Cáceres, Spain
| | - José A G Agúndez
- University Institute of Molecular Pathology Biomarkers, UNEx. ARADyAL Instituto de Salud Carlos III, Cáceres, Spain
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Hucker P, Dacko M, Zaitsev M. Combining prospective and retrospective motion correction based on a model for fast continuous motion. Magn Reson Med 2021; 86:1284-1298. [PMID: 33829538 DOI: 10.1002/mrm.28783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE Prospective motion correction (PMC) and retrospective motion correction (RMC) have different advantages and limitations. The present work aims to combine the advantages of both for rigid body motion, aiming at correcting for faster motions than was previously achievable. Additionally, it provides insights into the effects of motion on pulse sequences and MR signals with a goal of further improving motion correction in the future. METHODS The effective encoding trajectory and a global phase offset in a moving object are calculated based on complete gradient waveforms of an arbitrary sequence and a continuous motion model. These data are used to feed the forward signal model, which is then used in iterative image reconstruction to suppress the artifacts still present after the PMC. RESULTS Verification experiments with a rotation phantom and in vivo were performed. Predictions of simulated motion artifacts for PMC based on sequence waveforms are very accurate. The performance at combined PMC+RMC is limited by Nyquist violations in the sampled k-space and can be compensated by oversampling. CONCLUSION The combined correction results in better images than pure PMC in the presence of fast motion. The predictions of artifacts are very accurate, allowing for comparing sequences or protocols in simulations. The observed artifacts due to Nyquist violations are expected to be corrected by utilizing parallel imaging.
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Affiliation(s)
- Patrick Hucker
- Center for Diagnostic and Therapeutic Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Dacko
- Center for Diagnostic and Therapeutic Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maxim Zaitsev
- Center for Diagnostic and Therapeutic Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,High Field Magnetic Resonance Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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Abstract
PURPOSE OF THE REVIEW Patients diagnosed with essential tremor (ET) report frequent sleep complaints. This review focuses on the main findings of studies addressing sleep features in patients diagnosed with ET, updating previously reported information. Bad quality of sleep and excessive daytime somnolence are very frequent in patients with ET, although the effects of the drugs used for the therapy of ET could contribute to these complaints. REM sleep behavior disorder, restless legs, insomnia, and nocturia are frequent complaints as well. There is a lack of studies addressing polysomnographic features of ET.
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Mood and emotional disorders associated with parkinsonism, Huntington disease, and other movement disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:175-196. [PMID: 34389117 DOI: 10.1016/b978-0-12-822290-4.00015-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This chapter provides a review of mood, emotional disorders, and emotion processing deficits associated with diseases that cause movement disorders, including Parkinson's disease, Lewy body dementia, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, frontotemporal dementia with parkinsonism, Huntington's disease, essential tremor, dystonia, and tardive dyskinesia. For each disorder, a clinical description of the common signs and symptoms, disease progression, and epidemiology is provided. Then the mood and emotional disorders associated with each of these diseases are described and discussed in terms of clinical presentation, incidence, prevalence, and alterations in quality of life. Alterations of emotion communication, such as affective speech prosody and facial emotional expression, associated with these disorders are also discussed. In addition, if applicable, deficits in gestural and lexical/verbal emotion are reviewed. Throughout the chapter, the relationships among mood and emotional disorders, alterations of emotional experiences, social communication, and quality of life, as well as treatment, are emphasized.
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Kudrevatykh A, Senkevich K, Miliukhina I. Postural instability and neuropsychiatric disturbance in the overlapping phenotype of essential tremor and Parkinson's Disease. Neurophysiol Clin 2020; 50:489-494. [PMID: 32873435 DOI: 10.1016/j.neucli.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to perform a comparative analysis of postural and neuropsychiatric features in patients with essential tremor (ET), various Parkinson's disease (PD) phenotypes, and the phenotype of combined ET and PD (ET-PD). METHODS 169 PD patients with early (1.0-2.0) and 111 PD patients with advanced (2.5-3.0) stages based on the Hoehn and Yahr scale, 55 patients with ET and 26 patients with ET-PD were enrolled in the study. Motor and non-motor symptoms of patients with PD, ET and ET-PD were studied using standardized scales and stabilometry. RESULTS Patients with ETPD had milder manifestations of parkinsonism compared to PD patients at the same stages of the disease. Patients in the advanced PD group showed more pronounced posture and balance impairment compared to all other groups assessed by standardized walking and balance scales. No difference using scales for postural assessment was found between ETPD, ET and early stage PD. Using stabilometry, we discovered that indexes of stabilometric parameters were lower in ETPD patients compared to ET and advanced PD, although no difference between ETPD and early PD was found. PD patients in early stages had lower results in most of the indexes compared to ET. CONCLUSION Here, we conducted for the first time a stabilometric examination of ET-PD patients, which could be helpful in differential diagnosis. This analysis helps expand understanding of the clinical manifestations of PD, ET and ET-PD.
