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Salari M, Rashedi R, Moghadam NB, Etemadifar M. Positional head tremor in professional billiards player. Acta Neurol Belg 2024:10.1007/s13760-024-02577-y. [PMID: 38758354 DOI: 10.1007/s13760-024-02577-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Mehri Salari
- Functional Neurology Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ronak Rashedi
- Functional Neurology Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Nahid Beladi Moghadam
- Functional Neurology Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Etemadifar
- Department of Functional Neurosurgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
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Kim M, Kim E, Moon SM, Kim J, Kang H. A Case of Task-Specific Tremor of the Hand While Driving. J Mov Disord 2024; 17:112-114. [PMID: 37822128 PMCID: PMC10846965 DOI: 10.14802/jmd.23175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Minkyeong Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Eunji Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Seok Min Moon
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Juhyeon Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Heeyoung Kang
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, Korea
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Ondo WG, Koneru V, Arif C. Task Specific Tremor in Parkinson's Disease Responds to Apomorphine. Tremor Other Hyperkinet Mov (N Y) 2023; 13:20. [PMID: 37275945 PMCID: PMC10237238 DOI: 10.5334/tohm.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023] Open
Abstract
Background Task specific tremor (TST) is a poorly understood entity without any standard treatments, that may subsequently develop tremor during additional tasks, later develop postural/kinetic tremor (essential tremor criteria), and later develop Parkinson's disease. The pathophysiology is not understood as it has features of tremor, dystonia, and parkinsonism. Objectives To assess response of TST to apomorphine and thus infer pathophysiology. Methods We administered sublingual apomorphine to 8 patients diagnosed with Parkinson's disease based on clinical criteria and dopamine imaging, who all initially presented with TST and later presented other parkinsonian signs and dopamine imaging deficits. Results Apomorphine improved TST, which was refractory to oral levodopa and other tremor therapies, in 6/8 subjects. Discussion These results offer a treatment option for TST, which is usually refractory to other pharmacologic treatments, in patients with other parkinsonian features, and infers a dopaminergic pathophysiology of TST.
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Affiliation(s)
- William G. Ondo
- Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, Weill Cornel Medical School, US
| | - Vindhya Koneru
- Houston Methodist Neurological Institute, Houston Methodist West Hospital, Houston, US
| | - Chia Arif
- St. Mary Medical Center-Langhorne, PA, US
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Treatment of Dystonic Tremor of the Upper Limbs: A Single-Center Retrospective Study. J Clin Med 2023; 12:jcm12041427. [PMID: 36835960 PMCID: PMC9961630 DOI: 10.3390/jcm12041427] [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: 12/23/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
Tremor is part of the phenomenological spectrum of dystonia. Treatments available for tremor in dystonia are oral medications (OM), botulinum neurotoxin (BoNT), and brain surgery (deep brain stimulation or thalamotomy). There is limited knowledge regarding the outcome of different treatment options, and evidence is especially scarce for the tremor of the upper limbs occurring in people with dystonia. In this single-center retrospective study, we evaluated the outcome of different treatments in a cohort of people with upper limb dystonic tremors. Demographic, clinical, and treatment data were analyzed. Dropout rates and side effects were specifically assessed, as well as the 7-point patient-completed clinical global impression scale (p-CGI-S, 1: very much improved; 7: very much worse) as outcome measures. A total of 47 subjects (46.8% female) with dystonic tremor, tremor associated with dystonia, or task-specific tremor were included, with a median age at onset of 58 years (7-86). A total of 31 subjects were treated with OM, 31 with BoNT, and 7 with surgery. Dropout rates with OM were 74.2% due to either lack of efficacy (n = 10) or side effects (n = 13). A total of 7 patients treated with BoNT (22.6%) had mild weakness, causing dropout in 2. P-CGI-S was ≤3 (improvement) in 39% with OM, compared to 92% with BoNT and 100% with surgery. These findings suggest good symptom control of the tremor of the upper limb in dystonia with BoNT and surgery, with higher rates of dropout and side effects with OM. Randomized controlled studies are needed to confirm our findings and provide further insight into better selecting suitable patients for BoNT or brain surgery.
