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Schoeberl F, Dowsett J, Pradhan C, Grabova D, Köhler A, Taylor P, Zwergal A. TMS of the left primary motor cortex improves tremor intensity and postural control in primary orthostatic tremor. J Neurol 2024; 271:2938-2947. [PMID: 38625401 PMCID: PMC11136716 DOI: 10.1007/s00415-024-12376-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/17/2024]
Abstract
A ponto-cerebello-thalamo-cortical network is the pathophysiological correlate of primary orthostatic tremor. Affected patients often do not respond satisfactorily to pharmacological treatment. Consequently, the objective of the current study was to examine the effects of a non-invasive neuromodulation by theta burst repetitive transcranial magnetic stimulation (rTMS) of the left primary motor cortex (M1) and dorsal medial frontal cortex (dMFC) on tremor frequency, intensity, sway path and subjective postural stability in primary orthostatic tremor. In a cross-over design, eight patients (mean age 70.2 ± 5.4 years, 4 female) with a primary orthostatic tremor received either rTMS of the left M1 leg area or the dMFC at the first study session, followed by the other condition (dMFC or M1 respectively) at the second study session 30 days later. Tremor frequency and intensity were quantified by surface electromyography of lower leg muscles and total sway path by posturography (foam rubber with eyes open) before and after each rTMS session. Patients subjectively rated postural stability on the posturography platform following each rTMS treatment. We found that tremor frequency did not change significantly with M1- or dMFC-stimulation. However, tremor intensity was lower after M1- but not dMFC-stimulation (p = 0.033/ p = 0.339). The sway path decreased markedly after M1-stimulation (p = 0.0005) and dMFC-stimulation (p = 0.023) compared to baseline. Accordingly, patients indicated a better subjective feeling of postural stability both with M1-rTMS (p = 0.007) and dMFC-rTMS (p = 0.01). In conclusion, non-invasive neuromodulation particularly of the M1 area can improve postural control and tremor intensity in primary orthostatic tremor by interference with the tremor network.
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Affiliation(s)
- Florian Schoeberl
- Department of Neurology and German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Munich, Germany
| | - James Dowsett
- Division of Psychology, University of Stirling, Stirling, UK
| | - Cauchy Pradhan
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Munich, Germany
| | - Denis Grabova
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Munich, Germany
| | - Angelina Köhler
- Department of Neurology and German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Munich, Germany
| | - Paul Taylor
- Faculty of Philosophy, Philosophy of Science and the Study of Religion, LMU Munich, Munich, Germany
| | - Andreas Zwergal
- Department of Neurology and German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Munich, Germany.
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Xiong X, Dai L, Chen W, Lu J, Hu C, Zhao H, Ke J. Dynamics and concordance alterations of regional brain function indices in vestibular migraine: a resting-state fMRI study. J Headache Pain 2024; 25:1. [PMID: 38178029 PMCID: PMC10768112 DOI: 10.1186/s10194-023-01705-y] [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: 10/06/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Prior MRI studies on vestibular migraine (VM) have revealed abnormalities in static regional intrinsic brain activity (iBA) and dynamic functional connectivity between brain regions or networks. However, the temporal variation and concordance of regional iBA measures remain to be explored. METHODS 57 VM patients during the interictal period were compared to 88 healthy controls (HC) in this resting-state functional magnetic resonance imaging (fMRI) study. The dynamics and concordance of regional iBA indices, including amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo), were examined by utilizing sliding time-window analysis. Partial correlation analyses were performed between clinical parameters and resting-state fMRI indices in brain areas showing significant group differences. RESULTS The VM group showed increased ALFF and ReHo dynamics, as well as increased temporal concordance between ALFF and ReHo in the bilateral paracentral lobule and supplementary motor area relative to the HC group. We also found decreased ReHo dynamics in the right temporal pole, and decreased ALFF dynamics in the right cerebellum posterior lobe, bilateral angular gyrus and middle occipital gyrus (MOG) in the VM group compared with the HC group. Moreover, a positive correlation was observed between ALFF dynamics in the left MOG and vertigo disease duration across all VM patients. CONCLUSION Temporal dynamics and concordance of regional iBA indices were altered in the motor cortex, cerebellum, occipital and temporoparietal cortex, which may contribute to disrupted multisensory processing and vestibular control in patients with VM. ALFF dynamics in the left MOG may be useful biomarker for evaluating vertigo burden in this disorder.
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Affiliation(s)
- Xing Xiong
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
- Institute of Medical imaging, Soochow University, Soochow, Jiangsu Province, People's Republic of China
| | - Lingling Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
- Institute of Medical imaging, Soochow University, Soochow, Jiangsu Province, People's Republic of China
| | - Wen Chen
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
- Institute of Medical imaging, Soochow University, Soochow, Jiangsu Province, People's Republic of China
| | - Jiajie Lu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
- Institute of Medical imaging, Soochow University, Soochow, Jiangsu Province, People's Republic of China
| | - Hongru Zhao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.
| | - Jun Ke
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.
- Institute of Medical imaging, Soochow University, Soochow, Jiangsu Province, People's Republic of China.
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Sozzi S, Ghai S, Schieppati M. The 'Postural Rhythm' of the Ground Reaction Force during Upright Stance and Its Conversion to Body Sway-The Effect of Vision, Support Surface and Adaptation to Repeated Trials. Brain Sci 2023; 13:978. [PMID: 37508910 PMCID: PMC10377030 DOI: 10.3390/brainsci13070978] [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: 05/11/2023] [Revised: 06/12/2023] [Accepted: 06/18/2023] [Indexed: 07/30/2023] Open
Abstract
The ground reaction force (GRF) recorded by a platform when a person stands upright lies at the interface between the neural networks controlling stance and the body sway deduced from centre of pressure (CoP) displacement. It can be decomposed into vertical (VGRF) and horizontal (HGRF) vectors. Few studies have addressed the modulation of the GRFs by the sensory conditions and their relationship with body sway. We reconsidered the features of the GRFs oscillations in healthy young subjects (n = 24) standing for 90 s, with the aim of characterising the possible effects of vision, support surface and adaptation to repeated trials, and the correspondence between HGRF and CoP time-series. We compared the frequency spectra of these variables with eyes open or closed on solid support surface (EOS, ECS) and on foam (EOF, ECF). All stance trials were repeated in a sequence of eight. Conditions were randomised across different days. The oscillations of the VGRF, HGRF and CoP differed between each other, as per the dominant frequency of their spectra (around 4 Hz, 0.8 Hz and <0.4 Hz, respectively) featuring a low-pass filter effect from VGRF to HGRF to CoP. GRF frequencies hardly changed as a function of the experimental conditions, including adaptation. CoP frequencies diminished to <0.2 Hz when vision was available on hard support surface. Amplitudes of both GRFs and CoP oscillations decreased in the order ECF > EOF > ECS ≈ EOS. Adaptation had no effect except in ECF condition. Specific rhythms of the GRFs do not transfer to the CoP frequency, whereas the magnitude of the forces acting on the ground ultimately determines body sway. The discrepancies in the time-series of the HGRF and CoP oscillations confirm that the body's oscillation mode cannot be dictated by the inverted pendulum model in any experimental conditions. The findings emphasise the robustness of the VGRF "postural rhythm" and its correspondence with the cortical theta rhythm, shed new insight on current principles of balance control and on understanding of upright stance in healthy and elderly people as well as on injury prevention and rehabilitation.
