1
|
Yilmaz AY, Ruzicka E, Jankovic J. Leg stereotypy syndrome: phenomenological and quantitative analysis. J Neurol 2024; 271:5519-5524. [PMID: 38898269 DOI: 10.1007/s00415-024-12501-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Leg stereotypy syndrome (LSS) is a very common, yet underrecognized condition. The pathophysiology of the condition is not well understood. OBJECTIVE To evaluate and describe the visual kinematic characteristics of the repetitive leg movements in individuals with LSS. METHODS In this study, we identified and videotaped individuals diagnosed with LSS at the Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas between 2000 and 2023. Only patients with LSS and without any co-morbidities were included in the study. Their medical records were carefully reviewed, and the demographic and clinical data were entered into a database. Video recordings of the repetitive leg movements were then analyzed using TremAn software. RESULTS We identified 14 individuals with LSS who were videotaped at our center. The videos of the 5 cases were too brief and therefore not suitable for TremAn quantitative analysis. The remaining 9 individuals exhibited regular rhythmic oscillations of the legs. Among these, two individuals displayed rhythmic movements only in video segments where their legs were in crossed positions. The other 7 individuals had regular rhythmic oscillations, always with the toes resting on the floor with the heels raised. Frequency analysis showed values between 4.5 and 6.5 Hz, fairly consistent with a variance below 0.5 Hz in individual cases. The oscillation frequency changed from 5.7 Hz to 2.7 Hz while standing. CONCLUSION In this study, 6 of 9 individuals with LSS showed 4.5-6.5 Hz regular rhythmic leg movements. Studies involving a larger LSS population with additional electrophysiological evaluations are needed to obtain further insights into this common movement disorder.
Collapse
Affiliation(s)
- Abdullah Yasir Yilmaz
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, 77030-4202, USA
| | - Evzen Ruzicka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, 77030-4202, USA.
| |
Collapse
|
2
|
Fasano A, Jinnah HA. Describing Clinical Features of Movement Disorders for Effective Research Reporting. Mov Disord Clin Pract 2024. [PMID: 39030741 DOI: 10.1002/mdc3.14140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 07/22/2024] Open
Affiliation(s)
- Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Hyder A Jinnah
- Department of Neurology, Human Genetics, and Pediatrics; Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
3
|
Shih LC, Stevenson MT, Bellows S, Fasano A, Kuo SH, Lyons KE, Moore H, Shill HA, Shukla AW, Singer C, Elble RJ. Validation of a New Patient-Reported Outcome Measure of the Functional Impact of Essential Tremor on Activities of Daily Living. Tremor Other Hyperkinet Mov (N Y) 2024; 14:26. [PMID: 38765931 PMCID: PMC11100532 DOI: 10.5334/tohm.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
Background The Essential Tremor Rating Assessment Scale (TETRAS) is a popular scale for essential tremor (ET), but its activities of daily living (ADL) and performance (P) subscales are based on a structured interview and physical exam. No patient-reported outcome (PRO) scale for ET has been developed according to US regulatory guidelines. Objective Develop and validate a TETRAS PRO subscale. Methods Fourteen items, rated 0-4, were derived from TETRAS ADL and structured cognitive interviews of 18 ET patients. Convergent validity analyses of TETRAS PRO versus TETRAS ADL, TETRAS-P, and the Quality of Life in Essential Tremor Questionnaire (QUEST) were computed for 67 adults with ET or ET plus. Test-retest reliability was computed at intervals of 1 and 30 days. The influence of mood (Hospital Anxiety and Depression Scale, HADS) and coping behaviors (Essen Coping Questionnaire, ECQ) was examined with multiple linear regression. Results TETRAS PRO was strongly correlated (r > 0.7) with TETRAS ADL, TETRAS-P, and QUEST and exhibited good to excellent reliability (Cronbach alpha 95%CI = 0.853-0.926; 30-day test-retest intraclass correlation 95%CI = 0.814-0.921). The 30-day estimate of minimum detectable change (MDC) was 6.6 (95%CI 5.2-8.0). TETRAS-P (rsemipartial = 0.607), HADS depression (rsemipartial = 0.384), and the coping strategy of information seeking and exchange of experiences (rsemipartial = 0.176) contributed statistically to TETRAS PRO in a multiple linear regression (R2 = 0.67). Conclusions TETRAS PRO is a valid and reliable scale that is influenced strongly by tremor severity, moderately by mood (depression), and minimally by coping skills. The MDC for TETRAS PRO is probably sufficient to detect clinically important change.