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Kocaman GE, Ardıçlı D, Yılmaz D. Clinical and laboratory features of children with tremor: a single-center experience. Acta Neurol Belg 2022; 122:479-484. [PMID: 34618342 DOI: 10.1007/s13760-021-01804-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022]
Abstract
AIM Tremor is an involuntary, rhythmic, oscillatory movement of body parts around a central point or plane which arises from contraction of antagonist muscles. Evaluation of pediatric patients with tremor can be challenging due to limited population-based studies in children. The aim of this study is to evaluate the demographic, clinical and laboratory features of childhood tremor, retrospectively. MATERIALS AND METHODS Patients under the age of 18 years presenting with tremor (n = 111) to the Pediatric Neurology Unit of Kecioren Research and Training Hospital between January 2014 and December 2019 were included in the study. Patients with neuromuscular disease, vertebral pathology or incomplete data in hospital records were not included. Also, benign tremor causes (jitteriness, shuddering attack, etc.) seen in the neonatal and infancy period were excluded from the study as the number of patients was insufficient. Demographic data, type and duration of tremor, accompanying symptoms, chronic diseases and medications, family history, physical and neurological examination, laboratory findings, neuroimaging findings were retrospectively analyzed and recorded. RESULTS A total of 111 children (59 girls and 52 boys) were included in our study and the female to male ratio was 1.1. The mean age at tremor onset and age at admission to hospital were 13.2 ± 2.8 years (range 4-17 years), and 14.8 ± 2.0 years (range 6-17 years), respectively. The most common type of tremor was essential tremor (62.2%), followed by enhanced physiologic (18.9%). None of the patients had acute metabolic disorder. Diagnostic tests revealed the etiology in 12 patients. These were vitamin B12 deficiency in 11 patients and multiple sclerosis in one patient. Drug-induced and task-specific tremors were determined in 4 patients each. It was determined that in patients with a positive family history, tremor appeared or was noticed at a younger age. CONCLUSIONS Most of the cases with tremor can be diagnosed accurately by a detailed medical history, physical and neurological examination. Essential tremor is the most common type of tremor in children. Laboratory tests and imaging methods have limited additional yield in elucidating the etiology. Early recognition of tremor and related signs and symptoms in childhood is important for the detection and treatment of the possible underlying cause.
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Affiliation(s)
- Gizem Eşme Kocaman
- Department of Pediatrics, Ankara Kecioren Training and Research Hospital, Ankara, Turkey.
| | - Didem Ardıçlı
- Department of Pediatric Neurology, Ankara Kecioren Training and Research Hospital, Ankara, Turkey
- Department of Pediatric Neurology, Ankara City Hospital, Ankara, Turkey
| | - Deniz Yılmaz
- Department of Pediatric Neurology, Ankara Kecioren Training and Research Hospital, Ankara, Turkey
- Department of Pediatric Neurology, Ankara City Hospital, Ankara, Turkey
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Datta A, Batra N, Pandey S. Primary Writing Tremor: Current Concepts. Ann Indian Acad Neurol 2021; 24:319-326. [PMID: 34446992 PMCID: PMC8370167 DOI: 10.4103/aian.aian_1264_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 12/19/2020] [Accepted: 12/30/2020] [Indexed: 11/07/2022] Open
Abstract
Primary Writing Tremor (PWT) is a type of task specific tremor which happens only while writing (Type A PWT) or assuming a writing position of the hand (Type B PWT). There is a considerable overlap of clinical features between PWT and writer's cramp which creates difficulty in diagnosing this condition in the clinic. PWT usually affects the dominant hand and is typically 5-7hz in frequency, worsened by anxiety, temporarily relieved by alcohol and associated with reduced writing speeds. There are a variety of hypotheses about the phenomenology of PWT (regarding whether it is a variant of essential tremor, focal dystonia or an independent entity). Unlike writer's cramp, PWT shows normal reciprocal inhibition of H reflex, does not exhibit excessive EMG activity in proximal muscles, and on fMRI shows underactivation of cingulum and overactivation of primary motor and supplementary areas. There are no randomised controlled trials currently for the treatment of PWT. Treatment modalities available are: medical treatment, botulinum toxin, surgical management (including DBS) as well as adaptive strategies and occupational therapy.