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Affiliation(s)
| | - Shashank Ghai
- Department of Political, Historical, Religious and Cultural Studies, Karlstad University, 65188 Karlstad, Sweden
- Centre for Societal Risk Research, Karlstad University, 65188 Karlstad, Sweden
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Timmers ER, Klamer MR, Marapin RS, Lammertsma AA, de Jong BM, Dierckx RAJO, Tijssen MAJ. [ 18F]FDG PET in conditions associated with hyperkinetic movement disorders and ataxia: a systematic review. Eur J Nucl Med Mol Imaging 2023; 50:1954-1973. [PMID: 36702928 PMCID: PMC10199862 DOI: 10.1007/s00259-023-06110-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE To give a comprehensive literature overview of alterations in regional cerebral glucose metabolism, measured using [18F]FDG PET, in conditions associated with hyperkinetic movement disorders and ataxia. In addition, correlations between glucose metabolism and clinical variables as well as the effect of treatment on glucose metabolism are discussed. METHODS A systematic literature search was performed according to PRISMA guidelines. Studies concerning tremors, tics, dystonia, ataxia, chorea, myoclonus, functional movement disorders, or mixed movement disorders due to autoimmune or metabolic aetiologies were eligible for inclusion. A PubMed search was performed up to November 2021. RESULTS Of 1240 studies retrieved in the original search, 104 articles were included. Most articles concerned patients with chorea (n = 27), followed by ataxia (n = 25), dystonia (n = 20), tremor (n = 8), metabolic disease (n = 7), myoclonus (n = 6), tics (n = 6), and autoimmune disorders (n = 5). No papers on functional movement disorders were included. Altered glucose metabolism was detected in various brain regions in all movement disorders, with dystonia-related hypermetabolism of the lentiform nuclei and both hyper- and hypometabolism of the cerebellum; pronounced cerebellar hypometabolism in ataxia; and striatal hypometabolism in chorea (dominated by Huntington disease). Correlations between clinical characteristics and glucose metabolism were often described. [18F]FDG PET-showed normalization of metabolic alterations after treatment in tremors, ataxia, and chorea. CONCLUSION In all conditions with hyperkinetic movement disorders, hypo- or hypermetabolism was found in multiple, partly overlapping brain regions, and clinical characteristics often correlated with glucose metabolism. For some movement disorders, [18F]FDG PET metabolic changes reflected the effect of treatment.
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Affiliation(s)
- Elze R Timmers
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Marrit R Klamer
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Ramesh S Marapin
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Adriaan A Lammertsma
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen (UMCG), University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Bauke M de Jong
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen (UMCG), University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands.
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB, Groningen, the Netherlands.
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Mental calculation increases physiological postural tremor, but does not influence physiological goal-directed kinetic tremor. Eur J Appl Physiol 2022; 122:2661-2671. [PMID: 36121480 PMCID: PMC9613750 DOI: 10.1007/s00421-022-05039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 09/05/2022] [Indexed: 11/25/2022]
Abstract
Purpose During a cognitive effort, an increase in cortical electrical activity, functional alterations in the anterior cingulate cortex, and modifications in cortical inputs to the active motor units have been reported. In light of this, an increase in tremor could be anticipated as result of a mental task. In the present work, we tested this hypothesis. Methods In 25 individuals, tremor was measured with a three-axial accelerometer during 300 s of postural and goal-directed tasks performed simultaneously to mental calculation, or during control (same tasks without mental calculation). Hand and finger dexterity were also evaluated. Electromyographic (EMG) recordings from the extensor digitorum communis were collected during the postural task. Results Hand and finger dexterity was negatively affected by the mental task (p = .003 and p = .00005 respectively). During mental calculation, muscle tremor increased in the hand postural (+ 29%, p = .00005) but not in the goal-directed task (− 1.5%, p > .05). The amplitude of the main frequency peak also increased exclusively in the hand postural task (p = .028), whilst no shift in the position of the main frequency peak was observed. EMG was not affected. Conclusion These results support the position of the contribution of a central component in the origin of physiological hand postural tremor. It is suggested that the different effect of mental calculation on hand postural and goal-directed tasks can be attributed to the different origins and characteristics of hand postural and goal-directed physiological tremor.
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Cabaraux P, Agrawal SK, Cai H, Calabro RS, Casali C, Damm L, Doss S, Habas C, Horn AKE, Ilg W, Louis ED, Mitoma H, Monaco V, Petracca M, Ranavolo A, Rao AK, Ruggieri S, Schirinzi T, Serrao M, Summa S, Strupp M, Surgent O, Synofzik M, Tao S, Terasi H, Torres-Russotto D, Travers B, Roper JA, Manto M. Consensus Paper: Ataxic Gait. CEREBELLUM (LONDON, ENGLAND) 2022; 22:394-430. [PMID: 35414041 DOI: 10.1007/s12311-022-01373-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/19/2022]
Abstract
The aim of this consensus paper is to discuss the roles of the cerebellum in human gait, as well as its assessment and therapy. Cerebellar vermis is critical for postural control. The cerebellum ensures the mapping of sensory information into temporally relevant motor commands. Mental imagery of gait involves intrinsically connected fronto-parietal networks comprising the cerebellum. Muscular activities in cerebellar patients show impaired timing of discharges, affecting the patterning of the synergies subserving locomotion. Ataxia of stance/gait is amongst the first cerebellar deficits in cerebellar disorders such as degenerative ataxias and is a disabling symptom with a high risk of falls. Prolonged discharges and increased muscle coactivation may be related to compensatory mechanisms and enhanced body sway, respectively. Essential tremor is frequently associated with mild gait ataxia. There is growing evidence for an important role of the cerebellar cortex in the pathogenesis of essential tremor. In multiple sclerosis, balance and gait are affected due to cerebellar and spinal cord involvement, as a result of disseminated demyelination and neurodegeneration impairing proprioception. In orthostatic tremor, patients often show mild-to-moderate limb and gait ataxia. The tremor generator is likely located in the posterior fossa. Tandem gait is impaired in the early stages of cerebellar disorders and may be particularly useful in the evaluation of pre-ataxic stages of progressive ataxias. Impaired inter-joint coordination and enhanced variability of gait temporal and kinetic parameters can be grasped by wearable devices such as accelerometers. Kinect is a promising low cost technology to obtain reliable measurements and remote assessments of gait. Deep learning methods are being developed in order to help clinicians in the diagnosis and decision-making process. Locomotor adaptation is impaired in cerebellar patients. Coordinative training aims to improve the coordinative strategy and foot placements across strides, cerebellar patients benefiting from intense rehabilitation therapies. Robotic training is a promising approach to complement conventional rehabilitation and neuromodulation of the cerebellum. Wearable dynamic orthoses represent a potential aid to assist gait. The panel of experts agree that the understanding of the cerebellar contribution to gait control will lead to a better management of cerebellar ataxias in general and will likely contribute to use gait parameters as robust biomarkers of future clinical trials.
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Affiliation(s)
- Pierre Cabaraux
- Unité Des Ataxies Cérébelleuses, Department of Neurology, CHU de Charleroi, Charleroi, Belgium.