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Affiliation(s)
- Anastasia Kudrevatykh
- Institute of Experimental Medicine, St. Petersburg, Russia; First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia
| | - Konstantin Senkevich
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia; Petersburg Nuclear Physics Institute Named by B.P. Konstantinov of National Research Centre "Kurchatov Institute", Gatchina, Russia.
| | - Irina Miliukhina
- Institute of Experimental Medicine, St. Petersburg, Russia; First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia; Petersburg Nuclear Physics Institute Named by B.P. Konstantinov of National Research Centre "Kurchatov Institute", Gatchina, Russia
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Qi S, Cao H, Wang R, Jian Z, Bian Y, Yang J. Relative increase in cerebellar gray matter in young onset essential tremor: Evidence from voxel-based morphometry analysis. J Clin Neurosci 2020; 79:251-256. [PMID: 33070906 DOI: 10.1016/j.jocn.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/02/2020] [Indexed: 02/01/2023]
Abstract
This study is to investigate the presence of brain gray matter abnormalities in young onset essential tremor (ET) patients with arm tremor. Thirty ET patients together with 30 healthy volunteers were taken as candidates. Magnetic resonance imaging (MRI) was performed and voxel-based morphometry was used to compare gray matter density between the patients and volunteers. Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) rating scale was applied to assess tremor severity in the patients. Eventually Twenty-Seven ET patients and Twenty-Seven volunteers were enrolled in the study. Voxel-based morphometry showed significant expansion of the bilateral cerebellum, occipital fusiform cortices, right inferior temporal gyrus, and precentral lobes (P < 0.05, TFCE corrected). Decrease in gray matter was detected only in the left parietal lobe. Region of interest analysis showed volume enlargement in thalamus, midbrain, and precuneus (P < 0.05, TFCE corrected). Importantly, significant negative correlation was found between the lateralized index of cerebellum and the tremor score which might implicate that the altered rightward lateralization in the cerebellum is possibly a response of the tremor effects in ET patients. Cerebellar gray matter expansion in young onset ET patients with arm tremor might be the result of compensation towards decline of cerebellar function.
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Affiliation(s)
- Shun Qi
- Department of Radiology, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, PR China; Center for Brain Science and Intelligence Technology, Xi'an Jiaotong University, Xi'an 710061, PR China
| | - Hongmei Cao
- Department of Neurology, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, PR China
| | - Rong Wang
- Department of Radiology, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, PR China
| | - Zhijie Jian
- Department of Radiology, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, PR China
| | - Yitong Bian
- Department of Radiology, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, PR China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, PR China; Department of Biomedical Engineering, The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, PR China.
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Bahadoran P, Varela R, De Angelis A, Paviour D, Agrawal N. Screening for depression in movement disorders clinic. Neurol Sci 2020; 42:969-978. [PMID: 32681218 DOI: 10.1007/s10072-020-04571-7] [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: 02/04/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Depression is the most common, though often under-recognised, neuropsychiatric disturbance in movement disorders (MD). OBJECTIVE This study aimed to establish whether a briefer screening measure such as a visual analogue screening measure (Emotions Thermometer) or Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) could be a potentially suitable screening tool for depression in MD patients. METHOD Patients attending a regional MD outpatient clinic completed the Emotional Thermometer 7-item tool (ET7), the Hospital Anxiety and Depression Scale (HADS) and the Neurological Disorders Depression Inventory for Epilepsy (NDDIE). We used the Major Depression Inventory which provided the diagnosis of depression based on ICD-10 and DSM-IV as our diagnostic gold standard to compare the performance of ET7 and its individual sub-scales, its briefer version ET4, HADS, and NDDIE. Sensitivity, specificity, positive predictive value, negative predictive value and receiver operating characteristic curves were calculated to compare the performance of the screening tools. RESULTS In total, 188 patients were included in the analysis. The most accurate tools as determined by Receiver Operating Characteristics curve were HADS-D for ICD-10 depressive episode and DepT for DSM-IV major depression. ET4 performed well as a 'rule-out' screening tool for both DSM-IV and ICD-10 depression. ET4 performance was comparable to HADS without the need for clinician scoring. The briefer ET4 performed almost as well as ET7. CONCLUSION Emotions Thermometer and NDDI-E are quick and reliable screening tools for depression in the MD population and are comparable to HADS. We suggest routine use of visual analogue ET4 as it is briefer, requires less time to complete and does not require scoring from the clinicians. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening.
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Affiliation(s)
- Parviz Bahadoran
- Atkinson Morley Regional Neurosciences Centre, St. George's Hospital, London, UK.
