1
|
Zhao B, Zhao C, Zhao Y. Steroid-Responsive Myorhythmia in Pectoralis Muscles. JAMA Neurol 2024:2820253. [PMID: 38949818 DOI: 10.1001/jamaneurol.2024.2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
This case report describes a patient experiencing involuntary contractions in his right pectoralis muscles with anti-Tr antibodies in his serum, which is characteristic of myorhythmia.
Collapse
Affiliation(s)
- Bing Zhao
- Department of Neurology, Qilu Hospital of Shandong University (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Cuiping Zhao
- Department of Neurology, Qilu Hospital of Shandong University (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Yuying Zhao
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| |
Collapse
|
2
|
Panyakaew P, Phuenpathom W, Bhidayasiri R, Hallett M. Bedside clinical assessment of patients with common upper limb tremor and algorithmic approach. ASIAN BIOMED 2024; 18:37-52. [PMID: 38708334 PMCID: PMC11063083 DOI: 10.2478/abm-2024-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
The diagnostic approach for patients with tremor is challenging due to the complex and overlapping phenotypes among tremor syndromes. The first step in the evaluation of tremor is to identify the tremulous movement and exclude the tremor mimics. The second step is to classify the tremor syndrome based on the characteristics of tremor from historical clues and focused examination (Axis 1). Comprehensive tremor examinations involve the assessment of tremor in different conditions (rest, action or mixed, position or task-specific), distribution of tremor (upper limb, lower limb, head, jaw), positive signs for functional tremor (FT) if suspected (distractibility, entrainment, co-contraction), and associated neurological signs including parkinsonism, dystonic posture, cerebellar/brainstem signs, neuropathy, and cognitive impairment. A pivotal feature in this step is to determine any distinct feature of a specific isolated or combined tremor syndrome. In this review, we propose an algorithm to assess upper limb tremors. Ancillary testing should be performed if clinical evaluation is unclear. The choice of investigation depends on the types of tremors considered to narrow down the spectrum of etiology (Axis 2). Laboratory blood tests are considered for acute onset and acute worsening of tremors, while structural neuroimaging is indicated in unilateral tremors with acute onset, nonclassical presentations, and a combination of neurological symptoms. Neurophysiological study is an important tool that aids in distinguishing between tremor and myoclonus, etiology of tremor and document specific signs of FT. Treatment is mainly symptomatic based depending on the etiology of the tremor and the patient's disabilities.
Collapse
Affiliation(s)
- Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok10330, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Warongporn Phuenpathom
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok10330, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok10330, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok10330, Thailand
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892-1428, USA
| |
Collapse
|
3
|
Yang X, Liu Q, Lai MF, Ma XH, Hao XT, Xu JJ, Guo WJ. Case report: Orthostatic leg tremor as the initial manifestation in a patient with metabotropic glutamate receptor-5 encephalitis without cortical dysfunction: complexities in identification and treatment. Front Neurol 2023; 14:1288075. [PMID: 38162450 PMCID: PMC10755007 DOI: 10.3389/fneur.2023.1288075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Objective Metabotropic glutamate receptor 5 (mGluR5) encephalitis is such a rare type of autoimmune encephalitis that its diagnosis remains a challenge. Case report A 19-year-old female patient initially presented with anxiety and orthostatic leg tremors without cortical dysfunction. We found that this patient was positive for mGluR5 antibodies in both serum (1:1,000) and cerebrospinal fluid (1:32). After comprehensive intervention, the patient showed complete recovery at the 18-month follow-up. Discussion This report expands our knowledge of the possible presentations of mGluR5 encephalitis for early diagnosis, which makes it possible to prevent serious consequences and improve the prognosis.