| | | | - Huaying Cai
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | | | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Loic Damm
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France
| | - Sarah Doss
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Christophe Habas
- Université Versailles Saint-Quentin, Versailles, France.,Service de NeuroImagerie, Centre Hospitalier National des 15-20, Paris, France
| | - Anja K E Horn
- Institute of Anatomy and Cell Biology I, Ludwig Maximilians-University Munich, Munich, Germany
| | - Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Maria Petracca
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Ashwini K Rao
- Department of Rehabilitation & Regenerative Medicine (Programs in Physical Therapy), Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Serena Ruggieri
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy.,Neuroimmunology Unit, IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.,Movement Analysis LAB, Policlinico Italia, Rome, Italy
| | - Susanna Summa
- MARlab, Neuroscience and Neurorehabilitation Department, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig Maximilians-University Munich, Munich, Germany
| | - Olivia Surgent
- Neuroscience Training Program and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany
| | - Shuai Tao
- Dalian Key Laboratory of Smart Medical and Health, Dalian University, Dalian, 116622, China
| | - Hiroo Terasi
- Department of Neurology, Tokyo Medical University, Tokyo, Japan
| | - Diego Torres-Russotto
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Brittany Travers
- Department of Kinesiology and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Jaimie A Roper
- School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Mario Manto
- Unité Des Ataxies Cérébelleuses, Department of Neurology, CHU de Charleroi, Charleroi, Belgium.,Service Des Neurosciences, University of Mons, UMons, Mons, Belgium
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Erro R, Fasano A, Barone P, Bhatia KP. Milestones in Tremor Research: ten years later. Mov Disord Clin Pract 2022; 9:429-435. [PMID: 35582314 PMCID: PMC9092753 DOI: 10.1002/mdc3.13418] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Roberto Erro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” Neuroscience section, University of Salerno Baronissi Italy
| | - 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
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” Neuroscience section, University of Salerno Baronissi Italy
| | - Kailash P. Bhatia
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery London United Kingdom
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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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Liatis T, Gutierrez‐Quintana R, Mari L, Czopowicz M, Polidoro D, Bhatti SFM, Cozzi F, Tirrito F, Brocal J, José‐López R, Kaczmarska A, Cappello R, Harris G, Alves L, Rusbridge C, Rossmeisl JH. Primary orthostatic tremor and orthostatic tremor-plus in dogs: 60 cases (2003-2020). J Vet Intern Med 2022; 36:179-189. [PMID: 34897811 PMCID: PMC8783359 DOI: 10.1111/jvim.16328] [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] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Orthostatic tremor (OT) is a rare movement disorder characterized by high-frequency (>12 Hz) involuntary, rhythmic, sinusoidal movements affecting predominantly the limbs while standing. OBJECTIVE To describe the signalment, presenting complaints, phenotype, diagnostic findings, treatment, and outcome of a large sample of dogs with OT. ANIMALS Sixty dogs diagnosed with OT based on conscious electromyography. METHODS Multicenter retrospective case series study. Dogs were included if they had a conscious electromyography consistent with muscle discharge frequency >12 Hz while standing. RESULTS Fifty-three cases were diagnosed with primary OT (POT). Giant breed dogs represented most cases (83%; 44/53). Most dogs (79%; 42/53) were younger than 2 years of age at onset of signs, except for Retrievers which were all older than 3.5 years of age. The most common presenting complaints were pelvic limb tremors while standing (85%; 45/53) and difficulty when rising or sitting down (45%; 24/53). Improvement of clinical signs occurred in most dogs (85%; 45/53) treated medically with phenobarbital, primidone, gabapentin, pregabalin or clonazepam, but it was mostly partial rather than complete. Orthostatic tremor-plus was seen in 7 dogs that had concurrent neurological diseases. CONCLUSIONS AND CLINICAL IMPORTANCE Primary OT is a progressive disease of young, purebred, giant/large-breed dogs, which appears to begin later in life in Retrievers. Primary OT apparently responds partially to medications. Orthostatic tremor-plus exists in dogs and can be concomitant or associated with other neurological diseases.
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Affiliation(s)
- Theofanis Liatis
- Small Animal Hospital, School of Veterinary MedicineUniversity of GlasgowGlasgowUnited Kingdom
| | | | - Lorenzo Mari
- Small Animal Referral CentreAnimal Health TrustNewmarketUnited Kingdom
- Wear ReferralsStockton‐on‐TeesUnited Kingdom
| | - Michał Czopowicz
- Division of Veterinary Epidemiology and EconomicsInstitute of Veterinary Medicine, Warsaw University of Life Sciences—SGGWWarsawPoland
| | - Dakir Polidoro
- Small Animal Teaching Hospital, Small Animal Department, Faculty of Veterinary MedicineGhent UniversityGhentBelgium
| | - Sofie F. M. Bhatti
- Small Animal Teaching Hospital, Small Animal Department, Faculty of Veterinary MedicineGhent UniversityGhentBelgium
| | | | | | - Josep Brocal
- Small Animal Hospital, School of Veterinary MedicineUniversity of GlasgowGlasgowUnited Kingdom
- Wear ReferralsStockton‐on‐TeesUnited Kingdom
| | - Roberto José‐López
- Small Animal Hospital, School of Veterinary MedicineUniversity of GlasgowGlasgowUnited Kingdom
| | - Adriana Kaczmarska
- Small Animal Hospital, School of Veterinary MedicineUniversity of GlasgowGlasgowUnited Kingdom
| | | | - Georgina Harris
- The Queen's Veterinary School Hospital, Department of Veterinary MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Lisa Alves
- The Queen's Veterinary School Hospital, Department of Veterinary MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Clare Rusbridge
- Fitzpatrick Referrals Orthopaedics and NeurologyGodalmingUnited Kingdom
- School of Veterinary MedicineUniversity of SurreyGuilfordUnited Kingdom
| | - John H. Rossmeisl
- Department of Small Animal Clinical Sciences, Virginia‐Maryland College of Veterinary MedicineVirginia Polytechnic Institute and State UniversityBlacksburgVirginiaUSA
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Electroencephalography in Orthostatic Tremor: A Prospective Study of 30 Patients. Tremor Other Hyperkinet Mov (N Y) 2021; 11:18. [PMID: 34046248 PMCID: PMC8139292 DOI: 10.5334/tohm.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Orthostatic tremor (OT) is characterized by a sensation of instability while standing, associated with high frequency (1318 Hz) tremor in the legs. Small retrospective series have reported electroencephalography (EEG) findings in OT with discordant results. Methods We prospectively enrolled 30 OT subjects. Mean age = 68.3 (range 5487) with mean disease duration 16.3 years (range 444). A modified 1020 system EEG recording with additional midline electrodes was obtained. EMG electrodes were placed on quadricep muscles. EEG recording was performed at rest, during sleep and while standing unassisted. Results In all subjects, EEG showed normal background, normal drowsiness and/or stage 2 sleep, and normal responses to hyperventilation and photic stimulation. These normal results persisted during stance. EEG abnormalities were found in 3 subjects (anterior-mid temporal slow activity), but were not position-dependent and were judged unlikely to be related to OT. Tremor artifact while standing was noted in all subjects, however it was measurable in 26 with frequency in the OT range in 25. When compared with EMG, the average difference in frequency was small at 1.2 Hz (range 0.52.5, p 0.46). Visual EEG analysis in OT patients did not reveal electrographic abnormalities even upon standing unassisted. Discussion EEG was normal on this prospective, relatively large OT series. Clinicians interpreting video-EEGs should be aware of the OT artifact that can be seen in EEG and EKG leads mostly while standing.
