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Piarroux J, Dimopoulou E, Taieb G, Souvannanorath S, Roze E, Lion-François L, Spitz MA, Broussolle E, Laurencin C, Chanson JB, Belleville-Goffeney J, François-Heude MC, Meyer P, Khalil M, Dereure M, Doummar D, Chevassus H, Apartis E, Roubertie A. Clinical and Electrophysiological Characterization of Essential Tremor in 18 Children and Adolescents. Tremor Other Hyperkinet Mov (N Y) 2023; 13:46. [PMID: 38145278 PMCID: PMC10742103 DOI: 10.5334/tohm.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/03/2023] [Indexed: 12/26/2023] Open
Abstract
Background Essential tremor (ET) is considered the most frequent abnormal movement in the general population, with childhood onset in 5 to 30% of the patients. Methods A multicenter, descriptive cross-sectional study enrolled patients ⩽18 years with a definite diagnosis of ET according to the International Parkinson and Movement Disorders Society criteria. Demographic data, clinical and electrophysiological characteristics of the tremor, neurological examination and impact on quality of life were collected. Results 9 males and 9 females were included (mean age of 13.9 years). Tremor was characterized by : upper limb onset at a mean age of 6.5 years; at enrollment, upper limbs localization, and involvement of an additional body region in 28% of the patients; kinetic tremor in all of the patients combined with postural tremor in 17 and rest tremor in 3; tremor mean frequency of 7.6 Hz, mean burst duration of 82.7 ms; identification of mild myoclonic jerks on the polymyographic recordings in 7 patients; altered quality of life with worse emotional outcomes in girls and when a disease duration >5 years was suggested. Discussion Childhood-onset ET is associated with delayed diagnosis and remarkable functional impact. Electromyographic identification of additional mild myoclonus is a new finding whose significance is discussed. Highlights ET onset involved upper limbs and at inclusion, 28% of the patients exhibited involvement of an additional body region.ET impacted quality of life for all patients.Girls and patients affected for >5 years reported worse emotional outcomes.Mild myoclonic jerks were identified on 7/17 polymyographic recordings.
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Affiliation(s)
- Julie Piarroux
- Department of Pediatric Neurology, Gui de Chauliac University Hospital, Montpellier, France
| | - Evgenia Dimopoulou
- Department of Pediatric Neurology, Gui de Chauliac University Hospital, Montpellier, France
| | - Guillaume Taieb
- University of Montpellier, CNRS (IGF), Department of Neurology, Montpellier, University Hospital 34295 Montpellier, France
| | - Sarah Souvannanorath
- Reference center for neuromuscular diseases, Henri-Mondor University Hospital, Assistance publique-Hôpitaux de Paris, Créteil, France
| | - Emmanuel Roze
- Department of Neurology, Salpêtrière Hospital, Sorbonne University and Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Marie-Aude Spitz
- Department of Pediatry, Strasbourg University Hospitals, Strasbourg, France
| | - Emmanuel Broussolle
- Research Unit UMR 5229, Marc-Jeannerod Institute of Cognitive Science, French National Center for Scientific Research (CNRS), University of Lyon, Bron, France
- Department of Neurology C, Civil Hospices of Lyon, Pierre-Wertheimer Neurological Hospital, Bron, France
- Faculty of Medicine Lyon-Sud Charles-Mérieux, University of Lyon, Oullins, France
| | - Chloé Laurencin
- Department of Neurology C, Civil Hospices of Lyon, Pierre-Wertheimer Neurological Hospital, Bron, France
- Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292, University Lyon 1, Lyon F-69000, France
| | - Jean-Baptiste Chanson
- Department of Neurology, Strasbourg University Hospitals, Strasbourg, France and Reference centre for neuromuscular diseases Nord/Est/Ile-de-France, France
| | | | | | - Pierre Meyer
- Department of Pediatric Neurology, Gui de Chauliac University Hospital, Montpellier, France
| | - Mirna Khalil
- Clinical Investigation Center, Montpellier University Hospital, France. INSERM, CIC1411, Montpellier, France
| | - Maelle Dereure
- Clinical Research and Epidemiology Unit, La Colombière University Hospital, Montpellier, France
| | - Diane Doummar
- Department of Pediatric Neurology and developmental pathologies, Sorbonne University and Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France, APHP. SU, FHU I2D2, F-75012, Paris, France
| | - Hugues Chevassus
- Clinical Investigation Center, Montpellier University Hospital, France. INSERM, CIC1411, Montpellier, France
| | - Emmanuelle Apartis
- Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, INSERM U1127, CNRS UMR7225, UM75, ICM, 75013 Paris, France
| | - Agathe Roubertie
- Department of Pediatric Neurology, Gui de Chauliac University Hospital, Montpellier, France
- Institute for Neurosciences of Montpellier, INSERM U 1298, University of Montpellier, Montpellier, France