Collapse
Affiliation(s)
- Xia Yang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qiong Liu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ming-feng Lai
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiao-hong Ma
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiao-ting Hao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jia-jun Xu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wan-jun Guo
- Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
| |
Collapse
|
4
|
Liatis T, Bhatti SFM, Dyrka M, Gutierrez‐Quintana R, Gonçalves R, Madden M, De Decker S. Idiopathic and structural episodic nonintentional head tremor in dogs: 100 cases (2004-2022). J Vet Intern Med 2023; 37:2301-2309. [PMID: 37850712 PMCID: PMC10658580 DOI: 10.1111/jvim.16880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Although idiopathic episodic head tremor (IEHT) in dogs is well-known, little is known about structural brain lesions causing structural episodic head tremor (SEHT). HYPOTHESIS/OBJECTIVES Describe semiology, magnetic resonance imaging (MRI) findings and outcome of dogs with IEHT or SEHT. We hypothesized that structural lesions affecting the middle cranial fossa or mesencephalic aqueduct could lead to SEHT. ANIMALS One hundred dogs with IEHT (n = 71) or SEHT (n = 29). METHODS Retrospective, multicenter, study of dogs with episodic (nonintentional) head tremor and brain MRI between 2004 and 2022. RESULTS Lesions on MRI in SEHT dogs were localized to the middle cranial fossa (15/29), cerebrocortex (3/29), brainstem (2/29), fourth ventricle (1/29) or multifocal (8/29) with thalamus involvement (6/8). Secondary compression of the mesencephalic aqueduct (19/29), third ventricle or interthalamic adhesion or both (14/29) was common. The most common underlying condition in dogs with SEHT was a pituitary mass. Dogs with SEHT were older, had additional neurological signs and were more likely to be euthanized after diagnosis (P < .001 for all) compared to IEHT dogs. Two SEHT dogs had only tremor. In IEHT dogs, 8/10 owners reported that the tremor decreased or abated over time (range, 106-2315 days) without treatment. Tremor remission occurred in SEHT dogs treated for underlying meningoencephalitis. CONCLUSIONS AND CLINICAL IMPORTANCE Presence of additional neurological signs and older age may indicate an underlying structural cause for episodic (nonintentional) head tremor involving the mesencephalic aqueduct, third ventricle, interthalamic adhesion or some combination of these. An intracranial structural abnormality cannot be excluded in dogs with normal neurological examination.
Collapse
Affiliation(s)
- Theofanis Liatis
- Department of Clinical Science and Services, Royal Veterinary CollegeUniversity of LondonHatfieldUK
| | - Sofie F. M. Bhatti
- Small Animal Department, Small Animal Teaching Hospital, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Magdalena Dyrka
- Small Animal Hospital, School of Biodiversity One Health and Veterinary MedicineUniversity of GlasgowGlasgowUK
| | - Rodrigo Gutierrez‐Quintana
- Small Animal Hospital, School of Biodiversity One Health and Veterinary MedicineUniversity of GlasgowGlasgowUK
| | - Rita Gonçalves
- Small Animal Teaching Hospital, School of Veterinary ScienceUniversity of LiverpoolNestonUK
| | - Megan Madden
- Hospital for Small Animals, Royal (Dick) School of Veterinary StudiesUniversity of EdinburghMidlothianUK
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary CollegeUniversity of LondonHatfieldUK
| |
Collapse
|
5
|
Giménez-Roldán S, Palmer VS, Spencer PS. Lathyrism in Spain: Lessons from 68 publications following the 1936-39 Civil War. JOURNAL OF THE HISTORY OF THE NEUROSCIENCES 2023; 32:423-455. [PMID: 37272829 DOI: 10.1080/0964704x.2023.2195442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
After the end of the Spanish Civil War (1936-1939), an estimated 1,000 patients presented with lathyrism due to their excessive and prolonged consumption of grasspea (Lathyrus sativus L.) against the backdrop of poverty, drought, and famine. Based on 68 scientific communications between 1941 and 1962 by qualified medical professionals, the disease emerged in different geographical locations involving selective populations: (1) farmers from extensive areas of central Spain, traditionally producers and consumers of grasspea; (2) immigrants in the industrial belt of Catalonia and in the Basque Country, areas with little or no production of grasspea, which was imported from producing areas; (3) workers in Galicia, an area where the legume is neither produced nor consumed, who were seasonally displaced to high-production areas of grasspea in Castille; and (4) inmates of overcrowded postwar Spanish prisons. Original reports included failed attempts by Carlos Jiménez Díaz (1898-1967) to induce experimental lathyrism, the neuropathology of lathyrism in early stages of the disease in two patients, as reported by Carlos Oliveras de la Riva (1914-2007), and the special susceptibility of children to develop a severe form of lathyrism after relatively brief periods of consumption of the neurotoxic seed of L. sativus. In the Spanish Basque Country, L. cicera L. (aizkol) was cultivated exclusively as animal fodder. Patients who were forced to feed on this plant developed unusual manifestations of lathyrism, such as axial myoclonus and severe neuropsychiatric disorders, unknown in other regions of the country and previously unreported. The postwar epidemic of lathyrism in Spain represents the most extensively studied outbreak of this self-limiting but crippling upper motor neuron disease.