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Lamy JC, Varriale P, Apartis E, Mehdi S, Blancher-Meinadier A, Kosutzka Z, Degos B, Frismand S, Simonetta-Moreau M, Meunier S, Roze E, Vidailhet M. Trans-Spinal Direct Current Stimulation for Managing Primary Orthostatic Tremor. Mov Disord 2021; 36:1835-1842. [PMID: 33772851 DOI: 10.1002/mds.28581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Primary orthostatic tremor (POT) is a rare disorder, characterized by 13 to 18 Hz tremor in the legs when standing and is often refractory to medical treatment. Epidural spinal cord stimulation has been proposed as an alternative treatment. However, this approach is invasive, which limits its application. OBJECTIVE Trans-spinal direct current stimulation (tsDCS) is a non-invasive method to modulate spinal cord circuits. The aim of this proof-of-concept study was to investigate the potential beneficial effect of tsDCS in POT. METHODS We conducted a double-blind, sham-controlled study in 16 patients with POT. In two separate visits, patients received sham tsDCS first followed by active (either cathodal or anodal) tsDCS. The primary outcome was the change in time in standing position. Secondary outcomes comprised quantitative assessment of tremor, measurement of corticospinal excitability including short-latency afferent inhibition, and clinical global impression-improvement (CGI-I). Measurements were made at baseline, after sham tsDCS, 0-30 min, and 30-60 min after active conditions. RESULTS Cathodal-tsDCS reduced tremor amplitude and frequency and lowered corticospinal excitability whereas anodal-tsDCS reduced tremor frequency only. CGI-I scores positively correlated with the time in standing position after both active tsDCS conditions. CONCLUSION A single session of tsDCS can improve instability in POT. This opens a new vista for experimental treatment options using multiple sessions of spinal DC stimulation. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jean-Charles Lamy
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France
| | - Pasquale Varriale
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France
| | - Emmanuelle Apartis
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France.,Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | - Sophien Mehdi
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France
| | - Anne Blancher-Meinadier
- Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | - Zuzana Kosutzka
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France.,2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Bertrand Degos
- Department of Neurology, Avicenne Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Sorbonne Paris Nord, Bobigny, France.,Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, Université PSL, Paris, France
| | - Solène Frismand
- Department of Neurology, University Hospital of Nancy, Nancy, France
| | - Marion Simonetta-Moreau
- Department of Neurology Toulouse Hospital, Toulouse NeuroImaging Center (ToNIC), INSERM, University Paul Sabatier, UPS, Toulouse, France
| | - Sabine Meunier
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France
| | - Emmanuel Roze
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France.,Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | - Marie Vidailhet
- Institut du Cerveau / Paris Brain Institute, ICM, Hôpital de la Pitié-Salpêtrière, CNRS UMR 7225, Inserm U 1127, Sorbonne Université UM75, Paris, France.,Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
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12
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Thompson R, Bhatti DE, Hellman A, Doss SJ, Malgireddy K, Shou J, Srikanth-Mysore C, Bendi S, Bertoni JM, Torres-Russotto D. Ataxia Prevalence in Primary Orthostatic Tremor. Tremor Other Hyperkinet Mov (N Y) 2020; 10:54. [PMID: 33362948 PMCID: PMC7747757 DOI: 10.5334/tohm.570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022] Open
Abstract
Background The exact pathophysiology of primary Orthostatic Tremor (OT) is unknown. A central oscillator is assumed, and previous imaging studies show involvement of cerebellar pathways. However, the presence of ataxia on clinical exam is disputed. We set out to study ataxia in OT prospectively. Methods EMG-confirmed primary OT subjects and spousal controls received a neurological exam with additional semiquantitative evaluations of ataxia as part of a multinational, prospective study. These included detailed limb coordination (DLC), detailed stance and gait evaluation (DS), and the Brief Ataxia Rating Scale (BARS). Intra- and inter-rater reliability were assessed and satisfactory. Results 34 OT subjects (mean age = 67 years, 88% female) and 21 controls (mean age = 66 years, 65% male) were enrolled. Average disease duration was 18 years (range 4-44). BARS items were abnormal in 88% of OT patients. The OT subjects were more likely to have appendicular and truncal ataxia with significant differences in DLC, DS and BARS. Ocular ataxia and dysarthria were not statistically different between the groups. Discussion Mild-to-moderate ataxia could be more common in OT than previously thought. This is supportive of cerebellar involvement in the pathophysiology of OT. We discuss possible implications for clinical care and future research. Highlights Previous studies of Primary Orthostatic Tremor (OT) have proposed pathophysiologic involvement of the cerebellar pathways.However, presence of ataxia has not been systematically studied in OT.This is a prospective comprehensive ataxia assessment in OT compared to controls. Mild-to-moderate appendiculo-truncal ataxia was found to be common in OT.
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Affiliation(s)
- Rebecca Thompson
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, US
| | - Danish E. Bhatti
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - Amy Hellman
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - Sarah J. Doss
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - Kalyan Malgireddy
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - James Shou
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - Channaiah Srikanth-Mysore
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - Sunil Bendi
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - John M. Bertoni
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
| | - Diego Torres-Russotto
- University of Nebraska Medical Center, Department of Neurological Sciences, Nebraska Medical Center, Omaha, NE, US
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Willacker L, Roccato M, Can BN, Dieterich M, Taylor PCJ. Reducing variability of perceptual decision making with offline theta-burst TMS of dorsal medial frontal cortex. Brain Stimul 2020; 13:1689-1696. [PMID: 33035723 DOI: 10.1016/j.brs.2020.09.011] [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: 11/26/2019] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Recent evidence suggests that the dorsal medial frontal cortex (dMFC) may make an important contribution to perceptual decision-making, and not only to motor control. OBJECTIVE/HYPOTHESIS By fitting psychometric functions to behavioural data after TMS we tested whether the dMFC is critical specifically for the precision and/or bias of perceptual judgements. Additionally we aimed to disentangle potential roles of the dMFC in dealing with perceptual versus response switching. METHODS A subjective visual vertical task (SVV) was used in which participants weight visual (and other, e.g., vestibular) information to establish whether a line is oriented vertically. To ensure a high perceptual demand (putatively necessary to demonstrate a dMFC involvement) SVV lines were presented inside pop-out targets within a visual search array. Distinct features of perceptual performance were analysed before as compared to following theta-burst TMS stimulation of the dMFC, a control site, or no stimulation, in three groups, each of 20 healthy participants. RESULTS dMFC stimulation improved the precision of verticality judgments. Moreover, dMFC stimulation improved accuracy, selectively when response switches occurred with perceptual repeats. CONCLUSION These findings point to a causal role of the dMFC in establishing the precision of perceptual decision making, demonstrably dissociable from an additional role in motor control in attentionally demanding contexts.
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Affiliation(s)
- Lina Willacker
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, D-81377, München, Germany; German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, D-81377, München, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University München, D-82152, Planegg, Germany.
| | - Marco Roccato
- Department of General Psychology, University of Padova, I- 35131, Padova, Italy.
| | - Beril Nisa Can
- Department of Psychology, Ludwig-Maximilians-Universität München, D-80802, München, Germany.
| | - Marianne Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, D-81377, München, Germany; German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, D-81377, München, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University München, D-82152, Planegg, Germany; Synergy - Munich Cluster for Systems Neurology, Munich, D-81377, München, Germany.
| | - Paul C J Taylor
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, D-81377, München, Germany; German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, D-81377, München, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University München, D-82152, Planegg, Germany; Department of Psychology, Ludwig-Maximilians-Universität München, D-80802, München, Germany; Faculty of Philosophy and Philosophy of Science, Ludwig-Maximilians-Universität München, München, Germany; Munich Center for Neurosciences, Ludwig-Maximilians-Universität München, München, Germany.
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14
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Möhwald K, Wuehr M, Schenkel F, Feil K, Strupp M, Schniepp R. The gait disorder in primary orthostatic tremor. J Neurol 2020; 267:285-291. [PMID: 32915312 PMCID: PMC7718181 DOI: 10.1007/s00415-020-10177-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To uncover possible impairments of walking and dynamic postural stability in patients with primary orthostatic tremor (OT). METHODS Spatiotemporal gait characteristics were quantified in 18 patients with primary OT (mean age 70.5 ± 5.9 years, 10 females) and 18 age-matched healthy controls. One-third of patients reported disease-related fall events. Walking performance was assessed on a pressure-sensitive carpet under seven conditions: walking at preferred, slow, and maximal speed, with head reclination or eyes closed, and while performing a cognitive or motor dual-task paradigm. RESULTS Patients exhibited a significant gait impairment characterized by a broadened base of support (p = 0.018) with increased spatiotemporal gait variability (p = 0.010). Walking speed was moderately reduced (p = 0.026) with shortened stride length (p = 0.001) and increased periods of double support (p = 0.001). Gait dysfunction became more pronounced during slow walking (p < 0.001); this was not present during fast walking. Walking with eyes closed aggravated gait disability as did walking during cognitive dual task (p < 0.001). CONCLUSION OT is associated with a specific gait disorder with a staggering wide-based walking pattern indicative of a sensory and/or a cerebellar ataxic gait. The aggravation of gait instability during visual withdrawal and the normalization of walking with faster speeds further suggest a proprioceptive or vestibulo-cerebellar deficit as the primary source of gait disturbance in OT. In addition, the gait decline during cognitive dual task may imply cognitive processing deficits. In the end, OT is presumably a complex network disorder resulting in a specific spino-cerebello-frontocortical gait disorder that goes beyond mere tremor networks.