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Kocaman GE, Ardıçlı D, Yılmaz D. Clinical and laboratory features of children with tremor: a single-center experience. Acta Neurol Belg 2022; 122:479-484. [PMID: 34618342 DOI: 10.1007/s13760-021-01804-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022]
Abstract
AIM Tremor is an involuntary, rhythmic, oscillatory movement of body parts around a central point or plane which arises from contraction of antagonist muscles. Evaluation of pediatric patients with tremor can be challenging due to limited population-based studies in children. The aim of this study is to evaluate the demographic, clinical and laboratory features of childhood tremor, retrospectively. MATERIALS AND METHODS Patients under the age of 18 years presenting with tremor (n = 111) to the Pediatric Neurology Unit of Kecioren Research and Training Hospital between January 2014 and December 2019 were included in the study. Patients with neuromuscular disease, vertebral pathology or incomplete data in hospital records were not included. Also, benign tremor causes (jitteriness, shuddering attack, etc.) seen in the neonatal and infancy period were excluded from the study as the number of patients was insufficient. Demographic data, type and duration of tremor, accompanying symptoms, chronic diseases and medications, family history, physical and neurological examination, laboratory findings, neuroimaging findings were retrospectively analyzed and recorded. RESULTS A total of 111 children (59 girls and 52 boys) were included in our study and the female to male ratio was 1.1. The mean age at tremor onset and age at admission to hospital were 13.2 ± 2.8 years (range 4-17 years), and 14.8 ± 2.0 years (range 6-17 years), respectively. The most common type of tremor was essential tremor (62.2%), followed by enhanced physiologic (18.9%). None of the patients had acute metabolic disorder. Diagnostic tests revealed the etiology in 12 patients. These were vitamin B12 deficiency in 11 patients and multiple sclerosis in one patient. Drug-induced and task-specific tremors were determined in 4 patients each. It was determined that in patients with a positive family history, tremor appeared or was noticed at a younger age. CONCLUSIONS Most of the cases with tremor can be diagnosed accurately by a detailed medical history, physical and neurological examination. Essential tremor is the most common type of tremor in children. Laboratory tests and imaging methods have limited additional yield in elucidating the etiology. Early recognition of tremor and related signs and symptoms in childhood is important for the detection and treatment of the possible underlying cause.
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Affiliation(s)
- Gizem Eşme Kocaman
- Department of Pediatrics, Ankara Kecioren Training and Research Hospital, Ankara, Turkey.
| | - Didem Ardıçlı
- Department of Pediatric Neurology, Ankara Kecioren Training and Research Hospital, Ankara, Turkey
- Department of Pediatric Neurology, Ankara City Hospital, Ankara, Turkey
| | - Deniz Yılmaz
- Department of Pediatric Neurology, Ankara Kecioren Training and Research Hospital, Ankara, Turkey
- Department of Pediatric Neurology, Ankara City Hospital, Ankara, Turkey
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Louis ED, Kuo SH, Tate WJ, Kelly GC, Faust PL. Cerebellar pathology in childhood-onset vs. adult-onset essential tremor. Neurosci Lett 2017; 659:69-74. [PMID: 28867587 DOI: 10.1016/j.neulet.2017.08.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 01/04/2023]
Abstract
Although the incidence of ET increases with advancing age, the disease may begin at any age, including childhood. The question arises as to whether childhood-onset ET cases manifest the same sets of pathological changes in the cerebellum as those whose onset is during adult life. We quantified a broad range of postmortem features (Purkinje cell [PC] counts, PC axonal torpedoes, a host of associated axonal changes [PC axonal recurrent collateral count, PC thickened axonal profile count, PC axonal branching count], heterotopic PCs, and basket cell rating) in 60 ET cases (11 childhood-onset and 49 adult-onset) and 30 controls. Compared to controls, childhood-onset ET cases had lower PC counts, higher torpedo counts, higher heterotopic PC counts, higher basket cell plexus rating, and marginally higher PC axonal recurrent collateral counts. The median PC thickened axonal profile count and median PC axonal branching count were two to five times higher in childhood-onset ET than controls, but the differences did not reach statistical significance. Childhood-onset and adult-onset ET had similar PC counts, torpedo counts, heterotopic PC counts, basket cell plexus rating, PC axonal recurrent collateral counts, PC thickened axonal profile count and PC axonal branching count. In conclusion, we found that childhood-onset and adult-onset ET shared similar pathological changes in the cerebellum. The data suggest that pathological changes we have observed in the cerebellum in ET are a part of the pathophysiological cascade of events in both forms of the disease and that both groups seem to reach the same pathological endpoints at a similar age of death.