| | - Rita Varela
- Atkinson Morley Regional Neurosciences Centre, St. George's Hospital, London, UK
| | - Andrea De Angelis
- Atkinson Morley Regional Neurosciences Centre, St. George's Hospital, London, UK
| | - Dominic Paviour
- Atkinson Morley Regional Neurosciences Centre, St. George's Hospital, London, UK
| | - Niruj Agrawal
- Atkinson Morley Regional Neurosciences Centre, St. George's Hospital, London, UK
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Sengul Y, Sengul HS, Gokcal E, Ustun I, Ozturk A, Yilmaz O, Yildiz GB, Louis ED. Alexithymia is a non motor symptom of essential tremor regardless of the presence of depression and anxiety. Neurol Res 2020; 42:946-951. [PMID: 32657241 DOI: 10.1080/01616412.2020.1792702] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Essential tremor (ET) is one of the most common movement disorders. Aside from tremor, patients may exhibit other motor features as well as non-motor features, including neuropsychiatric symptoms. The cerebellum and cerebellar connections are thought to play a key role in the pathophysiology of ET. Cognitive and affective disturbances can occur in the context of cerebellar disease. Our aim was to study the prevalence and clinical correlates of alexithymia and its relationship to depression and anxiety in ET patients and control subjects (CS). METHOD We enrolled 100 ET patients and 100 age- and gender-matched CS. The Toronto Alexithymia Scale-20 (TAS-20), the Beck depression inventory-II and the Beck anxiety inventory were administered. RESULTS Alexithymia levels were significantly higher in ET patients than CS (respective mean TAS-20 scores = 50.63 ± 9.79 vs. 44.05 ± 12.51, p < 0.001). There were robust associations between alexithymia, depressive symptoms, and anxiety but, after excluding the ET patients and the CS who had moderate or severe depression or who had moderate or severe anxiety, the total alexithymia score remained significantly higher in the ET than the CS group (46.78 ± 9.19 vs. 41.18 ± 11.79, p ≤ 0.01). CONCLUSION This study suggests that prevalence of alexithymia is significantly higher in ET patients. Alexithymia might be another non-motor neuropsychiatric symptom of the disease. Further studies are needed to confirm and expand upon our findings.
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Affiliation(s)
- Yildizhan Sengul
- Department of Neurology, Faculty of Medicine, Bezmialem Foundation University, IST , City of Istanbul, TR.,Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University , New Haven, CT, USA
| | - Hakan Serdar Sengul
- Department of Psychiatry, GOP Taksim Research and Training Hospital, IST , City of Istanbul, TR
| | - Elif Gokcal
- Department of Neurology, Faculty of Medicine, Bezmialem Foundation University, IST , City of Istanbul, TR
| | - Ismet Ustun
- Department of Neurology, Faculty of Medicine, Bezmialem Foundation University, IST , City of Istanbul, TR
| | - Ahmet Ozturk
- Department of Psychiatry, Faculty of Medicine, Bezmialem Foundation University, IST , City of Istanbul, TR
| | - Onur Yilmaz
- Department of Psychiatry, Faculty of Medicine, Bezmialem Foundation University, IST , City of Istanbul, TR
| | - Gulsen B Yildiz
- Department of Neurology, Faculty of Medicine, Bezmialem Foundation University, IST , City of Istanbul, TR
| | - Elan D Louis
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern , Dallas TX, USA
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14
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Çelık RGG, Köksal A, Şahın B, Şen A, Sakalli NK, Nalbantoğlu M. The Relationship Between Serum Uric Acid Levels and Clinical Features in Essential Tremor. ACTA ACUST UNITED AC 2020; 57:33-36. [PMID: 32110148 DOI: 10.29399/npa.24761] [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: 05/27/2019] [Accepted: 11/06/2019] [Indexed: 01/01/2023]
Abstract
Introduction In this study, we aimed to investigate the effect of uric acid on the disease, its severity and progression in ET patients with partially co-clinical features with Parkinson's disease (PD). Methods Serum UA levels of 87 consecutive ET patients were measured and were matched according to age and sex with 87 healthy controls. Fahn-Tolosa-Marin scale was used for the severity of tremor. Sociodemographic characteristics, type of ET, duration of disease, and treatment modalities were evaluated. Results The mean uric acid level was calculated as 4.986±2.1458 mg/dL and 6.004±1.523 mg/dL in the patient and control groups, respectively (p≤0.005). The blood UA level of patients with sporadic (n: 61) ET was found to be lower than the familial ET (n: 26) (p≤0.005). The tremor severity of the family ET patients was lower than the sporadic ET. (n: 61) (p≤0.005). The mean blood UA level (4.429±1.216 mg/dL) in the patients with high total tremor severity scores (n: 48) was found lower than in the patients with low total tremor severity scores (n: 39) (5.673±2.106 mg/dL) (P=0.000). The serum UA level was significantly lower in the patients whose disease duration longer than 5 years than in patients whose duration of the disease was shorter than 5 years. 5.732±1.240 for ≥5 years; 6.438±0.286≤5 years) (P=0.001). Conclusion We hypothesize that as a result of high antioxidant properties of high serum uric acid levels, it is a biomarker that can show disease risk and progression in patients with ET as well as PD.