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Affiliation(s)
- Ken Möhwald
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany. .,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany
| | - Fabian Schenkel
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Feil
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael Strupp
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Roman Schniepp
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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15
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Bicart-Sée L, Thibault JL, Poujois A, Woimant F, Bouquet-Castiglione F, Lozeron P, Kubis N. Associated co-morbidities in a retrospective cohort of orthostatic tremor. J Neurol 2020; 268:467-473. [PMID: 32816109 DOI: 10.1007/s00415-020-10168-z] [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: 05/01/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Orthostatic tremor (OT) is characterized by tremor in orthostatism. Primary OT is characterized by a high-frequency tremor at surface EMG recording and assumed to be idiopathic, whereas slow-frequency OT is classically associated with neurological pathologies. We report here a retrospective monocentric cohort study of primary (fast OT) and pseudo-OT (slow OT) patients to describe associated neurological and non-neurological co-morbidities. METHODS Between November 2014 and October 2019, 27 patients with OT were selected from the EMG database of the Department of Clinical Physiology in Lariboisière' s hospital. Patients were classified in primary OT if tremor frequency was ≥ 13 Hz and in pseudo-OT if tremor frequency was < 13 Hz. RESULTS Leg tremor on standing represented 10.2% of all tremor recordings. Ten patients were included in the primary and 17 in the pseudo-OT group. Females were predominant (62.9%) (p = 0.04). Mean age at diagnosis was 64.8 ± 1.1 years. At the first visit, a movement disorder was associated with 30% of primary OT, among them one CADASIL patient, whereas extrapyramidal or cerebellar disorders were reported in 100% of pseudo-OT, among them three Wilson's disease patients. These pathologies all preceded primary OT and occurred concomitantly with pseudo-OT. Frequency remained unchanged during evolution, except pseudo-OT in two patients that completely resolved following the introduction of antiParkinsonian drugs. Treatment of primary OT was partially effective in 28% and in 50% of pseudo-OT patients. CONCLUSION In this monocentric study, movement disorders were present in 30% of primary OT patients. This result questions the term "idiopathic" or "primary" OT, but the small number of patients does not allow answering this issue.
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Affiliation(s)
- Louise Bicart-Sée
- Service de Physiologie Clinique-Explorations Fonctionnelles, APHP, Hôpital Lariboisière, 75010, Paris, France
| | - Jean-Luc Thibault
- Service de Physiologie Clinique-Explorations Fonctionnelles, APHP, Hôpital Lariboisière, 75010, Paris, France
| | - Aurélia Poujois
- Centre de référence de la Maladie de Wilson et autres maladies rares liees au cuivre, Service de Neurologie, Hôpital Fondation Adolphe de Rothschild, 75019, Paris, France
| | - France Woimant
- Centre de référence de la Maladie de Wilson et autres maladies rares liees au cuivre, AP-HP, Hôpital Lariboisière, Service de Neurologie, 75010, Paris, France
| | | | - Pierre Lozeron
- Service de Physiologie Clinique-Explorations Fonctionnelles, APHP, Hôpital Lariboisière, 75010, Paris, France.,Laboratory for Vascular Translational Science, Université de Paris, INSERM U1148, 75018, Paris, France
| | - Nathalie Kubis
- Service de Physiologie Clinique-Explorations Fonctionnelles, APHP, Hôpital Lariboisière, 75010, Paris, France. .,Laboratory for Vascular Translational Science, Université de Paris, INSERM U1148, 75018, Paris, France.
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16
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Kim HA, Bisdorff A, Bronstein AM, Lempert T, Rossi-Izquierdo M, Staab JP, Strupp M, Kim JS. Hemodynamic orthostatic dizziness/vertigo: Diagnostic criteria. J Vestib Res 2020; 29:45-56. [PMID: 30883381 PMCID: PMC9249281 DOI: 10.3233/ves-190655] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 02/25/2019] [Indexed: 11/15/2022]
Abstract
This paper presents the diagnostic criteria for hemodynamic orthostatic dizziness/vertigo to be included in the International Classification of Vestibular Disorders (ICVD). The aim of defining diagnostic criteria of hemodynamic orthostatic dizziness/vertigo is to help clinicians to understand the terminology related to orthostatic dizziness/vertigo and to distinguish orthostatic dizziness/vertigo due to global brain hypoperfusion from that caused by other etiologies. Diagnosis of hemodynamic orthostatic dizziness/vertigo requires: A) five or more episodes of dizziness, unsteadiness or vertigo triggered by arising or present during upright position, which subsides by sitting or lying down; B) orthostatic hypotension, postural tachycardia syndrome or syncope documented on standing or during head-up tilt test; and C) not better accounted for by another disease or disorder. Probable hemodynamic orthostatic dizziness/vertigo is defined as follows: A) five or more episodes of dizziness, unsteadiness or vertigo triggered by arising or present during upright position, which subsides by sitting or lying down; B) at least one of the following accompanying symptoms: generalized weakness/tiredness, difficulty in thinking/concentrating, blurred vision, and tachycardia/palpitations; and C) not better accounted for by another disease or disorder. These diagnostic criteria have been derived by expert consensus from an extensive review of 90 years of research on hemodynamic orthostatic dizziness/vertigo, postural hypotension or tachycardia, and autonomic dizziness. Measurements of orthostatic blood pressure and heart rate are important for the screening and documentation of orthostatic hypotension or postural tachycardia syndrome to establish the diagnosis of hemodynamic orthostatic dizziness/vertigo.
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Affiliation(s)
- Hyun Ah Kim
- Department of Neurology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Alexandre Bisdorff
- Department of Neurology, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - Adolfo M. Bronstein
- Department of Neuro-otology, Division of Brain Sciences, Imperial College London, Charing Cross Hospital Campus, London, UK
| | - Thomas Lempert
- Department of Neurology, Schlosspark-Klinik, Berlin, Germany
| | | | - Jeffrey P. Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology – Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Dizziness Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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17
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Dijkstra BW, Bekkers EMJ, Gilat M, de Rond V, Hardwick RM, Nieuwboer A. Functional neuroimaging of human postural control: A systematic review with meta-analysis. Neurosci Biobehav Rev 2020; 115:351-362. [PMID: 32407735 DOI: 10.1016/j.neubiorev.2020.04.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/07/2020] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Abstract
Postural instability is a strong risk factor for falls that becomes more prominent with aging. To facilitate treatment and prevention of falls in an aging society, a thorough understanding of the neural networks underlying postural control is warranted. Here, we present a systematic review of the functional neuroimaging literature of studies measuring posture-related neural activity in healthy subjects. Study methods were overall heterogeneous. Eleven out of the 14 studies relied on postural simulation in a supine position (e.g. motor imagery). The key nodes of human postural control involved the brainstem, cerebellum, basal ganglia, thalamus and several cortical regions. An activation likelihood estimation meta-analysis revealed that the anterior cerebellum was consistently activated across the wide range of postural tasks. The cerebellum is known to modulate the brainstem nuclei involved in the control of posture. Hence, this systematic review with meta-analysis provides insight into the neural correlates which underpin human postural control and which may serve as a reference for future neural network and region of interest analyses.
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Affiliation(s)
- Bauke W Dijkstra
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
| | - Esther M J Bekkers
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
| | - Moran Gilat
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
| | - Veerle de Rond
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
| | - Robert M Hardwick
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium; Institute of Neuroscience, Université Catholique De Louvain, Brussels, Belgium.
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
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18
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Yoshii F, Takahashi W, Aono K. Levodopa-Responsive Primary Slow Orthostatic Tremor: A Premotor Sign of Parkinson's Disease? Case Rep Neurol 2020; 12:1-6. [PMID: 32009929 PMCID: PMC6984156 DOI: 10.1159/000504798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 11/23/2022] Open
Abstract
We present a case of primary orthostatic tremor (OT) responsive to dopaminergic medication. The patient was a 62-year-old woman, who had leg tremor on standing for 2 years. No parkinsonian or other neurological signs were observed. Surface electromyography of the quadriceps muscles showed regular 5–6 Hz muscle discharges. [<sup>123</sup>I]-FP-CIT DAT-SPECT imaging revealed decreased specific binding ratio values in the striatum compared with age-matched controls. Her leg tremor almost completely disappeared following administration of levodopa 200 mg and pramipexole 0.75 mg. Since her OT with low-frequency discharge was responsive to dopaminergic medication, we speculate that it may be a premotor sign of Parkinson's disease.