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Affiliation(s)
- 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, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - William J Tate
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Geoffrey C Kelly
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
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Ghosh D, Brar H, Lhamu U, Rothner AD, Erenberg G. A Series of 211 Children with Probable Essential Tremor. Mov Disord Clin Pract 2016; 4:231-236. [PMID: 30363473 DOI: 10.1002/mdc3.12385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 11/09/2022] Open
Abstract
Background The objective of this study was to characterize the clinical features, course, and treatment of essential tremor (ET) in children. Methods A retrospective chart review was conducted over 25 years (1984-2011). Inclusion criteria were age <21 years and satisfying the core diagnostic criteria for ET. Primary exclusion criteria included other neurological findings, tremorogenic medications, sudden onset/stepwise progression, primary orthostatic tremor, and isolated task specificity; and secondary exclusion criteria were abnormal neuroimaging or metabolic/thyroid studies. Cases were reviewed for age, sex, family history, tremor characteristics, functional impairment, treatment, and follow-up. Results In total, 211 children had ET, including 130 males and 81 females. The mean ± standard deviation age was at diagnosis was 14.09 ± 5.0 years, the age of onset was 9.71 ± 5.62 years, and the age of onset was birth in 7 children. One hundred ninety-nine children had bilateral hand tremor, 34 had asymmetry, 9 had unilateral onset but later became bilateral. Twelve children had voice tremors, 13 had leg tremors, 5 had head tremors, and 7 had trunk tremors. Tremor at rest was present in 20 children. Thirty-five percent of the children had a family history of ET, including in a father (n = 21), mother (n = 13), brother (n = 6), sister (n = 3), and other family member (n = 28). Fifty-five percent of patients had functional disabilities, including writing (n = 66), eating (n = 28) drinking from a cup (n = 13), typing (n = 4), playing instruments (n = 6), buttoning (n = 6), and playing (n = 3). For treatment, 33 patients received propranolol, 1 received atenolol, 13 received primidone, 3 received metoprolol, and 1 received nadolol. In total, 99 patients were followed for a mean ± standard deviation of 1.82 ± 2.21 years.If left untreated, tremor remained unchanged in 33 patients, and 7 had an apparent short-term improvement. On propranolol, 15 of 20 patients significantly improved. Conclusions This is the largest series to date of ET in children. The current findings indicate that onset at birth is possible, family history is less common in children than in adults, and tremor at rest is possible. Functional disability was noted in 55% of children, and 29.4% required medication.
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Affiliation(s)
- Debabrata Ghosh
- Departments of Neurology and Pediatrics Nationwide Children's Hospital Ohio State University Medical Center Columbus Ohio USA
| | - Harmeet Brar
- Pediatric Neurology Center Children's Hospital Cleveland Clinic Cleveland Ohio USA
| | - Ugen Lhamu
- Department of Pediatrics New York Metropolitan Hospital New York New York USA
| | - A David Rothner
- Pediatric Neurology Center Children's Hospital Cleveland Clinic Cleveland Ohio USA
| | - Gerald Erenberg
- Pediatric Neurology Center Children's Hospital Cleveland Clinic Cleveland Ohio USA
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Van Gerpen JA, Ross OA. Essential Tremor. Mov Disord 2015. [DOI: 10.1016/b978-0-12-405195-9.00036-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Louis ED, Ottman R. Is there a one-way street from essential tremor to Parkinson's disease? Possible biological ramifications. Eur J Neurol 2013; 20:1440-4. [PMID: 24033795 DOI: 10.1111/ene.12256] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 07/26/2013] [Indexed: 11/28/2022]
Abstract
There is considerable evidence for an association between essential tremor (ET) and Parkinson's disease (PD), although the topic remains somewhat controversial. An important issue, not previously addressed, is what seems to be the unidirectional nature of the relationship (ET→ET + PD and not PD→PD + ET). The aims of this review are (i) to discuss the evidence for and against a unidirectional relationship and (ii) to discuss the implications of such a unidirectional relationship, if it exists, for disease mechanisms. Evidence 'for' a unidirectional relationship includes (i) abundant clinical anecdotal observation and (ii) clinical and epidemiological studies. Evidence 'against' is theoretical rather than empirical. Overall, the evidence 'for' is stronger, although additional studies are needed in order to be certain; for the time being, it might be best to leave this as an open question. The biological ramifications/extensions of such a unidirectional relationship include (i) that the association is causal (i.e., some aspect of ET pathophysiology predisposes an individual to develop PD) and (ii) that some ET cases may have a circumscribed form of Lewy body disease, and the secondary development of PD may represent a spread of those Lewy bodies in the brainstem. The presence and nature of the links between ET and PD are controversial. Further primary data (epidemiological and pathological) are needed to improve understanding of the relationship and its implications for the pathogenesis of both disorders.