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Affiliation(s)
- R Gökçen Gözübatik Çelık
- Department of Neurology, Bakırköy Research and Training Hospital for Neurologic and Psychiatric Diseases, İstanbul, Turkey
| | - Ayhan Köksal
- Department of Neurology, Bakırköy Research and Training Hospital for Neurologic and Psychiatric Diseases, İstanbul, Turkey
| | - Buket Şahın
- Department of Neurology, Bakırköy Research and Training Hospital for Neurologic and Psychiatric Diseases, İstanbul, Turkey
| | - Aysu Şen
- Department of Neurology, Bakırköy Research and Training Hospital for Neurologic and Psychiatric Diseases, İstanbul, Turkey
| | - Nazan Karagöz Sakalli
- Department of Neurology, Bakırköy Research and Training Hospital for Neurologic and Psychiatric Diseases, İstanbul, Turkey
| | - Mecbure Nalbantoğlu
- Department of Neurology, Bilim University School of Medicine, İstanbul, Turkey
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15
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Sun QY, Xu Q, Tian Y, Hu ZM, Qin LX, Yang JX, Huang W, Xue J, Li JC, Zeng S, Wang Y, Min HX, Chen XY, Wang JP, Xie B, Liang F, Zhang HN, Wang CY, Lei LF, Yan XX, Xu HW, Duan RH, Xia K, Liu JY, Jiang H, Shen L, Guo JF, Tang BS. Expansion of GGC repeat in the human-specific NOTCH2NLC gene is associated with essential tremor. Brain 2019; 143:222-233. [PMID: 31819945 DOI: 10.1093/brain/awz372] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/06/2019] [Accepted: 10/04/2019] [Indexed: 12/22/2022] Open
Abstract
Abstract
Essential tremor is one of the most common movement disorders. Despite its high prevalence and heritability, the genetic aetiology of essential tremor remains elusive. Up to now, only a few genes/loci have been identified, but these genes have not been replicated in other essential tremor families or cohorts. Here we report a genetic study in a cohort of 197 Chinese pedigrees clinically diagnosed with essential tremor. Using a comprehensive strategy combining linkage analysis, whole-exome sequencing, long-read whole-genome sequencing, repeat-primed polymerase chain reaction and GC-rich polymerase chain reaction, we identified an abnormal GGC repeat expansion in the 5′ region of the NOTCH2NLC gene that co-segregated with disease in 11 essential tremor families (5.58%) from our cohort. Clinically, probands that had an abnormal GGC repeat expansion were found to have more severe tremor phenotypes, lower activities of daily living ability. Obvious genetic anticipation was also detected in these 11 essential tremor-positive families. These results indicate that abnormal GGC repeat expansion in the 5′ region of NOTCH2NLC gene is associated with essential tremor, and provide strong evidence that essential tremor is a family of diseases with high clinical and genetic heterogeneities.
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Affiliation(s)
- Qi-Ying Sun
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qian Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yun Tian
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zheng-Mao Hu
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China
| | - Li-Xia Qin
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jin-Xia Yang
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wen Huang
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Jin Xue
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Jin-Chen Li
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Sheng Zeng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ying Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | | | - Xiao-Yu Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jun-Pu Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bin Xie
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fan Liang
- GrandOmics Biosciences, Beijing, China
| | - Hai-Nan Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chun-Yu Wang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li-Fang Lei
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xin-Xiang Yan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong-Wei Xu
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ran-Hui Duan
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China
| | - Kun Xia
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China
| | - Jing-Yu Liu
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Center for Human Genome Research, College of Life Science and Technology, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ji-Feng Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bei-Sha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
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Altunisik E, Baykan AH. Comparison of the Olfactory Bulb Volume and the Olfactory Tract Length Between Patients Diagnosed with Essential Tremor and Healthy Controls: Findings in Favor of Neurodegeneration. Cureus 2019; 11:e5846. [PMID: 31754581 PMCID: PMC6830855 DOI: 10.7759/cureus.5846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Essential tremor (ET) is the most common movement disorder. In recent years, an increasing number of studies have shown that this disease also has a variety of non-motor findings and may be of a neurodegenerative nature. This study aimed to evaluate the olfactory bulb volume (OBV) and the olfactory tract length (OTL) and to demonstrate possible neurodegeneration in ET patients using magnetic resonance imaging (MRI). Methods The study included 30 ET patients (mean age=29.53±11.82 years) and 30 healthy controls (mean age=30.00±11.68 years). In the cranial MRI examination of both groups, the right, left and total OBV values were measured in mm3 and the right and left OTL values were calculated manually in mm. Results There was no significant difference between the patient and control groups in the measured OBV values, but the OTL value of the patient group was statistically significantly lower than the control group. Conclusion Our study showed that the olfactory system might be involved in ET cases. We think that olfactory dysfunction, one of the non-motor symptoms in ET, can be clearly elucidated through both anatomical and functional studies, to be conducted with larger patient groups.