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Affiliation(s)
- Fumihito Yoshii
- Department of Neurology, Saiseikai Shonan Hiratsuka Hospital, Hiratsuka, Japan.,Department of Neurology, Tokai University Oiso Hospital, Naka-gun, Japan
| | - Wakoh Takahashi
- Department of Neurology, Tokai University Oiso Hospital, Naka-gun, Japan
| | - Koji Aono
- Department of Rehabilitation, Isehara Kyodo Hospital, Isehara, Japan
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19
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Benito-León J, Romero JP, Louis ED, Sánchez-Ferro A, Matarazzo M, Molina-Arjona JA, Mato-Abad V. Diffusion tensor imaging in orthostatic tremor: a tract-based spatial statistics study. Ann Clin Transl Neurol 2019; 6:2212-2222. [PMID: 31588694 PMCID: PMC6856595 DOI: 10.1002/acn3.50916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 11/24/2022] Open
Abstract
Objective The pathogenesis of orthostatic tremor (OT) is unknown. We investigated OT‐related white matter changes and their correlations with scores from a neuropsychological testing battery. Methods Diffusion tensor imaging measures were compared between 14 OT patients and 14 age‐ and education‐matched healthy controls, using whole‐brain tract‐based spatial statistics analysis. Correlations between altered diffusion metrics and cognitive performance in OT group were assessed. Results In all cognitive domains (attention, executive function, visuospatial ability, verbal memory, visual memory, and language), OT patients’ cognitive performance was significantly worse than that of healthy controls. OT patients demonstrated altered diffusivity metrics not only in the posterior lobe of the cerebellum (left cerebellar lobule VI) and in its efferent cerebellar fibers (left superior cerebellar peduncle), but also in medial lemniscus bilaterally (pontine tegmentum), anterior limb of the internal capsule bilaterally, right posterior limb of the internal capsule, left anterior corona radiata, right insula, and the splenium of corpus callosum. No relationship was found between diffusion measures and disease duration in OT patients. Diffusion white matter changes, mainly those located in right anterior limb of the internal capsule, were correlated with poor performance on tests of executive function, visuospatial ability, verbal memory, and visual memory in OT patients. Interpretation White matter changes were preferentially located in the cerebellum, its efferent pathways, as well as in the pontine tegmentum and key components of the frontal–thalamic–cerebellar circuit. Further work needs to be done to understand the evolution of these white matter changes and their functional consequences.
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Affiliation(s)
- Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
| | - Juan P Romero
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain.,Brain Damage Unit, Hospital Beata Maria Ana, Madrid, Spain
| | - Elan D Louis
- 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, Connecticut.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Alvaro Sánchez-Ferro
- Department of Neurology, HM CINAC, University Hospital HM Puerta del Sur, Móstoles, Spain.,Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Michele Matarazzo
- Pacific Parkinson's Research Centre and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Virginia Mato-Abad
- Faculty of Biosanitary Sciences, ISLA, Computer Science Faculty, A Coruña University, A Coruña, Spain
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20
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Wang S, Wang H, Zhao D, Liu X, Yan W, Wang M, Zhao R. Grey matter changes in patients with vestibular migraine. Clin Radiol 2019; 74:898.e1-898.e5. [PMID: 31451181 DOI: 10.1016/j.crad.2019.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/22/2019] [Indexed: 01/03/2023]
Abstract
AIM To identify structural changes in the brain regions of patients with vestibular migraine (VM) so as to better understand its pathophysiology. MATERIAL AND METHODS The differences in grey matter (GM) in patients with VM, patients with migraine without aura (MWoA), and healthy controls (HC) were investigated. Using a GE Signa 3 T magnetic resonance imaging (MRI) system, 3D structural images were acquired from 18 VM, 21 MWoA, and 21 age-, gender-, and education level-matched HC using a T1-weighted magnetization-prepared rapid acquisition gradient-echo (MPRAGE) sequence. The volumetric abnormalities of GM were estimated by voxel-based morphometry. Analysis of variance and Bonferroni multiple comparisons were applied. RESULTS Compared with HC, patients with VM had significantly increased GM volume of the right medial superior frontal gyrus (p=0.008) and the right angular gyrus (p=0.009). Compared to patients with MWoA, patients with VM also had significantly increased volume of the right medial superior frontal gyrus (p=0.001), the right angular gyrus (p=0.008), and the left middle frontal gyrus (p=0.001). CONCLUSIONS The GM volume of some brain regions of patients with VM is significantly larger than the other two groups. The increased GM volume in these brain regions in patients with VM may be related to self-adaptation of the nervous system, leading to an abnormal brain sensitization. Some of the brain regions with increased GM volume identified in this study were involved in assessment, integration, and expectations of pain and were strongly related to mood and anxiety.
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Affiliation(s)
- S Wang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266003, China
| | - H Wang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266003, China.
| | - D Zhao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266003, China
| | - X Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266003, China
| | - W Yan
- Department of Neurology, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266003, China
| | - M Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266003, China
| | - R Zhao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Jiangsu Road 16, Qingdao, 266003, China
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21
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Chien JH, Torres-Russotto D, Wang Z, Gui C, Whitney D, Siu KC. The use of smartphone in measuring stance and gait patterns in patients with orthostatic tremor. PLoS One 2019; 14:e0220012. [PMID: 31318952 PMCID: PMC6638990 DOI: 10.1371/journal.pone.0220012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/05/2019] [Indexed: 12/16/2022] Open
Abstract
Orthostatic tremor (OT) is a rare movement disorder characterized by a fast tremor (13–18 Hz) in the lower extremities during stance. Patients with OT typically complain of instability while standing/walking. However, due to the geographical limitation, the standing instability or gait problems in patients with OT cannot be assessed and monitored frequently. The increasing popularity of using smartphone-based accelerometers could be a solution to eliminate this limitation. This study examined the feasibility of using smartphone-based accelerometers to identify the changes in body movement in different standing and locomotor tasks. Twenty patients with OT and seven healthy controls were consented to participate in this study. Subjects stood with eyes open or eyes closed for 20 seconds. They also performed four different locomotor tasks (normal walking, tandem walk, walking on an elevated surface, and obstacle negotiation). When performed different locomotor tasks, patients with OT had a larger acceleration of body movement than controls in the medial-lateral direction (tandem walk: p = 0.026, walking on an elevated surface: p = 0.002, and stepping over the obstacle: p = 0.028). Patients with OT had smaller acceleration of body movement than controls while standing with eyes open in the vertical direction (p = 0.012), in the anterior-posterior direction (p = 0.013) and in the medial-lateral direction (p = 0.011). This study provides objective evidence of balance instability in patients with OT not only while standing but also during different challenging locomotor tasks by using smartphone-based accelerometers.
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Affiliation(s)
- Jung Hung Chien
- Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- * E-mail:
| | - Diego Torres-Russotto
- Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Zhuo Wang
- Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Chenfan Gui
- Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - David Whitney
- Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Ka-Chun Siu
- Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
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22
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Ahmadi SA, Vivar G, Frei J, Nowoshilow S, Bardins S, Brandt T, Krafczyk S. Towards computerized diagnosis of neurological stance disorders: data mining and machine learning of posturography and sway. J Neurol 2019; 266:108-117. [PMID: 31286203 DOI: 10.1007/s00415-019-09458-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
Abstract
We perform classification, ranking and mapping of body sway parameters from static posturography data of patients using recent machine-learning and data-mining techniques. Body sway is measured in 293 individuals with the clinical diagnoses of acute unilateral vestibulopathy (AVS, n = 49), distal sensory polyneuropathy (PNP, n = 12), anterior lobe cerebellar atrophy (CA, n = 48), downbeat nystagmus syndrome (DN, n = 16), primary orthostatic tremor (OT, n = 25), Parkinson's disease (PD, n = 27), phobic postural vertigo (PPV n = 59) and healthy controls (HC, n = 57). We classify disorders and rank sway features using supervised machine learning. We compute a continuous, human-interpretable 2D map of stance disorders using t-stochastic neighborhood embedding (t-SNE). Classification of eight diagnoses yielded 82.7% accuracy [95% CI (80.9%, 84.5%)]. Five (CA, PPV, AVS, HC, OT) were classified with a mean sensitivity and specificity of 88.4% and 97.1%, while three (PD, PNP, and DN) achieved a mean sensitivity of 53.7%. The most discriminative stance condition was ranked as "standing on foam-rubber, eyes closed". Mapping of sway path features into 2D space revealed clear clusters among CA, PPV, AVS, HC and OT subjects. We confirm previous claims that machine learning can aid in classification of clinical sway patterns measured with static posturography. Given a standardized, long-term acquisition of quantitative patient databases, modern machine learning and data analysis techniques help in visualizing, understanding and utilizing high-dimensional sensor data from clinical routine.