Collapse
Affiliation(s)
- Ludy C. Shih
- Beth Israel Deaconess Medical Center, Department of Neurology, Boston, MA 02215, US
- Harvard Medical School, Boston, MA 02215, US
| | | | - Steven Bellows
- Baylor College of Medicine, Department of Neurology, Houston, TX, US
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Sheng-Han Kuo
- Columbia University, Department of Neurology, New York, NY, US
| | - Kelly E. Lyons
- University of Kansas Medical Center, Department of Neurology, US
| | - Henry Moore
- University of Miami School of Medicine, Department of Neurology, Miami, FL, US
| | | | - Aparna Wagle Shukla
- Fixel Institute for Neurological Diseases, University of Florida, Department of Neurology, Gainesville, FL, US
| | - Carlos Singer
- University of Miami School of Medicine, Department of Neurology, Miami, FL, US
| | - Rodger J. Elble
- Southern Illinois University School of Medicine, Department of Neurology, Springfield, IL, US
| |
Collapse
|
4
|
Elble RJ. Bayesian Interpretation of Essential Tremor Plus. J Clin Neurol 2022; 18:127-139. [PMID: 35274833 PMCID: PMC8926770 DOI: 10.3988/jcn.2022.18.2.127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/21/2022] Open
Abstract
Essential tremor (ET) plus is a new tremor classification that was introduced in 2018 by a task force of the International Parkinson and Movement Disorder Society. Patients with ET plus meet the criteria for ET but have one or more additional systemic or neurologic signs of uncertain significance or relevance to tremor (“soft signs”). Soft signs are not sufficient to diagnose another tremor syndrome or movement disorder, and soft signs in ET plus are known to have poor interrater reliability and low diagnostic sensitivity and specificity. Therefore, the clinical significance of ET plus must be interpreted probabilistically when judging whether a patient is more likely to have ET or a combined tremor syndrome, such as dystonic tremor. Such a probabilistic interpretation is possible with Bayesian analysis. This review presents a Bayesian analysis of ET plus in patients suspected of having ET versus a dystonic tremor syndrome, which is the most common differential diagnosis in patients referred for ET. Bayesian analysis of soft signs provides an estimate of the probability that a patient with possible ET is more likely to have an alternative diagnosis. ET plus is a distinct tremor classification and should not be viewed as a subtype of ET. ET plus covers a more-comprehensive phenotyping of people with possible ET, and the clinical interpretation of ET plus is enhanced with Bayesian analysis of associated soft signs.
Collapse
Affiliation(s)
- Rodger J. Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL, USA
| |
Collapse
|
5
|
Abstract
Tremor is the most commonly encountered movement disorder in clinical practice. A wide range of pathologies may manifest with tremor either as a presenting or predominant symptom. Considering the marked etiological and phenomenological heterogeneity, it would be desirable to develop a classification of tremors that reflects their underlying pathophysiology. The tremor task force of the International Parkinson Disease and Movement Disorders Society has worked toward this goal and proposed a new classification system. This system has remained a prime topic of scientific communications on tremor in recent times. The new classification is based on two axes: 1. based on the clinical features, history, and tremor characteristics and 2. based on the etiology of tremor. In this article, we discuss the key aspects of the new classification, review various tremor syndromes, highlight some of the controversies in the field of tremor, and share the potential future perspectives.