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Affiliation(s)
- E D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Louis ED. When do essential tremor patients develop head tremor? Influences of age and duration and evidence of a biological clock. Neuroepidemiology 2013; 41:110-5. [PMID: 23860504 DOI: 10.1159/000351698] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 04/09/2013] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Essential tremor (ET) is a chronic, progressive neurological disease. Head (neck) tremor may eventually develop in as many as 30-60% of patients, yet it is unclear why. Is its appearance merely a function of advancing disease duration? Alternatively, is patient age a primary factor? The latter would argue for the presence of a biological clock that is important for the expression of this clinical feature of ET. METHODS A total of 363 ET patients were enrolled in a cross-sectional, clinical-epidemiological study. Each ET patient underwent a 20-min videotaped neurological examination which included an assessment of the presence/absence of head tremor. RESULTS Head tremor was present on examination in 140 (38.6%) patients. Young patients, even with longer-duration tremor, rarely had head tremor: 2/27 (7.4%) patients<40 years old with tremor duration≥10 years had head tremor versus 121/283 (42.8%) older patients (>60 years old) with tremor duration≥10 years (p<0.001). In a multivariate logistic regression analysis, while head tremor was associated with age (p<0.001) it was not independently associated with tremor duration (p=0.26); interestingly, it was associated with gender in that model (p<0.001). With the exception of 1 patient, head tremor did not begin before the age of 36. CONCLUSIONS Data suggest that the appearance of head tremor in ET depends on a biological factor that is intrinsic to the patient (i.e. age) and is not a clear consequence of advancing disease duration.
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Affiliation(s)
- Elan D Louis
- G.H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY 10032, USA.
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&NA;. Essential tremor in children is generally mild, but some patients may require pharmacological treatment. DRUGS & THERAPY PERSPECTIVES 2010. [DOI: 10.2165/11205170-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Seiler FA, Lew SM. Aqueductal stenosis presenting as isolated tremor: case report and review of the literature. Pediatr Neurosurg 2010; 46:392-5. [PMID: 21412026 DOI: 10.1159/000323419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 12/03/2010] [Indexed: 11/19/2022]
Abstract
Essential tremor is rare in children, particularly in the absence of a significant family history. We report the case of a child with compensated hydrocephalus secondary to aqueductal stenosis whose sole presenting symptom was tremor. An otherwise healthy 6-year-old male developed a fine hand tremor, which over the course of 4 years both increased in intensity and spread to involve the lower limbs and head. After an MRI had confirmed hydrocephalus due to aqueductal stenosis, the patient underwent an endoscopic third ventriculostomy. His tremor improved markedly, but did not completely resolve. Occult hydrocephalus should be considered in the differential diagnosis of new-onset tremor. Progression of the tremor should halt with treatment of the hydrocephalus, and clinical improvement may be seen.
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Affiliation(s)
- F Arran Seiler
- Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA.
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Abstract
Essential tremor (ET) is a common, often familial, movement disorder characterized by tremor of the limbs, head, and voice. Epidemiological surveys indicate that up to 5% of the adult population has ET, and 5-30% of adults with ET report symptom onset during childhood. There is, however, little published regarding ET in the pediatric population, and no prospective studies targeted specifically to children. Retrospective studies from subspecialty movement disorder clinics indicate that childhood-onset ET is usually hereditary, begins at a mean age of 6 years, and affects boys three times as often as girls. While ET occasionally results in disability during childhood, only one-quarter of children seeing a neurologist for ET require pharmacotherapy. Small case series suggest that propranolol is effective in approximately 50% of children with ET, but controlled treatment trials are lacking.