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Affiliation(s)
- Erman Altunisik
- Neurology, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | - Ali H Baykan
- Radiology, Adiyaman University Faculty of Medicine, Adiyaman, TUR
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17
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No reliable gray matter changes in essential tremor. Neurol Sci 2019; 40:2051-2063. [PMID: 31115799 DOI: 10.1007/s10072-019-03933-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/09/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Voxel-based morphometry (VBM) has been used to study human brain gray matter (GM) alterations in essential tremor (ET) for over one decade. However, the literature revealed heterogeneous findings. METHODS We therefore conducted a coordinate-based meta-analysis to synthesize the VBM studies to examine which brain regions show the most reliable GM alterations in patients with ET relative to healthy controls. RESULTS A total of 16 original VBM studies, comprising 387 patients with ET and 355 healthy controls, were included in this meta-analysis. This quantitative meta-analysis revealed no evidence of robust and reliable alterations in regional brain GM structures in ET. Meta-regression analyses indicate that many moderators (e.g., MR field strength, statistical methodology, age, onset age, gender, illness severity, illness duration, and family history) account for some of the heterogeneity in GM across studies. CONCLUSIONS High heterogeneity in GM alterations across studies may reflect true heterogeneity in ET regarding the clinic, etiology, and pathology, as well as possibly the VBM methodological variations. Currently, this heterogeneity limits the use of VBM as a reliable tool to distinguish ET from healthy controls. In order to improve reproducibility of VBM results in ET, future research may benefit from increasing the sample size, comprehensively subtyping ET phenotypes, and using well-designed and standardized imaging acquisition and analytical protocols. Furthermore, data sharing should be considered as a high priority.
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18
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Diaz DT, Cersonsky TEK, Kellner S, Zdrodowska MA, Hickman R, Cosentino S, Monin JK, Louis ED. Enfeeblement in Essential Tremor: Development and Validation of a New Psychometric Measure. J Geriatr Psychiatry Neurol 2019; 32:145-151. [PMID: 30857453 PMCID: PMC8524327 DOI: 10.1177/0891988719834345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Despite a growing body of knowledge regarding essential tremor (ET), past studies have fallen short in capturing the full impact of ET on patients and caregivers. We propose enfeeblement (i.e., having the qualities of being prematurely old, helpless, or debilitated) as a novel clinical outcome measure in ET. Due to the lack of enfeeblement scales for ET in the literature, we developed and validated an enfeeblement scale for ET. METHODS The Essential Tremor Enfeeblement Survey (ETES) consists of eight 5-point Likert-type scale questions and is designed to be a caregiver-reported outcome. RESULTS Enfeeblement scores showed a floor effect of 15.3%, no ceiling effects, and demonstrated good overall test-retest reliability (intraclass correlation coefficient = 0.73), favorable internal consistency (Cronbach α coefficient = 0.92) and good convergent validity. CONCLUSION The ETES has robust properties. Aside from future studies of enfeeblement in ET, enfeeblement should be explored more broadly as a psychometric measure across other neurological disorders.
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Affiliation(s)
- Daniel Trujillo Diaz
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Tess E. K. Cersonsky
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Sarah Kellner
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Maria Anna Zdrodowska
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Ruby Hickman
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Stephanie Cosentino
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Joan K. Monin
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Elan D. Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
- Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA
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19
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Louis ED, Joyce JL, Cosentino S. Mind the gaps: What we don't know about cognitive impairment in essential tremor. Parkinsonism Relat Disord 2019; 63:10-19. [PMID: 30876840 DOI: 10.1016/j.parkreldis.2019.02.038] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/18/2019] [Accepted: 02/23/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Although the hallmark feature of essential tremor (ET) is tremor, there is growing appreciation that cognitive impairment also occurs, including increased prevalence of mild cognitive impairment (MCI) and increased prevalence and incidence of dementia. With emerging knowledge of ET-cognitive impairment, come fundamental questions regarding its course, bases, predictors and clinical outcomes. Studies in the general population and in Parkinson's disease (PD), a related movement disorder, offer a starting point from which to begin filling these clinically important knowledge gaps. METHODS A PubMed search (June 2018) identified articles for this review. RESULTS Much of our knowledge of cognitive impairment in ET is of the static condition (e.g., prevalence of cognitive impairment in ET), with nearly no information on its bases, predictors and dynamics (i.e., course, and clinical outcomes). In PD, where such data have been published, rates of cognitive decline and conversion to MCI/dementia are higher than in the general population. Predictors of cognitive change in PD and the general population have also been identified, yet they only partially overlap one another. CONCLUSION The predictors and dynamics of cognitive impairment have been investigated fairly extensively in the general population, to a somewhat lesser extent in PD, and are emerging only now in ET. We suggest that longitudinal studies specific to ET are needed, and we outline variables to be considered in these investigations. Increased knowledge of ET-cognitive impairment will facilitate meaningful counseling of patients and their families.