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Affiliation(s)
- Abhigyan Datta
- Maulana Azad Medical College, and Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Nitya Batra
- Maulana Azad Medical College, and Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Sanjay Pandey
- Maulana Azad Medical College, and Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
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Bârlescu LA, Kassubek J. [Diagnostic procedures and therapy in tremor disorders: current clinical concepts]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 88:794-814. [PMID: 33307562 DOI: 10.1055/a-1165-7378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Tremor is the most common movement disorder, occurring as an isolated tremor syndrome, as a symptom of neurological diseases or diseases from other medical specialty fields, or after the intake of drugs / toxins. The heterogeneous variety of the clinical presentations, the etiologies, and the therapeutical options require the continuous development of the clinical concepts in tremor disorders. This review summarizes the current state of the art of the clinical recommendations for the diagnostic and therapeutic procedures in tremor.
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Yong SW, Park DG, Yoon JH, Baik JS. Is an Isolated Weight-Holding Tremor a New Subtype of Isometric Tremor? Yonsei Med J 2020; 61:644-646. [PMID: 32608210 PMCID: PMC7329742 DOI: 10.3349/ymj.2020.61.7.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/13/2020] [Accepted: 05/29/2020] [Indexed: 11/27/2022] Open
Abstract
A weight-holding tremor is a rare type of hand tremor that occurs only when someone holds some weight. Here we report three cases of isolated weight-holding tremors, of which one patient was diagnosed with Parkinson's disease (PD) and the others as a variant of essential tremor (ET). A 68-year-old woman presented with a left-hand tremor that appeared only when she held objects with some weight. Her tremor was reminiscent of the re-emergent tremor of PD, and dopamine transporter imaging revealed reduced uptake at the right posterior putamen. A 21-year-old man and a 71-year-old woman also presented with similar weight-holding tremors. However, these tremors were not re-emergent, and no signs of parkinsonism were observed during follow-up. Although the underlying etiologies of these tremors differed, all three tremors worsened as the held weight increased. These tremors could be isolated isometric tremors, but further research is needed to clarify the nature of this rare tremor.
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Affiliation(s)
- Seok Woo Yong
- Department of Neurology, College of Medicine, Ajou University, Suwon, Korea
| | - Don Gueu Park
- Department of Neurology, College of Medicine, Ajou University, Suwon, Korea
| | - Jung Han Yoon
- Department of Neurology, College of Medicine, Ajou University, Suwon, Korea
| | - Jong Sam Baik
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
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Abstract
INTRODUCTION OR BACKGROUND Tremor is one of the commonest movement disorders and can be disabling. There are many causes and treatment options include medications, adaptations, botulinum toxin injections and functional neurosurgery. SOURCES OF DATA Pubmed.gov peer-reviewed journal articles and reviews. AREAS OF AGREEMENT A new tremor classification has been published. Axis 1 of this classification highlights the clinical characteristics of tremor and axis 2 is dedicated to aetiology. The cerebello-thalamo-cortical network and connections to other brain areas is emerging as pivotal to many types of tremor. AREAS OF CONTROVERSY There has been ongoing debate around the clinical entity of essential tremor and its pathophysiological basis. GROWING POINTS Increasing understanding of the pathophysiology underpinning tremor is helping to improve classification and is pushing forward trials of new treatment options, particularly surgical options. AREAS TIMELY FOR DEVELOPING RESEARCH With deeper phenotyping from the new classification, genetics of common forms of tremor are ripe for discovery. New pharmacological therapeutic options are needed to complement the better understanding of the basis of tremor.