Collapse
Affiliation(s)
| | - Valerie S Palmer
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Peter S Spencer
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
6
|
Espay AJ, Fasano A. The Existential Essentialism in Tremor Nosology - 7 Pitfalls, 2 Remedies, and a Path Ahead. Mov Disord Clin Pract 2023; 10:S36-S41. [PMID: 37637985 PMCID: PMC10448133 DOI: 10.1002/mdc3.13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/23/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alberto J. Espay
- James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of NeurologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's DiseaseMorton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
| |
Collapse
|
7
|
Grippe T, Fasano A, Chen R. Different types of tremor and myoclonus in an atypical case of shaking upon standing. Parkinsonism Relat Disord 2023; 111:105175. [PMID: 37271568 DOI: 10.1016/j.parkreldis.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/22/2022] [Accepted: 09/21/2022] [Indexed: 06/06/2023]
Abstract
Shaking upon standing is associated with a spectrum of different conditions. We describe an unusual case with a combination of slow orthostatic tremor, orthostatic myoclonus, and parkinsonism. The case illustrates the utility of electrophysiology for precise characterization of physical findings to establish the diagnosis.
Collapse
Affiliation(s)
- Talyta Grippe
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Canada; Department of Parkinson's Disease & Movement Disorders Rehabilitation, Moriggia-Pelascini Hospital - Gravedona ed Uniti, Como, 22015, Italy; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
8
|
Marsili L, Bologna M, Mahajan A. Diagnostic Uncertainties in Tremor. Semin Neurol 2023; 43:156-165. [PMID: 36913973 DOI: 10.1055/s-0043-1763508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
The approach and diagnosis of patients with tremor may be challenging for clinicians. According to the most recent consensus statement by the Task Force on Tremor of the International Parkinson Movement Disorder Society, the differentiation between action (i.e., kinetic, postural, intention), resting, and other task- and position-specific tremors is crucial to this goal. In addition, patients with tremor must be carefully examined for other relevant features, including the topography of the tremor, since it can involve different body areas and possibly associate with neurological signs of uncertain significance. Following the characterization of major clinical features, it may be useful to define, whenever possible, a particular tremor syndrome and to narrow down the spectrum of possible etiologies. First, it is important to distinguish between physiological and pathological tremor, and, in the latter case, to differentiate between the underlying pathological conditions. A correct approach to tremor is particularly relevant for appropriate referral, counseling, prognosis definition, and therapeutic management of patients. The purpose of this review is to outline the possible diagnostic uncertainties that may be encountered in clinical practice in the approach to patients with tremor. In addition to an emphasis on a clinical approach, this review discusses the important ancillary role of neurophysiology and innovative technologies, neuroimaging, and genetics in the diagnostic process.
Collapse
Affiliation(s)
- Luca Marsili
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Abhimanyu Mahajan
- Rush Parkinson's Disease and Movement Disorders Program, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
9
|
Are smartphones and machine learning enough to diagnose tremor? J Neurol 2022; 269:6104-6115. [PMID: 35861853 DOI: 10.1007/s00415-022-11293-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/09/2022] [Accepted: 07/13/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Patients with essential tremor (ET), Parkinson's disease (PD) and dystonic tremor (DT) can be difficult to classify and often share similar characteristics. OBJECTIVES To use ubiquitous smartphone accelerometers with and without clinical features to automate tremor classification using supervised machine learning, and to use unsupervised learning to evaluate if natural clusterings of patients correspond to assigned clinical diagnoses. METHODS A supervised machine learning classifier was trained to classify 78 tremor patients using leave-one-out cross-validation to estimate performance on unseen accelerometer data. An independent cohort of 27 patients were also studied. Next, we focused on a subset of 48 patients with both smartphone-based tremor measurements and detailed clinical assessment metrics and compared two separate machine learning classifiers trained on these data. RESULTS The classifier yielded a total accuracy of 74.4% and F1-score of 0.74 for a trinary classification with an area under the curve of 0.904, average F1-score of 0.94, specificity of 97% and sensitivity of 84% in classifying PD from ET or DT. The algorithm classified ET from non-ET with 88% accuracy, but only classified DT from non-DT with 29% accuracy. A poorer performance was found in the independent cohort. Classifiers trained on accelerometer and clinical data respectively obtained similar results. CONCLUSIONS Machine learning classifiers achieved a high accuracy of PD, however moderate accuracy of ET, and poor accuracy of DT classification. This underscores the difficulty of using AI to classify some tremors due to lack of specificity in clinical and neuropathological features, reinforcing that they may represent overlapping syndromes.