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Affiliation(s)
- Joseph Ferrara
- Parkinson Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA
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Tan EK, Lee SS, S FC, Lum SY. Evidence of increased odds of essential tremor in Parkinson's disease. Mov Disord 2008; 23:993-997. [PMID: 18383536 DOI: 10.1002/mds.22005] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In a case control study using a standardized protocol, 600 subjects were evaluated for essential tremor (ET). We demonstrated that ET was significantly more frequent in patients with Parkinson's disease (PD) (12/204, 5.9%) compared to diseased controls (2/206, 1%) and healthy controls (1/190, 0.5%). A regression analysis with ET as outcome and group (either PD or healthy controls or diseased controls) as independent variable (adjusting for age and sex) revealed that PD had higher odds of having ET than diseased controls (OR = 5.43, 95% CI = 1.16, 25.39, P < 0.001) and healthy controls (OR = 10.87, 95% CI = 1.39, 85.15, P < 0.001). The low frequency of ET in our controls was further confirmed in a follow-up study in a group of age and gender matched general medical patients who attended an outpatient clinic (0% frequency). Eight of 204 PD (3.9%) compared to none of diseased (0%) (P = 0.004) and healthy controls (0%) (P = 0.008) had a prior diagnosis of ET. The duration of ET symptoms in patients with PD was 25.1 +/- 19.6 (range 3-60) years. A multivariate analysis demonstrated that a lower dose of levodopa (OR = 0.993, 95%CI for OR = 0.988, 0.997, P < 0.001) and a higher age of onset of disease (OR = 1.108, 95%CI for OR = 1.035, 1.187, P < 0.001) were associated with increased odds of PD with ET, compared to patients with PD without ET. In our Asian population, patients with PD were 5 to 10 times more likely to have ET compared to diseased and healthy controls, suggesting that the association of ET and PD is unlikely to be ethnicity-specific.
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Affiliation(s)
- Eng-King Tan
- Department of Neurology, Singapore General Hospital, National Neuroscience Institute, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Seng-Swim Lee
- Department of Medicine, Singapore General Hospital, Singapore
| | - Fook-Chong S
- Department of Clinical Research, Singapore General Hospital, Singapore
| | - Sau-Ying Lum
- Department of Neurology, Singapore General Hospital, National Neuroscience Institute, Singapore
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Louis ED, Keating GA, Bogen KT, Rios E, Pellegrino KM, Factor-Litvak P. Dietary epidemiology of essential tremor: meat consumption and meat cooking practices. Neuroepidemiology 2008; 30:161-6. [PMID: 18382115 DOI: 10.1159/000122333] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 01/23/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM Harmane [1-methyl-9H-pyrido(3,4-b)indole] is a tremor-producing neurotoxin. Blood harmane concentrations are elevated in essential tremor (ET) patients for unclear reasons. Potential mechanisms include increased dietary harmane intake (especially through well-cooked meat) or genetic-metabolic factors. We tested the hypothesis that meat consumption and level of meat doneness are higher in ET cases than in controls. METHODS Detailed data were collected using the Lawrence Livermore National Laboratory Meat Questionnaire. RESULTS Total current meat consumption was greater in men with than without ET (135.3 +/- 71.1 vs. 110.6 +/- 80.4 g/day, p = 0.03) but not in women with versus without ET (80.6 +/- 50.0 vs. 79.3 +/- 51.0 g/day, p = 0.76). In an adjusted logistic regression analysis in males, higher total current meat consumption was associated with ET (OR = 1.006, p = 0.04, i.e., with 10 additional g/day of meat, odds of ET increased by 6%). Male cases had higher odds of being in the highest than lowest quartile of total current meat consumption (adjusted OR = 21.36, p = 0.001). Meat doneness level was similar in cases and controls. CONCLUSION This study provides evidence of a dietary difference between male ET cases and male controls. The etiological ramifications of these results warrant additional investigation.
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Neurological outcomes in children with and without amalgam-related mercury exposure: seven years of longitudinal observations in a randomized trial. J Am Dent Assoc 2008; 139:138-45. [PMID: 18245680 DOI: 10.14219/jada.archive.2008.0128] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although large-scale, randomized trials involving children have been completed and their results demonstrate an absence of neurobehavioral effects from clinical exposure to mercury amalgam, neurological findings from such studies have not been reported. METHODS The authors conducted a randomized, prospective trial examining the safety of dental amalgam in which 507 children aged 8 through 12 years were assigned to treatment with either amalgam or resin-based composite. During seven years of follow-up, the authors performed annual clinical neurological examinations, including an evaluation of neurological hard signs (NHSs), presence of tremor and neurological soft signs (NSSs). RESULTS The authors found no significant differences between treatment groups in any of the neurological measures. Groups did not differ with respect to the presence or absence of NHSs or tremor, nor the presence or absence or severity of NSSs at any point. As expected, NSS severity scores diminished with increasing age. CONCLUSIONS Even at the levels of amalgam exposure in this study (a mean of 7.7-10.7 amalgam surfaces per subject across the seven years of follow-up), the authors conclude that exposure to mercury from dental amalgam does not adversely affect neurological status. CLINICAL IMPLICATIONS The current evidence is that potential neurobehavioral or neurological effects from dental amalgam mercury exposure in children are inconsequential.
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