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Affiliation(s)
- Tabish A Saifee
- UCL Queen Square Institute of Neurology, Queen Square, London, UK
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Lenka A, Jhunjhunwala KR, Panda R, Saini J, Bharath RD, Yadav R, Pal PK. Altered brain network measures in patients with primary writing tremor. Neuroradiology 2017; 59:1021-1029. [PMID: 28779337 DOI: 10.1007/s00234-017-1895-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Primary writing tremor (PWT) is a rare task-specific tremor, which occurs only while writing or while adopting the hand in the writing position. The basic pathophysiology of PWT has not been fully understood. The objective of this study is to explore the alterations in the resting state functional brain connectivity, if any, in patients with PWT using graph theory-based analysis. METHODS This prospective case-control study included 10 patients with PWT and 10 age and gender matched healthy controls. All subjects underwent MRI in a 3-Tesla scanner. Several parameters of small-world functional connectivity were compared between patients and healthy controls by using graph theory-based analysis. RESULTS There were no significant differences in age, handedness (all right handed), gender distribution (all were males), and MMSE scores between the patients and controls. The mean age at presentation of tremor in the patient group was 51.7 ± 8.6 years, and the mean duration of tremor was 3.5 ± 1.9 years. Graph theory-based analysis revealed that patients with PWT had significantly lower clustering coefficient and higher path length compared to healthy controls suggesting alterations in small-world architecture of the brain. The clustering coefficients were lower in PWT patients in left and right medial cerebellum, right dorsolateral prefrontal cortex (DLPFC), and left posterior parietal cortex (PPC). CONCLUSION Patients with PWT have significantly altered small-world brain connectivity in bilateral medial cerebellum, right DLPFC, and left PPC. Further studies with larger sample size are required to confirm our results.
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Affiliation(s)
- Abhishek Lenka
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India.,Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, Karnataka, 560029, India
| | - Ketan Ramakant Jhunjhunwala
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India.,Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, Karnataka, 560029, India
| | - Rajanikant Panda
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India
| | - Rose Dawn Bharath
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, Karnataka, 560029, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, Karnataka, 560029, India.
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Sadnicka A, Kassavetis P, Pareés I, Meppelink AM, Butler K, Edwards M. Task-specific dystonia: pathophysiology and management. J Neurol Neurosurg Psychiatry 2016; 87:968-74. [PMID: 26818730 DOI: 10.1136/jnnp-2015-311298] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/22/2015] [Indexed: 12/23/2022]
Abstract
Task-specific dystonia is a form of isolated focal dystonia with the peculiarity of being displayed only during performance of a specific skilled motor task. This distinctive feature makes task-specific dystonia a particularly mysterious and fascinating neurological condition. In this review, we cover phenomenology and its increasingly broad-spectrum risk factors for the disease, critically review pathophysiological theories and evaluate current therapeutic options. We conclude by highlighting the unique features of task-specific dystonia within the wider concept of dystonia. We emphasise the central contribution of environmental risk factors, and propose a model by which these triggers may impact on the motor control of skilled movement. By viewing task-specific dystonia through this new lens which considers the disorder a modifiable disorder of motor control, we are optimistic that research will yield novel therapeutic avenues for this highly motivated group of patients.
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Affiliation(s)
- Anna Sadnicka
- Sobell Department for Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | | | - Isabel Pareés
- Department of Neurology, San Carlos Health Research Institute (IdISSC) Universidad Complutense de Madrid, Madrid, Spain
| | - Anne Marthe Meppelink
- Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Katherine Butler
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Mark Edwards
- Institute of Cardiovascular and Cell Sciences, St George's University, London, UK
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Lee A, Voget J, Furuya S, Morise M, Altenmüller E. Quantification of sound instability in embouchure tremor based on the time-varying fundamental frequency. J Neural Transm (Vienna) 2016; 123:515-21. [DOI: 10.1007/s00702-016-1533-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/23/2016] [Indexed: 11/29/2022]
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Frucht SJ. Evaluating the musician with dystonia of the upper limb: a practical approach with video demonstration. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2015; 2:16. [PMID: 26788352 PMCID: PMC4711181 DOI: 10.1186/s40734-015-0026-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/02/2015] [Indexed: 12/04/2022]
Abstract
Focal task-specific dystonia is an unusual movement disorder that may affect musicians specifically when they perform on their instruments. Muscles of the lower face, lower limb and upper limb may be involved depending on the nature of the instrument. We illustrate the rich phenomenology of focal task-specific dystonia affecting the upper limb in musicians, and present a practical approach for evaluating patients in the office.