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Affiliation(s)
- Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Jillian L Joyce
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Stephanie Cosentino
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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20
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Farrell K, Cosentino S, Iida MA, Chapman S, Bennett DA, Faust PL, Louis ED, Crary JF. Quantitative Assessment of Pathological Tau Burden in Essential Tremor: A Postmortem Study. J Neuropathol Exp Neurol 2019; 78:31-37. [PMID: 30476290 PMCID: PMC6289218 DOI: 10.1093/jnen/nly104] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Essential tremor (ET) patients develop more cognitive impairment and dementia than controls, although there are surprisingly few data on the neuropathological basis for cognitive changes in ET. In this postmortem study, we assessed tau and other pathologies in 26 ET cases and 73 controls (non-ET) (1:3 matching). The mean age = 88.6 years; 55% were cognitively normal, 24% had mild cognitive impairment (MCI), and 20% had dementia. We found similar burdens of pathology using Braak, β-amyloid and Lewy body assessments in ET and controls. In contrast, among cognitively normal subjects, ET cases had a higher number of NFT-positive neurons in the neocortex than controls (p < 0.001); the number of NFT-positive neurons in the medial temporal lobe was similar in these 2 groups (p = 0.22). Among subjects with MCI, ET cases also had higher numbers of NFT-positive neurons in the neocortex than controls (p < 0.001) but again, not in the medial temporal lobe (p = 0.55). Among subjects with dementia, the number of NFT-positive neurons was similar in ET cases and controls. Cognitive function correlated with quantitative neurofibrillary tangle counts in ET cases and controls. In the context of ET, pre-dementia tau burden is higher than in the absence of ET, suggesting a predisposition to tau pathology.
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Affiliation(s)
- Kurt Farrell
- Department of Pathology
- Fishberg Department of Neuroscience, Friedman Brain Institute, Ronald M. Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Department of Neurology
- G.H. Sergievsky Center
- Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, New York
- Department of Psychology, Goldsmiths College, University of London, New Cross, London, United Kingdom
| | - Megan A Iida
- Department of Pathology
- Fishberg Department of Neuroscience, Friedman Brain Institute, Ronald M. Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Silvia Chapman
- Cognitive Neuroscience Division, Department of Neurology
- G.H. Sergievsky Center
- Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center, New York, New York
| | - David A Bennett
- Department of Neurological Sciences, Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York
| | - Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - John F Crary
- Department of Pathology
- Fishberg Department of Neuroscience, Friedman Brain Institute, Ronald M. Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, New York
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Rodríguez-Blázquez C, Forjaz MJ, Kurtis MM, Balestrino R, Martinez-Martin P. Rating Scales for Movement Disorders With Sleep Disturbances: A Narrative Review. Front Neurol 2018; 9:435. [PMID: 29951032 PMCID: PMC6008651 DOI: 10.3389/fneur.2018.00435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/23/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction: In recent years, a wide variety of rating scales and questionnaires for movement disorders have been developed and published, making reviews on their contents, and attributes convenient for the potential users. Sleep disorders are frequently present in movement disorders, and some movement disorders are accompanied by specific sleep difficulties. Aim: The aim of this study is to perform a narrative review of the most frequently used rating scales for movement disorders with sleep problems, with special attention to those recommended by the International Parkinson and Movement Disorders Society. Methods: Online databases (PubMed, SCOPUS, Web of Science, Google Scholar), related references from papers and websites and personal files were searched for information on comprehensive or global rating scales which assessed sleep disturbances in the following movement disorders: akathisia, chorea, dystonia, essential tremor, myoclonus, multiple system atrophy, Parkinson's disease, progressive supranuclear palsy, and tics and Tourette syndrome. For each rating scale, its objective and characteristics, as well as a summary of its psychometric properties and recommendations of use are described. Results: From 22 rating scales identified for the selected movement disorders, only 5 included specific questions on sleep problems. Movement Disorders Society-Unified Parkinson's Disease Rating scale (MDS-UPDRS), Non-Motor Symptoms Scale and Questionnaire (NMSS and NMSQuest), Scales for Outcomes in Parkinson's Disease (SCOPA)-Autonomic and Progressive Supranuclear Palsy Rating Scale (PSPRS) were the only rating scales that included items for assessing sleep disturbances. Conclusions: Despite sleep problems are frequent in movement disorders, very few of the rating scales addresses these specific symptoms. This may contribute to an infra diagnosis and mistreatment of the sleep problems in patients with movement disorders.
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Affiliation(s)
| | - Maria João Forjaz
- National School of Public Health and REDISSEC, Institute of Health Carlos III, Madrid, Spain
| | - Monica M. Kurtis
- Movement Disorders Unit, Neurology Department, Hospital Ruber International, Madrid, Spain
| | - Roberta Balestrino
- Department of Neuroscience “Rita Levi Montalcini, ” University of Turin, Turin, Italy
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Institute of Health Carlos III, Madrid, Spain
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Chen KH, Lin PC, Yang BS, Chen YJ. The difference in visuomotor feedback velocity control during spiral drawing between Parkinson's disease and essential tremor. Neurol Sci 2018; 39:1057-1063. [PMID: 29572654 DOI: 10.1007/s10072-018-3331-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
In a spiral task, the accuracy of the spiral trajectory, which is affected by tracing or tracking ability, differs between patients with Parkinson's disease (PD) and essential tremor (ET). However, not many studies have analyzed velocity differences between the groups during this task. This study aimed to examine differences between the groups related to this characteristic using a tablet. Fourteen PD, 12 ET, and 12 control group participants performed two tasks: tracing a given spiral (T1) and following a guiding point (T2). A digitized tablet was used to record movements and trajectory. Effects of direct visual feedback on intergroup and intragroup velocity were measured. Although PD patients had a significantly lower T1 velocity than the control group (p < 0.05), they could match the velocity of the guiding point (3.0 cm/s) in T2. There was no significant difference in the average T1 velocity between ET and the control groups (p = 0.26); however, the T2 velocity of ET patients was significantly higher than the control group (p < 0.05). They were also unable to adjust the velocity to match the guiding point, indicating that ET patients have a poorer ability to follow dynamic guidance. When both groups of patients have similar action tremor severity, their ability to follow dynamic guidance was still significantly different. Our study combined visual feedback with spiral drawing and demonstrated differences in the following-velocity distribution in PD and ET. This method may be used to distinguish the tremor presentation of both diseases, and thus, provide accurate diagnosis.
