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Riboldi GM, Frucht SJ. Is essential tremor a family of diseases or a syndrome? A family of diseases. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:7-29. [PMID: 35750371 DOI: 10.1016/bs.irn.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
It is now well-established that essential tremor (ET) can manifest with different clinical presentations and progressions (i.e., upper limb tremor, head tremor, voice tremor, lower limb tremor, task- or position-specific tremor, or a combination of those). Common traits and overlaps are identifiable across these different subtypes of ET, including a slow rate of progression, a response to alcohol and a positive family history. At the same time, each of these manifestations are associated with specific demographic, clinical and treatment-response characteristics suggesting a family of diseases rather than a spectrum of a syndrome. Here we summarize the most important clinical, demographic, neuropathological and imagingfeatures of ET and of its subtypes to support ET as a family of identifiable conditions. This classification has relevance for counseling of patients with regard to disease progression and treatment response, as well as for the design of therapeutic clinical trials.
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Affiliation(s)
- Giulietta M Riboldi
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University Langone Health, New York, NY, United States
| | - Steven J Frucht
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University Langone Health, New York, NY, United States.
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Deuschl G, Becktepe JS, Dirkx M, Haubenberger D, Hassan A, Helmich R, Muthuraman M, Panyakaew P, Schwingenschuh P, Zeuner KE, Elble RJ. The clinical and electrophysiological investigation of tremor. Clin Neurophysiol 2022; 136:93-129. [DOI: 10.1016/j.clinph.2022.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 01/18/2023]
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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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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.
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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
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Schreglmann SR, Baumann CR, Waldvogel D. Mirror Writing Tremor: Dystonic Clues…. Mov Disord Clin Pract 2015; 2:316-317. [PMID: 30363557 DOI: 10.1002/mdc3.12182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 03/05/2015] [Accepted: 03/11/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sebastian R Schreglmann
- Department of Neurology University Hospital Zurich Zurich Switzerland.,Department of Neurology Kantonsspital St. Gallen St. Gallen Switzerland
| | | | - Daniel Waldvogel
- Department of Neurology University Hospital Zurich Zurich Switzerland
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Pita Lobo P, Quattrocchi G, Jutras MF, Sangla S, Apartis E, Vidailhet M, Grabli D. Primary writing tremor and writer's cramp: two faces of a same coin? Mov Disord 2013; 28:1306-7. [PMID: 23401238 DOI: 10.1002/mds.25340] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/09/2012] [Indexed: 11/10/2022] Open
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Abstract
Task-specific tremor is a form of action tremor that occurs only or mainly when a person is performing a specific skilled task. The most frequently encountered form of task-specific tremor is primary writing tremor (PWT). Currently, there is debate about whether PWT is a variant of essential tremor, writer's cramp (dystonia), a separate entity, or in some cases related to essential tremor and in others to dystonia. PWT typically occurs at a frequency of 5-7Hz and has been subdivided into to two types: Type A, task-induced tremor, and type B, positionally sensitive tremor. Temporary suppression of the tremor by alcohol is seen in about one-third of cases. There are no randomized controlled therapeutic studies involving patients with PWT, although anecdotal reports of beneficial responses to propranolol, primidone, anticholinergics, botulinum toxin treatment, and stereotactic surgery have been reported. Reciprocal inhibition of the H-reflex and intracortical excitability are normal in PWT, unlike writer's cramp. Hyperactivity in the cerebellar hemispheres has been demonstrated with positron emission tomography in PWT. Other task-specific tremors have been described but have not been studied in detail.
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Affiliation(s)
- Peter G Bain
- Department of Medicine, Imperial College School of Medicine, Charing Cross Hospital Campus, London, UK.