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Affiliation(s)
- Steven J Frucht
- Mount Sinai Medical Center, Division of Movement Disorders, 5 East 98th Street, New York, NY 10029 USA
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Lee A, Furuya S, Altenmüller E. Epidemiology and treatment of 23 musicians with task specific tremor. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2014; 1:5. [PMID: 26788331 PMCID: PMC4677731 DOI: 10.1186/2054-7072-1-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/03/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Task specific tremors in musicians have been mainly described as primary bowing tremor in string instrumentalists in relatively small sample sizes. Our aim was to describe epidemiology, risk factors, phenomenology and treatment options of this disorder in 23 musicians of different instruments. METHODS We included 23 professional musicians (4 female, 19 male; mean age 51.5 ± 11.4 years) with a TSTM. During anamnesis, clinical examination, by mail or via telephone patients were asked for epidemiological, phenomenological information, risk factors and treatments. We then compared our findings to primary writing tremor, the most common task specific tremor. RESULTS Age at onset of the TST was 44.6 ± 13.6 years and tremor appeared 35.1 ± 13.5 years after beginning to play the instrument. The majority of patients were string instrumentalists, followed by woodwind instrumentalists. Other instrumentalists were a guitarist, pianist and percussionist respectively. In contrast to primary writing tremor, we also found proximal muscles of the upper extremity involved in tremor. A positive family history was found in Prior trauma was more common than in primary writing tremor. Treatment with a positive effect on tremor were in order of efficacy: Botulinumtoxin, Primidone, Propranolol, Trihexyphenidyl. No patient had undergone deep brain stimulation. CONCLUSION Task specific tremor in musicians is a heterogeneous disorder with a male gender predominance that shares many commonalities with PWT. The onset age as well as the time between starting to play the instrument and tremor onset has a wide range. Because previous trauma and overuse appear to be risk factors, preventive measures against playing related injuries are necessary. There appears to be a genetic predisposition for TST. No single beneficial medication exists and treatment of patients remains highly individual. It should be discussed, whether deep brain stimulation should be offered not only to patients that do not respond to any other medication but early in the course of the disease.
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Affiliation(s)
- André Lee
- Inistitute of Music Physiology and Musicians’ Medicine, Hannover University of Music, Drama and Media, Hannover, Germany
| | - Shinichi Furuya
- Inistitute of Music Physiology and Musicians’ Medicine, Hannover University of Music, Drama and Media, Hannover, Germany
| | - Eckart Altenmüller
- Inistitute of Music Physiology and Musicians’ Medicine, Hannover University of Music, Drama and Media, Hannover, Germany
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Robakis D, Louis ED. Another case of "shopping bag" tremor: a difficult to classify action tremor. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:269. [PMID: 25506044 PMCID: PMC4259080 DOI: 10.7916/d8pv6hvj] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/13/2014] [Indexed: 12/01/2022]
Abstract
This letter was written in response to: Zesiewicz T, Vu T, Carranza MA, et al. Unusual wrist tremor: unilateral isometric tremor?
Tremor Other Hyperkinet Mov. 2014; 4: http://tremorjournal.org/article/view/194
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Affiliation(s)
- Daphne Robakis
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Elan D Louis
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA ; GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA ; Department of Epidemiology, Mailman School of Public Health, 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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Lee A, Tominaga K, Furuya S, Miyazaki F, Altenmüller E. Electrophysiological characteristics of task-specific tremor in 22 instrumentalists. J Neural Transm (Vienna) 2014; 122:393-401. [PMID: 25056709 DOI: 10.1007/s00702-014-1275-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/14/2014] [Indexed: 11/30/2022]
Abstract
Our aim was to address three characteristics of task-specific tremor in musicians (TSTM): First, we quantified muscular activity of flexor and extensor muscles, of coactivation as well as tremor acceleration. Second, we compared muscular activity between task-dependent and position-dependent tremor. Third, we investigated, whether there is an overflow of muscular activity to muscles adjacent to the affected muscles in TSTM. Tremor acceleration and muscular activity were measured in the affected muscles and the muscles adjacent to the affected muscles in 22 patients aged 51.5 ± 11.4 years with a task-specific tremor. We assessed power of muscular oscillatory activity and calculated the coherence between EMG activity of affected muscles and tremor acceleration as well as between adjacent muscles and tremor acceleration. This was done for task-dependent and position-dependent tremor. We found the highest power and coherence of muscular oscillatory activity in the frequency range of 3-8 Hz for affected and adjacent muscles. No difference was found between task-dependent and position-dependent tremor in neither power nor coherence measures. Our results generalize previous results of a relation between coactivation and tremor among a variety of musicians. Furthermore, we found coherence of adjacent muscles and TSTM. This indicates that overflow exists in TSTM and suggests an association of TST with dystonia.