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Affiliation(s)
- Kai-Hsiang Chen
- Department of Neurology, Hsinchu Branch, National Taiwan University Hospital, Hsinchu City, 300, Taiwan
| | - Po-Chieh Lin
- Department of Mechanical Engineering, National Chiao Tung University, 1001 University Road, Hsinchu City, 30010, Taiwan
| | - Bing-Shiang Yang
- Department of Mechanical Engineering, National Chiao Tung University, 1001 University Road, Hsinchu City, 30010, Taiwan. .,Institute of Biomedical Engineering, National Chiao Tung University, Hsinchu City, 300, Taiwan.
| | - Yu-Jung Chen
- Department of Mechanical Engineering, National Chiao Tung University, 1001 University Road, Hsinchu City, 30010, Taiwan
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23
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Cao H, Wang R, Luo X, Li X, Hallett M, Thompson-Westra J, Yang J, Qu Q, Yang X. A Voxel-Based Magnetic Resonance Imaging Morphometric Study of Cerebral and Cerebellar Gray Matter in Patients Under 65 Years with Essential Tremor. Med Sci Monit 2018; 24:3127-3135. [PMID: 29754151 PMCID: PMC5973500 DOI: 10.12659/msm.906437] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/02/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study was to compare the morphological changes in cerebral and cerebellar gray matter in patients with essential tremor under 60-years-of-age, with age-matched and gender-matched normal healthy volunteer control subjects, using functional magnetic resonance imaging (fMRI) and voxel-based morphometry (VBM) analysis. MATERIAL AND METHODS A retrospective, controlled, comparative clinical study included 17 patients with essential tremor, <60 years-of-age, and 17 age-matched and gender-matched healthy volunteer control subjects, recruited between June 2010-July 2012. MRI and VBM analysis were used to compare cerebral and cerebellar gray matter density between groups. The Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) rating scale was used to assess tremor severity in the patient group. Clinical and demographic characteristics were recorded for all study participants. RESULTS MRI and VBM analysis showed significant bilateral expansion of the cerebellum, occipital fusiform cortices, right inferior temporal gyrus, and precentral lobes in patients with essential tremor (P<0.005); reduction in gray matter was found in the left parietal lobe. The region of interest (ROI) analysis showed volume enlargement in the thalamus, midbrain, and the precuneus (P<0.005). No significant correlation between changes in gray matter and changes in clinical variables, including age, gender, tremor duration, the activity of daily living (ADL) scale, the mini-mental state examination (MMSE) scale, family history, and tremor severity were found. CONCLUSIONS Predominantly cerebellar gray matter expansion in patients less than 60 years-of-age with essential tremor might be the result of compensation for the decline in cerebellar function.
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Affiliation(s)
- Hongmei Cao
- Department of Neurology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Rong Wang
- Department of Radiology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Xue Luo
- Department of Radiology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
- Department of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Xianjun Li
- Department of Radiology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
- Department of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, U.S.A
| | - Johanna Thompson-Westra
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, U.S.A
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
- Department of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Qiumin Qu
- Department of Neurology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Xiaobo Yang
- Department of Psychology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
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24
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Abstract
Tremor is a phenomenon observed in a broad spectrum of diseases with different pathophysiologies. While patients with tremor may not complain in the clinic of symptoms of imbalance, gait difficulties, or falls, laboratory research studies using quantitative analysis of gait and posture and neurophysiologic techniques have demonstrated impaired gait and balance across a variety of tremor etiologies. These findings have been supported by careful epidemiologic studies assessing symptoms of imbalance. Imaging and neurophysiologic studies have identified cerebellar networks as important mediators of tremor, and therefore a likely common site of dysfunction to explain the phenomenologic overlap between impaired postural and gait control with tremor. Further understanding of these mechanisms and networks is of crucial importance in the development of new treatments, particularly surgical or minimally invasive lesional therapies.