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Affiliation(s)
- Seyed-Ahmad Ahmadi
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany. .,Computer Aided Medical Procedures, Technical University of Munich, 85748, Garching, Germany.
| | - Gerome Vivar
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany.,Computer Aided Medical Procedures, Technical University of Munich, 85748, Garching, Germany
| | - Johann Frei
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany.,Computer Aided Medical Procedures, Technical University of Munich, 85748, Garching, Germany
| | - Sergej Nowoshilow
- IMP Research Institute of Molecular Pathology, Campus-Vienna-Biocenter 1, 1030, Vienna, Austria
| | - Stanislav Bardins
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Siegbert Krafczyk
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany
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23
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Santus G, Faletti S, Grandis DD. Orthostatic tremor and behavioral frontotemporal dementia: a case report with 7 years of follow-up. Neurol Sci 2019; 40:2415-2417. [PMID: 31129774 DOI: 10.1007/s10072-019-03924-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Gianna Santus
- Rehabilitation Department, Fondazione Poliambulanza, Istituto Ospedaliero, Via Bissolati 57, 25124, Brescia, Italy
| | - Sofia Faletti
- Rehabilitation Department, Fondazione Poliambulanza, Istituto Ospedaliero, Via Bissolati 57, 25124, Brescia, Italy.
| | - Domenico De Grandis
- Rehabilitation Department, Fondazione Poliambulanza, Istituto Ospedaliero, Via Bissolati 57, 25124, Brescia, Italy
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24
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Mousele C, Bentley P, Tai YF. A Rare Presentation of Orthostatic Tremor as Abdominal Tremor. Tremor Other Hyperkinet Mov (N Y) 2018; 8:603. [PMID: 30622838 PMCID: PMC6315046 DOI: 10.7916/d8w10ptg] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/22/2018] [Indexed: 11/14/2022] Open
Abstract
Background Orthostatic tremor (OT) is a weight-bearing hyperkinetic disorder characterized by unsteadiness while standing that is relieved when sitting or walking. Case report A 66-year-old male presented with a 5 year-history of tremor in his abdomen, but only when he stood in a stationary position. The tremor disappeared when he stood or walked. On examination, he had palpable tremor in his rectus abdominis and gastrocnemius virtually instantaneously after standing. His electromyography findings confirmed the presence of a 12-Hz tremor in the tibialis anterior while standing, with subharmonics recorded in the external obliques and rectus abdominis. Discussion Our case illustrates an unusual presentation of OT. The diagnosis is supported by its characteristic frequency and specific appearance only during upright stance.
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Affiliation(s)
- Christina Mousele
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London WC1N 3BG UK,*To whom correspondence should be addressed. E-mail:
| | - Paul Bentley
- Division of Brain Sciences, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London, W6 8RF UK
| | - Yen F. Tai
- Division of Brain Sciences, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London, W6 8RF UK
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25
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Edwards AE, Guven O, Furman MD, Arshad Q, Bronstein AM. Electroencephalographic Correlates of Continuous Postural Tasks of Increasing Difficulty. Neuroscience 2018; 395:35-48. [DOI: 10.1016/j.neuroscience.2018.10.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/13/2018] [Accepted: 10/23/2018] [Indexed: 12/27/2022]
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26
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Wuehr M, Schlick C, Möhwald K, Schniepp R. Walking in orthostatic tremor modulates tremor features and is characterized by impaired gait stability. Sci Rep 2018; 8:14152. [PMID: 30237442 PMCID: PMC6147915 DOI: 10.1038/s41598-018-32526-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/06/2018] [Indexed: 11/13/2022] Open
Abstract
Primary orthostatic tremor (OT) is characterized by high-frequency lower-limb muscle contractions and a disabling sense of unsteadiness while standing. Patients consistently report a relief of symptoms when starting to ambulate. Here, we systematically examined and linked tremor and gait characteristics in patients with OT. Tremor and gait features were examined in nine OT patients and controls on a pressure-sensitive treadmill for one minute of walking framed by two one-minute periods of standing. Tremor characteristics were assessed by time-frequency analysis of surface EMG-recordings from four leg muscles. High-frequency tremor during standing (15.29 ± 0.17 Hz) persisted while walking but was consistently reset to higher frequencies (16.34 ± 0.25 Hz; p < 0.001). Tremor intensity was phase-dependently modulated, being predominantly observable during stance phases (p < 0.001). Tremor intensity scaled with the force applied during stepping (p < 0.001) and was linked to specific gait alterations, i.e., wide base walking (p = 0.019) and increased stride-to-stride fluctuations (p = 0.002). OT during walking persists but is reset to higher frequencies, indicating the involvement of supraspinal locomotor centers in the generation of OT rhythm. Tremor intensity is modulated during the gait cycle, pointing at specific pathways mediating the peripheral manifestation of OT. Finally, OT during walking is linked to gait alterations resembling a cerebellar and/or sensory ataxic gait disorder.
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Affiliation(s)
- M Wuehr
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.
| | - C Schlick
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany
| | - K Möhwald
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - R Schniepp
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Munich, Germany
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27
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28
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29
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Wuehr M, Schlick C, Möhwald K, Schniepp R. Proprioceptive muscle tendon stimulation reduces symptoms in primary orthostatic tremor. J Neurol 2018; 265:1666-1670. [PMID: 29767354 DOI: 10.1007/s00415-018-8902-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/03/2018] [Accepted: 05/05/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Primary orthostatic tremor (OT) is characterized by high-frequency lower limb muscle contractions and a disabling sense of unsteadiness while standing. To date, therapeutic options for OT are limited. Here, we examined the effects of proprioceptive leg muscle stimulation via muscle tendon vibration (MTV) on tremor and balance control in patients with primary OT. METHODS Tremor in nine patients with primary OT was examined during four conditions: standing (1), standing with MTV on the bilateral soleus muscles (2), lying (3), and lying with MTV (4). Tremor characteristics were assessed by frequency domain analysis of surface EMG recordings from four leg muscles. Body sway was analyzed using posturographic recordings. RESULTS During standing, all patients showed a coherent high-frequency tremor in leg muscles and body sway that was absent during lying (p < 0.001). MTV during standing did not reset tremor frequency, but resulted in a decreased tremor intensity (p < 0.001; mean reduction: 32.5 ± 7.1%) and body sway (p = 0.032; mean reduction: 37.2 ± 6.8%). MTV did not affect muscle activity during lying. Four patients further reported a noticeable relief from unsteadiness during stimulation. CONCLUSION Proprioceptive stimulation did not reset tremor frequency consistent with the presumed central origin of OT. However, continuous MTV influenced the emergence of OT symptoms resulting in reduced tremor intensity, improved posture, and a relief from unsteadiness in half of the examined patients. These findings indicate that MTV either directly interferes with the peripheral manifestation of the central oscillatory pattern or prevents proprioceptive afferent feedback from becoming extensively synchronized at the tremor frequency.