Collapse
|
10
|
Mosteiro A, Compta Y, Valldeoriola F, Rumià J, Roldán P, Vollmer I, Vilaseca I, Llull BL. Deep brain stimulation as a palliative treatment for myorhythmia: A case of failure. Eur J Neurol 2022; 29:937-941. [PMID: 35141992 DOI: 10.1111/ene.15200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Myorhythmia is a hyperkinetic movement disorder that derives from a disruption of the Guillain-Mollaret triangle, due to an identifiable structural lesion. It is often disabling and with disappointing control under medical treatment. METHODS Herein, a case of myorhythmia secondary to a vascular insult in the brainstem is reported and an unsuccessful attempt to palliate it with functional neurosurgery. RESULTS A 67-year-old man displayed a repetitive, rhythmic, slow 2-3 Hz movement, 6 months after suffering a pontomesencephalic hypertensive haematoma. The kinetic phenomenon affected the orbicular and low facial muscles, the neck, the thorax and the upper limbs. Furthermore, he exhibited tremor of the soft palate and pendular nystagmus. On T2-weighted magnetic resonance imaging, hypertrophic degeneration of the inferior olivary complex was seen. He was diagnosed with secondary myorhythmia and multiple pharmacological treatments were tested, but failed. Ultimately, deep brain stimulation with bilateral electrodes placed in the thalamic ventralis intermedius nucleus was offered. Unfortunately, no alleviation of the symptoms was achieved other than mild improvement in involuntary eye movements. CONCLUSIONS This is the first case to report the use of deep brain stimulation for myorhythmia. Better understanding of the pathophysiology of this condition, and localization of the pacemaker, may allow identification of reliable neurosurgical therapeutic targets.
Collapse
Affiliation(s)
- Alejandra Mosteiro
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Yaroslau Compta
- Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Jordi Rumià
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pedro Roldán
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Iván Vollmer
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Isabel Vilaseca
- Department of ENT, Hospital Clínic de Barcelona, Barcelona, Spain
| | | |
Collapse
|
11
|
Rare tremors and tremors occurring in other neurological disorders. J Neurol Sci 2022; 435:120200. [DOI: 10.1016/j.jns.2022.120200] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/07/2022] [Accepted: 02/17/2022] [Indexed: 12/21/2022]
|
12
|
Finkener S, Piroth T, Högg M, Rüegg S, Nedeltchev K, Bally JF, Gschwind M. Recognizing myorhythmia 4 months after stroke – A teaching video. Clin Park Relat Disord 2022; 6:100141. [PMID: 35345471 PMCID: PMC8956862 DOI: 10.1016/j.prdoa.2022.100141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/27/2022] [Accepted: 03/09/2022] [Indexed: 12/02/2022] Open
Abstract
In this case study with video and neurophysiology, we describe a rare case of hemimyorhythmia occurring 4 months after a stroke with bilateral affection of the thalamus and right superior cerebellar peduncle (Guillain-Mollaret-triangle). This case and especially the video with the clinical and EMG presentation of a synchronous rhythmic pattern at 3,1 Hz makes an important educational contribution to the recognition of myorhythmia and discussed differential diagnoses.