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Affiliation(s)
- André Lee
- Institute of Music Physiology and Musicians' Medicine, Hannover University of Music, Drama and Media, Hannover, Germany,
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Abstract
PURPOSE OF REVIEW The purpose of this review is to explain a practical clinical approach to the diagnosis and management of tremor. RECENT FINDINGS A number of rare but important causes of tremor have been delineated, which means that attention to detail in clinical assessment of patients with tremor is even more important. SUMMARY Tremors are best divided into those occurring mainly at rest, mainly on posture, and mainly during action. This basic division leads directly to differential diagnosis and effective treatment.
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Frucht SJ. The definition of dystonia: current concepts and controversies. Mov Disord 2014; 28:884-8. [PMID: 23893444 DOI: 10.1002/mds.25529] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 04/17/2013] [Accepted: 05/02/2013] [Indexed: 11/07/2022] Open
Abstract
The definition of dystonia has been a subject of much debate and controversy for the last century. In this paper, a practical definition of dystonia for the movement disorders expert is presented, based on a new algorithm. © 2013 Movement Disorder Society.
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Affiliation(s)
- Steven J Frucht
- Department of Neurology, Mount Sinai Medical Center, New York, NY 10029, USA.
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19
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Coherence of coactivation and acceleration in task-specific primary bowing tremor. J Neural Transm (Vienna) 2014; 121:739-42. [PMID: 24553782 DOI: 10.1007/s00702-014-1177-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
Coherences between coactivation of wrist antagonist muscles and movement fluctuation were assessed in four violinists with a task-specific tremor and four age-matched healthy violinists using electromyography and accelerometer. We found coherence between individual muscular activation and tremor only in patients at a frequency range of 3-8 Hz. The finding corroborates the notion that primary bowing tremor emerges mainly due to central neurogenic contributions via motor-unit synchronization. Furthermore, the coherence between the muscular coactivation and tremor suggests a relation of the tremor to dystonia.
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20
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Lee A, Tominaga K, Furuya S, Miyazaki F, Altenmüller E. Task-specific tremor in violinists: Evidence of coactivation in the 3 to 8 Hz frequency range. Mov Disord 2013; 28:1890-2. [DOI: 10.1002/mds.25569] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/07/2013] [Accepted: 05/16/2013] [Indexed: 11/05/2022] Open
Affiliation(s)
- André Lee
- Institute for Music Physiology and Musicians' Medicine, Hannover University for Music, Drama, and Media; Hannover Germany
| | - Kenta Tominaga
- Institute for Music Physiology and Musicians' Medicine, Hannover University for Music, Drama, and Media; Hannover Germany
- Department of Engineering Science; Osaka University; Osaka Japan
| | - Shinichi Furuya
- Institute for Music Physiology and Musicians' Medicine, Hannover University for Music, Drama, and Media; Hannover Germany
| | - Fumio Miyazaki
- Department of Engineering Science; Osaka University; Osaka Japan
| | - Eckart Altenmüller
- Institute for Music Physiology and Musicians' Medicine, Hannover University for Music, Drama, and Media; Hannover Germany
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21
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Buijink AWG, Contarino MF, Koelman JHTM, Speelman JD, van Rootselaar AF. How to tackle tremor - systematic review of the literature and diagnostic work-up. Front Neurol 2012; 3:146. [PMID: 23109928 PMCID: PMC3478569 DOI: 10.3389/fneur.2012.00146] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 09/30/2012] [Indexed: 12/19/2022] Open
Abstract