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Affiliation(s)
- Hugo Morales-Briceño
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Alessandro F Fois
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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25
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Botulinum Toxin Type A Injections as Monotherapy for Upper Limb Essential Tremor Using Kinematics. Can J Neurol Sci 2017; 45:11-22. [DOI: 10.1017/cjn.2017.260] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AbstractBackground:There is a significant need for a targeted therapy for essential tremor (ET), as medications have not been developed specifically for ET, and the ones prescribed are often not well-tolerated, so that many patients remain untreated. Recent work has shown that, unlike previous experience, kinematically guided individualized botulinum toxin type A (BoNT-A) injections provide benefit along with minimal weakness. Ours is the first long-term (96-week) safety and efficacy study of BoNT-A as monotherapy for ET using kinematically driven injection parameters.Methods:Ten ET patients were administered six serial BoNT-A treatments every 16 weeks and were assessed at 6 weeks following treatment. During each study visit, the Fahn–Tolosa–Marin (FTM) scale, the Unified Parkinson’s Disease Rating Scale, and the Quality of Life for Essential Tremor Questionnaire (QUEST) were administered along with kinematic assessment of the treated limb. Participants performed scripted tasks with motion sensors placed over each arm joint. Dosing patterns were determined using the movement disorder neurologist’s interpretation of muscles contributing to the kinematically analyzed upper limb tremor biomechanics.Results:There was a 33.8% (p<0.05) functional improvement (FTM part C) and a 39.8% (p<0.0005) improvement in QUEST score at week 96 compared to pretreatment scores at week 0. Although there was a 44.6% (p<0.0005) non-dose-dependent reduction in maximal grip strength, only 2 participants complained of mild weakness. Following the fourth serial treatment, mean action tremor score was reduced by 62.9% (p=0.001) in the treated and by 44.4% (p=0.03) in the untreated arm at week 96 compared to week 48.Conclusions:Individualized BoNT-A dosing patterns to each individual’s tremor biomechanics provided an effective monotherapy for ET as function improved without functionally limiting muscle weakness.
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26
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Hamad M, Holland R, Kamal N, Luceri R, Mammis A. Potential for Intrathecal Baclofen in Treatment of Essential Tremor. World Neurosurg 2017; 105:170-175. [PMID: 28559069 DOI: 10.1016/j.wneu.2017.05.112] [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: 03/20/2017] [Revised: 05/16/2017] [Accepted: 05/18/2017] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Essential tremor (ET) is the most common movement disorder of adults, affecting an estimated 7 million Americans. Symptoms of ET range from slightly noticeable to debilitating, with 1 cohort study finding 15% of patients were forced into early retirement. Additionally, depression has also been correlated with the severity of disability of ET. Treatment options include propranolol and primidone. Current treatment options are not very effective, with more than half (56.3%) of patients discontinuing medications because of no changes in symptoms. METHODS Unfortunately, there is a relative void and controversy in the literature explaining ET pathophysiology; however, the gamma-aminobutyric acid (GABA) hypothesis is the strongest. We conducted a PubMed search on 30 September 2015 with no time constraints using the search terms "essential tremor" and "baclofen," which resulted in a total of 5 articles. RESULTS Neurohistopathologic studies have demonstrated decreased GABA-A and GABA-B receptors in the cerebellar cortex of ET patients. GABA, the major inhibitory neurotransmitter in the central nervous system, is proposed to have an inhibitory effect on pacemaker output activity of the cerebello-thalamo-cortical pathway, with lower receptors resulting in decreased inhibition of baseline tremors. Tariq et al showed delayed onset and intensity of tremor with oral administration of R-baclofen in a mouse model of ET. CONCLUSION With a better side-effect profile and success in a physiologically related condition, we propose more clinical trials and research be carried out on intrathecal baclofen as a potential treatment option, especially drug refractory ET, so as to increase the quality of life of this patient population.
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Affiliation(s)
- Mousa Hamad
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
| | - Ryan Holland
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Naveed Kamal
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Robert Luceri
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Antonios Mammis
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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27
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Nagy AM, Tolleson CM. Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders. Brain Sci 2016; 6:brainsci6040046. [PMID: 27740598 PMCID: PMC5187560 DOI: 10.3390/brainsci6040046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 09/23/2016] [Accepted: 09/28/2016] [Indexed: 11/16/2022] Open
Abstract
Deep brain stimulation (DBS) is a unique, functional neurosurgical therapy indicated for medication refractory movement disorders as well as some psychiatric diseases. Multicontact electrodes are placed in "deep" structures within the brain with targets varying depending on the surgical indication. An implanted programmable pulse generator supplies the electrodes with a chronic, high frequency electrical current that clinically mimics the effects of ablative lesioning techniques. DBS's efficacy has been well established for its movement disorder indications (Parkinson's disease, essential tremor, and dystonia). However, clinical outcomes are sometimes suboptimal, even in the absence of common, potentially reversible complications such as hardware complications, infection, poor electrode placement, and poor programming parameters. This review highlights some of the rescue procedures that have been explored in suboptimal DBS cases for Parkinson's disease, essential tremor, and dystonia. To date, the data is limited and difficult to generalize, but a large majority of published reports demonstrate positive results. The decision to proceed with such treatments should be made on a case by case basis. Larger studies are needed to clearly establish the benefit of rescue procedures and to establish for which patient populations they may be most appropriate.
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Affiliation(s)
- Adam M Nagy
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue South, A-0118 Medical Center North, Nashville, TN 37232, USA.
| | - Christopher M Tolleson
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue South, A-0118 Medical Center North, Nashville, TN 37232, USA.
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