Collapse
|
13
|
Salles PA, Espay AJ. 'Hand mechanogram' in epilepsia partialis continua. Pract Neurol 2021; 21:543-545. [PMID: 34753808 DOI: 10.1136/practneurol-2021-003041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/03/2022]
Abstract
Epilepsia partialis continua manifests as low-frequency, rhythmic involuntary movements of a focal body part. We report a young man, HIV-positive and with syphilis, who developed right-hand epilepsia partialis continua associated with a small left-sided cortico-subcortical frontal lesion. A pen and paper test provided 'mechanographic' data on frequency, amplitude and rhythmicity of the hand movements, helping distinguish it from other causes of low-frequency repetitive hand movements.
Collapse
Affiliation(s)
- Philippe A Salles
- Center for Movement Disorders, CETRAM, Santiago, Chile.,Department of Neuroscience, Clínica Dávila, Santiago, Chile
| | - Alberto J Espay
- Department of Neurology, UC Gardner Neuroscience Institute, Cincinnati, Ohio, USA .,Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| |
Collapse
|
14
|
Kashyap S, Ceponiene R, Savla P, Bernstein J, Ghanchi H, Ananda A. Resolution of tardive tremor after bilateral subthalamic nucleus deep brain stimulation placement. Surg Neurol Int 2020; 11:444. [PMID: 33408929 PMCID: PMC7771401 DOI: 10.25259/sni_723_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/19/2020] [Indexed: 11/04/2022] Open
Abstract
Background:Tardive tremor (TT) is an underrecognized manifestation of tardive syndrome (TS). In our experience, TT is a rather common manifestation of TS, especially in a setting of treatment with aripiprazole, and is a frequent cause of referrals for the evaluation of idiopathic Parkinson disease. There are reports of successful treatment of tardive orofacial dyskinesia and dystonia with deep brain stimulation (DBS) using globus pallidus interna (GPi) as the primary target, but the literature on subthalamic nucleus (STN) DBS for tardive dyskinesia (TD) is lacking. To the best of our knowledge, there are no reports on DBS treatment of TT.Case Description:A 75-year-old right-handed female with the medical history of generalized anxiety disorder and major depressive disorder had been treated with thioridazine and citalopram from 1980 till 2010. Around 2008, she developed orolingual dyskinesia. She was started on tetrabenazine in June 2011. She continued to have tremors and developed Parkinsonian gait, both of which worsened overtime. She underwent DBS placement in the left STN in January 2017 with near-complete resolution of her tremors. She underwent right STN implantation in September 2017 with similar improvement in symptoms.Conclusion:While DBS-GPi is the preferred treatment in treating oral TD and dystonia, DBS-STN could be considered a safe and effective target in patients with predominating TT and/or tardive Parkinsonism. This patient saw a marked improvement in her symptoms after implantation of DBS electrodes, without significant relapse or recurrence in the years following implantation.
Collapse
Affiliation(s)
- Samir Kashyap
- Department of Neurosurgery, Riverside University Health System, Moreno Valley, California, United States,
| | - Rita Ceponiene
- Department of Neurology, Kaiser Permanente Sourthern California Physician Medical Group, Los Angeles, California, United States,
| | - Paras Savla
- Department of Neurosurgery, Riverside University Health System, Moreno Valley, California, United States,
| | - Jacob Bernstein
- Department of Neurosurgery, Riverside University Health System, Moreno Valley, California, United States,
| | - Hammad Ghanchi
- Department of Neurosurgery, Riverside University Health System, Moreno Valley, California, United States,
| | - Ajay Ananda
- Department of Neurosurgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States
| |
Collapse
|
15
|
Ferreira SI, Cinnirella G, Ramos L, Suppa A, Pires LM, Nardone AM, Camerota L, Lanciotti S, Galasso C, De Maio F, de Melo JB, Carreira IM, Brancati F. Tremor is a major feature of 9p13 deletion syndrome. Am J Med Genet A 2020; 182:2694-2698. [PMID: 32896075 DOI: 10.1002/ajmg.a.61807] [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: 04/19/2020] [Revised: 06/23/2020] [Accepted: 07/04/2020] [Indexed: 11/09/2022]
Abstract
Proximal interstitial deletions of chromosome 9p13 have been described only in a few patients with developmental delay, moderate intellectual disability, craniofacial dysmorphism, short stature, genital anomalies, and precocious puberty. To corroborate and expand these findings, we report on two novel syndromic male patients with 9p13 deletions suffering from a similar form of tremor and compare them with literature data. Despite genomic variability in deletion sizes, all patients displayed homogeneous dysmorphism and clinical manifestations, including very invalidating tremor. Furthermore, we outlined a region of around 2 Mb shared in common by all patients with nearly 70 genes, among which NPR2 might have a role in the phenotype. These data delineate interstitial 9p13 deletion syndrome with tremor as a major feature.