Background: Tremor is the most prevalent movement disorder in clinical practice. It is defined as involuntary, rhythmic, oscillatory movements. The diagnostic process of patients with tremor can be laborious and challenging, and a clear, systematic overview of available diagnostic techniques is lacking. Tremor can be a symptom of many diseases, but can also represent a distinct disease entity. Objective: The objective of this review is to give a clear, systematic and step-wise overview of the diagnostic work-up of a patient with tremor. The clinical relevance and value of available laboratory tests in patients with tremor will be explored. Methods: We systematically searched through EMBASE. The retrieved articles were supplemented by articles containing relevant data or provided important background information. Studies that were included investigated the value and/or usability of diagnostic tests for tremor. Results: In most patients, history and clinical examination by an experienced movement disorders neurologist are sufficient to establish a correct diagnosis, and further ancillary examinations will not be needed. Ancillary investigation should always be guided by tremor type(s) present and other associated signs and symptoms. The main ancillary examination techniques currently are electromyography and SPECT imaging. Unfortunately, many techniques have not been studied in large prospective, diagnostic studies to be able to determine important variables like sensitivity and specificity. Conclusion: When encountering a patient with tremor, history, and careful clinical examination should guide the diagnostic process. Adherence to the diagnostic work-up provided in this review will help the diagnostic process of these patients.
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Affiliation(s)
- A W G Buijink
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, University of Amsterdam Amsterdam, Netherlands
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22
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Hess CW, Pullman SL. Tremor: clinical phenomenology and assessment techniques. Tremor Other Hyperkinet Mov (N Y) 2012; 2:tre-02-65-365-1. [PMID: 23439931 PMCID: PMC3517187 DOI: 10.7916/d8wm1c41] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 11/23/2011] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Tremors are among the most common movement disorders. As there can be considerable variability in the manner in which clinicians assess tremor, objective quantitative tools such as electromyography, accelerometry, and computerized, spiral analysis can be very useful in establishing a clinical diagnosis and in research settings. METHODS In this review, we discuss the various methods of quantitative tremor analysis and the classification and pathogenesis of tremor. The most common pathologic tremors and an approach to the diagnosis of tremor etiology are described. CONCLUSIONS Pathologic tremors are common, and the diagnosis of underlying etiology is not always straightforward. Computerized quantitative tremor analysis is a valuable adjunct to careful clinical evaluation in distinguishing tremulous diseases from physiologic tremors, and can also help shed light on their pathogenesis.
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Affiliation(s)
- Christopher W. Hess
- Clinical Motor Physiology Laboratory, Department of Neurology, Columbia University Medical Center, New York, New York, United States of America
| | - Seth L. Pullman
- Clinical Motor Physiology Laboratory, Department of Neurology, Columbia University Medical Center, New York, New York, United States of America
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Tedroff K, Rolfs A, Norling A. A novel SGCE gene mutation causing myoclonus dystonia in a family with an unusual phenotype. Acta Paediatr 2012; 101:e90-2. [PMID: 22026499 DOI: 10.1111/j.1651-2227.2011.02502.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Myoclonus dystonia is an autosomal dominant dystonia-plus syndrome, characterized by symptom variability within families. Most often is the myoclonus the most debilitating symptom, and many patients report myoclonus reduction after alcohol intake. In several families, mutations in the SGCE gene have been identified. METHOD We report of a three-generation family with myoclonus dystonia displaying a varied phenotype and maternal imprinting. Additionally, this family displays some unusual clinical presentations including alcohol-induced dystonia in an adult man, which will be discussed. RESULTS A novel mutation c.386T>C [p.I129T] was found within exon 3 of the SGCE gene in all three affected family members. In addition, two additional mutations [c.305G>A and IVS3+15G>A], judged to be polymorphisms in the SGCE gene, were found in two affected and one healthy family member. CONCLUSIONS This report presents a novel mutation in the SGCE gene causing myoclonus dystonia and extends the phenotype of myoclonus dystonia to also include alcohol-induced dystonia.
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Affiliation(s)
- Kristina Tedroff
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
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