Collapse
Affiliation(s)
- Abhishek Lenka
- Department of Neurology, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| |
Collapse
|
6
|
Sepúlveda Soto MC, Fasano A. Tremor: so common, so difficult. J Neurol Neurosurg Psychiatry 2020; 91:809-810. [PMID: 32457088 DOI: 10.1136/jnnp-2020-323189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada .,Division of Neurology, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto, ON, Canada.,The Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| |
Collapse
|
7
|
Amlang CJ, Trujillo Diaz D, Louis ED. Essential Tremor as a "Waste Basket" Diagnosis: Diagnosing Essential Tremor Remains a Challenge. Front Neurol 2020; 11:172. [PMID: 32269548 PMCID: PMC7109309 DOI: 10.3389/fneur.2020.00172] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/24/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: The diagnosis of essential tremor (ET) remains a clinical one, and diagnostic errors are common. We aimed to (1) determine precisely how frequently ET diagnoses are misapplied (i.e., what percentage of patients who have been assigned an “ET” diagnosis actually have another movement disorder), (2) determine which other movement disorders are most often misclassified as “ET,” and (3) examine the clinical features that were most associated with diagnostic errors. Methods: One hundred four consecutive patients were included who met the following criteria: (1) initial outpatient evaluation by one of the authors (EDL) between January 2015 and December 2019 and (2) pre-evaluation diagnosis of ET. Data on an extensive number of clinical features were extracted from the electronic medical record. Results: Forty-seven (45.2%) patients received a post-evaluation diagnosis of ET, 29 (27.9%) of dystonia, and 28 (26.9%) of other diagnoses including Parkinson's disease (PD) [6 (5.8%)]. Factors associated with an alternative post-evaluation diagnosis other than ET were pre-evaluation diagnosis made by a non-neurologist, shorter tremor duration, irregular tremor, abnormal limb postures, among others. Discussion: Diagnosing ET remains a challenge, with the diagnosis being over-applied and being used as a “waste basket.” More than one-half of the patients who were referred to our clinic with an intake diagnosis of ET were given an alternative post-evaluation diagnosis. While PD was reported to be the most frequently missed diagnosis in a past study, dystonia was most commonly missed in our study. Several clinical features can help to differentiate ET from other tremor disorders.
Collapse
Affiliation(s)
- Christian J Amlang
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Daniel Trujillo Diaz
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, United States
| |
Collapse
|
8
|
Essential tremor: New advances. Clin Park Relat Disord 2019; 3:100031. [PMID: 34316617 PMCID: PMC8298793 DOI: 10.1016/j.prdoa.2019.100031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/30/2019] [Accepted: 12/18/2019] [Indexed: 01/15/2023] Open
Abstract
Background Essential Tremor (ET) is one of the most common movement disorders but many controversies still exist in regards to its definition and pathophysiology. In view of the recent published criteria by the Tremor Task Force of the International Parkinson's and Movement Disorders Society (IPMDS), we intended to analyze if this has changed our view of ET and if new developments have arisen since. Methods A Medline search for English-written articles was done on June 15, 2019 using the keyword "Essential Tremor". Publications from November 2017 (publication date of the new tremor classification) were taken into account. Reviews, letters and original studies relevant to the subject were selected and reviewed according to the following themes: clinical characteristics, epidemiology, genetics, pathology, biomarkers and treatment. Results Out of 132 publications the most relevant articles were selected and reviewed (total of 65 articles). The great majority of these studies focused on surgical treatments (new targets, new technologies) while relatively few articles addressed epidemiology, pathology and pathophysiology. Conclusions The use of the new classification is not commonly used still, excepting more recent studies on therapeutics. This is in keeping with diverse opinions and criticisms reported by the IPMDS task force members themselves. One important change has been validating ET as a heterogeneous condition and defining the ET-plus category. We propose a further sub-group classification derived from the new definition of ET-plus.
Collapse
|