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Affiliation(s)
- M Wuehr
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - C Schlick
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - K Möhwald
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - R Schniepp
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
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30
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Ruiz-Julián M, Orozco JL, Gironell A. Complete Resolution of Symptoms of Primary Orthostatic Tremor with Perampanel. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2018; 8:552. [PMID: 29686940 PMCID: PMC5910539 DOI: 10.7916/d8qz3szd] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/27/2018] [Indexed: 12/01/2022]
Abstract
Background Primary orthostatic tremor (POT) is an infrequent disorder whose physiopathology is unknown. Current medication is largely ineffective or only offers mild benefits. Case Report A 75-year-old female with refractory POT treated with 4 mg/day of perampanel achieved complete symptom resolution. Owing to adverse effects, the patient reduced intake to 2 mg/day, but even at this lower dose the benefit was maintained. Discussion We report the complete resolution of POT symptoms using low doses of perampanel, an antiepileptic drug that blocks glutamate-mediated post-synaptic excitation. Further controlled studies are necessary to confirm this finding.
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Affiliation(s)
- María Ruiz-Julián
- Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Catalonia
| | - Jorge Luís Orozco
- Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Catalonia
| | - Alexandre Gironell
- Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Catalonia
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Antelmi E, Rocchi L, Cocco A, Erro R, Latorre A, Liguori R, Plazzi G, Berardelli A, Rothwell J, Bhatia KP. Cerebellar and brainstem functional abnormalities in patients with primary orthostatic tremor. Mov Disord 2018; 33:1024-1025. [DOI: 10.1002/mds.27331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/04/2018] [Accepted: 01/16/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum; University of Bologna; Bologna Italy
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology; University College London; London United Kingdom
| | - Lorenzo Rocchi
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology; University College London; London United Kingdom
| | - Antoniangela Cocco
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology; University College London; London United Kingdom
| | - Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology; University College London; London United Kingdom
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry; University of Salerno; Salerno Italy
| | - Anna Latorre
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology; University College London; London United Kingdom
- Department of Neurology and Psychiatry; “Sapienza” University of Rome; Rome Italy
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum; University of Bologna; Bologna Italy
- IRCCS, Institute of Neurological Sciences; Bologna Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum; University of Bologna; Bologna Italy
- IRCCS, Institute of Neurological Sciences; Bologna Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry; “Sapienza” University of Rome; Rome Italy
- Neuromed Institute; “Sapienza” University of Rome; Rome Italy
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology; University College London; London United Kingdom
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology; University College London; London United Kingdom
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32
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Maugest L, McGovern EM, Mazalovic K, Doulazmi M, Apartis E, Anheim M, Bourdain F, Benchetrit E, Czernecki V, Broussolle E, Bonnet C, Falissard B, Jahanshahi M, Vidailhet M, Roze E. Health-Related Quality of Life Is Severely Affected in Primary Orthostatic Tremor. Front Neurol 2018; 8:747. [PMID: 29379467 PMCID: PMC5775514 DOI: 10.3389/fneur.2017.00747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/27/2017] [Indexed: 12/17/2022] Open
Abstract
Background Primary orthostatic tremor (POT) is a movement disorder characterized by unsteadiness upon standing still due to a tremor affecting the legs. It is a gradually progressive condition with limited treatment options. Impairments in health-related quality of life (HQoL) seem to far exceed the physical disability associated with the condition. Methods A multi-center, mixed-methodology study was undertaken to investigate 40 consecutive patients presenting with POT to four movement disorder centers in France. HQoL was investigated using eight quantitative scales and a qualitative study which employed semi-structured interviews. Qualitative data were analyzed with a combination of grounded-theory approach. Results Our results confirm that HQoL in POT is severely affected. Fear of falling was identified as the main predictor of HQoL. The qualitative arm of our study explored our initial results in greater depth and uncovered themes not identified by the quantitative approach. Conclusion Our results illustrate the huge potential of mixed methodology in identifying issues influencing HQoL in POT. Our work paves the way for enhanced patient care and improved HQoL in POT and is paradigmatic of this modern approach for investigating HQoL issues in chronic neurological disorders.
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Affiliation(s)
- Lucie Maugest
- Département de Neurologie, EA 4184, Hôpital universitaire de Dijon, Dijon, France
| | - Eavan M McGovern
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Katia Mazalovic
- Département de Médecine générale, Faculté de Médecine, Université de Bourgogne, Dijon, France
| | - Mohamed Doulazmi
- Sorbonne Universités, UPMC Univ Paris 06, UMR8256, INSERM, CNRS, Institut de Biologie Paris Seine, Adaptation Biologique et Vieillissement, Paris, France
| | - Emmanuelle Apartis
- Département de Neurophysiologie, Hôpital de Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathieu Anheim
- Département de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Illkirch-Graffenstaden, France.,Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Frédéric Bourdain
- Département de Neurologie, Centre médico-chirurgical Foch, Suresnes, France
| | - Eve Benchetrit
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Virginie Czernecki
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Broussolle
- Département de Neurologie, Service de Mouvements anormaux, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon I, Faculté de Médecine Lyon Sud Charles Mérieux, Institut des Sciences Cognitives Marc Jeannerod, CNRS UMR 5229, Lyon, France
| | - Cecilia Bonnet
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bruno Falissard
- CESP, Univ. Paris-Sud, Université Paris-Saclay, UVSQ, INSERM U1178, Paris, France
| | - Marjan Jahanshahi
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
| | - Marie Vidailhet
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,UMR S 975, CNRS UMR 7225, ICM, Sorbonne Universités, UPMC Université Paris, Paris, France
| | - Emmanuel Roze
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,UMR S 975, CNRS UMR 7225, ICM, Sorbonne Universités, UPMC Université Paris, Paris, France
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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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Lenka A, Pal PK, Bhatti DE, Louis ED. Pathogenesis of Primary Orthostatic Tremor: Current Concepts and Controversies. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:513. [PMID: 29204315 PMCID: PMC5712672 DOI: 10.7916/d8w66zbh] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/31/2017] [Indexed: 12/01/2022]
Abstract
Background Orthostatic tremor (OT), a rare and complex movement disorder, is characterized by rapid tremor of both legs and the trunk while standing. These disappear while the patient is either lying down or walking. OT may be idiopathic/primary or it may coexist with several neurological conditions (secondary OT/OT plus). Primary OT remains an enigmatic movement disorder and its pathogenesis and neural correlates are not fully understood. Methods A PubMed search was conducted in July 2017 to identify articles for this review. Results Structural and functional neuroimaging studies of OT suggest possible alterations in the cerebello-thalamo-cortical network. As with essential tremor, the presence of a central oscillator has been postulated for OT; however, the location of the oscillator within the tremor network remains elusive. Studies have speculated a possible dopaminergic deficit in the pathogenesis of primary OT; however, the evidence in favor of this concept is not particularly robust. There is also limited evidence favoring the concept that primary OT is a neurodegenerative disorder, as a magnetic resonance spectroscopic imaging study revealed significant reduction in cerebral and cerebellar N-acetyl aspartate (NAA) levels, a marker of neuronal compromise or loss. Discussion Based on the above, it is clear that the pathogenesis of primary OT still remains unclear. However, the available evidence most strongly favors the existence of a central oscillatory network, and involvement of the cerebellum and its connections.
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Affiliation(s)
- Abhishek Lenka
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India.,Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Danish Ejaz Bhatti
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - 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
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Nonmotor Symptoms in Essential Tremor and Other Tremor Disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1373-1396. [PMID: 28805576 DOI: 10.1016/bs.irn.2017.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Tremor, like dystonia, is a term used at the phenomenological, syndromic, and aetiopathological level. Parkinsonian, essential, and dystonic tremor are the three most common tremor diagnoses encountered in clinical practice. Investigation of nonmotor symptoms in essential tremor and dystonic tremor syndromes is significantly hampered by the lack of clear clinical diagnostic criteria for these groups at a syndromic level, and the absence of biomarkers which allow definitive diagnosis at an aetiopathological level. Much work is needed in clarifying the motor features of these disorders in order to allow delineation of the nonmotor features of the most common tremor syndromes. With this limitation in mind, this chapter reviews what is known about nonmotor symptoms in these two tremor types. The final sections deal with nonmotor symptoms observed in patients with lesional tremor, thankfully a much more clearly defined albeit less common group of patients.
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