Collapse
Affiliation(s)
- Susana Isabel Ferreira
- Laboratory of Cytogenetics and Genomics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Giacomo Cinnirella
- Medical Genetics Residency Program, Tor Vergata University of Rome and University of L'Aquila, L'Aquila, Italy
| | - Lina Ramos
- Medical Genetics Unit, Pediatric Hospital, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University, Rome, Italy.,Neuromed IRCCS, Pozzilli, Isernia, Italy
| | - Luís Miguel Pires
- Laboratory of Cytogenetics and Genomics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | - Letizia Camerota
- Medical Genetics Residency Program, Tor Vergata University of Rome and University of L'Aquila, L'Aquila, Italy
| | - Silvia Lanciotti
- Medical Genetics Residency Program, Tor Vergata University of Rome and University of L'Aquila, L'Aquila, Italy
| | - Cinzia Galasso
- Department of Systems Medicine, Division of Child Neurology and Psychiatry, Tor Vergata University of Rome, Rome, Italy
| | - Fernando De Maio
- Department of Orthopaedic Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Joana Barbosa de Melo
- Laboratory of Cytogenetics and Genomics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Isabel Marques Carreira
- Laboratory of Cytogenetics and Genomics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Francesco Brancati
- Medical Genetics Laboratory, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| |
Collapse
|
16
|
Shobatake R, Kataoka H, Izumi T, Nobuyuki E, Kawahara M, Sugie K. Intracranial varicella zoster virus infection may elicit an unusual hyperkinetic volitional tremor. Clin Park Relat Disord 2020; 3:100069. [PMID: 34316649 PMCID: PMC8298806 DOI: 10.1016/j.prdoa.2020.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/15/2020] [Accepted: 08/07/2020] [Indexed: 11/21/2022] Open
Abstract
Central nervous system manifestations of varicella zoster virus (VZV) infection are uncommon, and associated involuntary movement is rare. Herein, we describe a patient with VZV induced encephalopathy who presented with an unusual hyperkinetic volitional tremor.
Collapse
Affiliation(s)
- Ryogo Shobatake
- Department of Neurology, Nara Medical University, Nara Medical University, Kashihara, Nara, Japan
- Department of Neurology, Nara City Hospital, Nara, Nara, Japan
| | - Hiroshi Kataoka
- Department of Neurology, Nara Medical University, Nara Medical University, Kashihara, Nara, Japan
| | - Tesseki Izumi
- Department of Neurology, Nara Medical University, Nara Medical University, Kashihara, Nara, Japan
| | - Eura Nobuyuki
- Department of Neurology, Nara Medical University, Nara Medical University, Kashihara, Nara, Japan
| | - Makoto Kawahara
- Department of Neurology, Nara Medical University, Nara Medical University, Kashihara, Nara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Nara Medical University, Kashihara, Nara, Japan
| |
Collapse
|
17
|
Sepúlveda Soto MC, Fasano A. Tremor: so common, so difficult. J Neurol Neurosurg Psychiatry 2020; 91:809-810. [PMID: 32457088 DOI: 10.1136/jnnp-2020-323189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada .,Division of Neurology, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto, ON, Canada.,The Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| |
Collapse
|
18
|
van de Wardt J, van der Stouwe AMM, Dirkx M, Elting JWJ, Post B, Tijssen MA, Helmich RC. Systematic clinical approach for diagnosing upper limb tremor. J Neurol Neurosurg Psychiatry 2020; 91:822-830. [PMID: 32457087 PMCID: PMC7402459 DOI: 10.1136/jnnp-2019-322676] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/19/2020] [Accepted: 03/22/2020] [Indexed: 12/18/2022]
Abstract
Tremor is the most common movement disorder worldwide, but diagnosis is challenging. In 2018, the task force on tremor of the International Parkinson and Movement Disorder Society published a consensus statement that proposes a tremor classification along two independent axes: a clinical tremor syndrome and its underlying aetiology. In line with this statement, we here propose a stepwise diagnostic approach that leads to the correct clinical and aetiological classification of upper limb tremor. We also describe the typical clinical signs of each clinical tremor syndrome. A key feature of our algorithm is the distinction between isolated and combined tremor syndromes, in which tremor is accompanied by bradykinesia, cerebellar signs, dystonia, peripheral neuropathy or brainstem signs. This distinction subsequently informs the selection of appropriate diagnostic tests, such as neurophysiology, laboratory testing, structural and dopaminergic imaging and genetic testing. We highlight treatable metabolic causes of tremor, as well as drugs and toxins that can provoke tremor. The stepwise approach facilitates appropriate diagnostic testing and avoids unnecessary investigations. We expect that the approach offered in this article will reduce diagnostic uncertainty and increase the diagnostic yield in patients with tremor.