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Hai C, Yu-ping W, Hua W, Ying S. Advances in primary writing tremor. Parkinsonism Relat Disord 2010; 16:561-5. [DOI: 10.1016/j.parkreldis.2010.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 06/17/2010] [Accepted: 06/18/2010] [Indexed: 10/19/2022]
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Ljubisavljevic M, Kacar A, Milanovic S, Svetel M, Kostic VS. Changes in cortical inhibition during task-specific contractions in primary writing tremor patients. Mov Disord 2006; 21:855-9. [PMID: 16482535 DOI: 10.1002/mds.20807] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Primary writing tremor (PWT) is a rare disease of unknown pathophysiology. We studied changes in silent period (SP) duration, after transcranial magnetic stimulation (TMS), set at 20% above the motor threshold in 6 PWT patients and 7 healthy control subjects. SP duration was tested during a task-specific act, i.e., writing that induced tremor in all patients in the affected hand (Wr); nonspecific voluntary contraction of intensity, matching that developed during writing (VCWr); and during near maximal voluntary contraction (VCNmax). There were no differences in SP duration during Wr and VCWr contraction on the right affected side or between sides in both PWT patients and control subjects, nor between the groups. However, during VCNmax, SP significantly shortened on both sides in PWT patients, whereas there were no changes in control subjects. Although it appears that inhibitory mechanism are not directly involved in the generation of the tremulous activity, the shortening of SP indicates that central inhibitory mechanisms are affected in PWT patients. Therefore, whereas the underlying pathophysiological mechanisms in PWT and writer's cramp may share common features, the results indicate that PWT is not a variant of focal task-specific dystonia but rather a separate nosological entity.
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Affiliation(s)
- Milos Ljubisavljevic
- Laboratory for Neurophysiology, Institute for Medical Research, Belgrade, Serbia.
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Singer C, Papapetropoulos S, Spielholz NI. Primary writing tremor: Report of a case successfully treated with botulinum toxin A injections and discussion of underlying mechanism. Mov Disord 2005; 20:1387-8. [PMID: 16007655 DOI: 10.1002/mds.20590] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Primary writing tremor (PWT) is a rare motor disorder of unknown etiology, where tremor is elicited primarily or exclusively with writing. We describe a patient with PWT, present a video before and after successful treatment with botulinum toxin type A injections, and discuss a possible underlying dystonic mechanism.
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Affiliation(s)
- Carlos Singer
- Department of Neurology, University of Miami School of Medicine, Miami, Florida 33136, USA.
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Berg D, Preibisch C, Hofmann E, Naumann M. Cerebral activation pattern in primary writing tremor. J Neurol Neurosurg Psychiatry 2000; 69:780-6. [PMID: 11080231 PMCID: PMC1737170 DOI: 10.1136/jnnp.69.6.780] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the cerebral activation pattern during writing of patients with writing tremor with healthy controls using functional MRI METHODS: Three patients with writing tremor and 10 healthy controls were examined using a 1.5 Tesla scanner. All subjects performed a paradigm of alternating 30 second periods of rest or writing. For functional imaging 60 EPI multislice data sets were acquired. All images were analyzed using SPM96 software. Data were analyzed for the group of patients with writing tremor and compared with those of the control group. RESULTS Both patients with writing tremor and controls showed a significant activation of the contralateral primary sensorimotor cortex, SMA, and area 44. By contrast, motor cortex activation in writing tremor also included the contralateral premotor area (area 6) and ipsilateral prefrontal area (inferior frontal gyrus; areas 10, 44, and 47). Only patients with writing tremor showed a bilateral activation of the parietal lobule (area 40) with a more pronounced activation on the contralateral side. Furthermore, there was a bilateral activation of the cerebellum with a more pronounced area of activation on the ipsilateral side. CONCLUSIONS Brain areas activated in writing tremor included activation patterns otherwise typical for both essential tremor and writer's cramp. Therefore a distinct category for writing tremor integrating hallmarks of essential tremor and writer's cramp is proposed.
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Affiliation(s)
- D Berg
- Department of Neurology, Bayerische Julius-Maximilians- Universität Würzburg, Josef-Schneider-Strasse 11, D - 97080 Würzburg, Germany
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