Collapse
Affiliation(s)
- Jaron van de Wardt
- Department of Neurology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - A M Madelein van der Stouwe
- Department of Neurology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands .,Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Michiel Dirkx
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Jan Willem J Elting
- Department of Neurology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.,Department of Clinical Neurophysiology, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Bart Post
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Marina Aj Tijssen
- Department of Neurology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Rick C Helmich
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
19
|
Thakolwiboon S, Ruthirago D, Laengvejkal P, Wilms H. Mystery Case: Symptomatic isolated tongue tremor of cortical origin due to stroke. Neurology 2020; 94:591-592. [DOI: 10.1212/wnl.0000000000009174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
20
|
Giza E, Dagklis IE, Kimiskidis V, Katsarou Z, Bostantjopoulou S. Functional rhythmic tongue movements. Acta Neurol Belg 2019; 119:629-630. [PMID: 29987754 DOI: 10.1007/s13760-018-0983-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/05/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Evangelia Giza
- 3rd University Department of Neurology, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece.,Department of Neurology, General Hospital "Hippokratio", Thessaloníki, Greece
| | - Ioannis E Dagklis
- 3rd University Department of Neurology, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece.
| | - Vasilios Kimiskidis
- Laboratory of Clinical Neurophysiology, "AHEPA" Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Zoe Katsarou
- Department of Neurology, General Hospital "Hippokratio", Thessaloníki, Greece
| | - Sevasti Bostantjopoulou
- 3rd University Department of Neurology, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| |
Collapse
|
21
|
Hassan A, Caviness J. Slow Orthostatic Tremor: Review of the Current Evidence. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 9:tre-09-721. [PMID: 31832265 PMCID: PMC6886496 DOI: 10.7916/tohm.v0.721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/07/2019] [Indexed: 12/01/2022]
Abstract
Background Orthostatic tremor (OT) is defined as tremor in the legs and trunk evoked during standing. While the classical description is tremor of ≥13 Hz, slower frequencies are recognized. There is disagreement as to whether the latter represents a slow variant of classical OT, or different tremor disorder(s) given frequent coexistent neurological disease. Methods A systematic literature search of PubMed was performed in February 2019 for “slow orthostatic tremor” and related terms which generated 573 abstracts, of which 61 were included. Results Between 1970 and 2019, there were 70 cases of electrophysiologically confirmed slow OT. Two-thirds were female, of mean age 60 years (range 26–86), and mean disease duration 6 years (range 0–32). One-third of cases were isolated, and two-thirds had a coexistent disorder(s), including parkinsonism (30%), ataxia (12%), and dystonia (10%). Postural arm tremor was present in 34%. Median tremor frequency was 6–7 Hz (range 3–12). Tremor bursts ranged from 50 to 150 ms duration, and were alternating or synchronous in antagonistic and/or analogous muscles. Low and high coherences were reported. Five cases (7%) had coexistent classical OT. Clonazepam was the most effective medication across all frequencies, and levodopa was effective for 4–7 Hz OT with coexistent parkinsonism. Two cases resolved with the treatment of Graves’ disease. Electrophysiology and imaging predominantly support a central tremor generator. Discussion While multiple lines of evidence separate slow OT from classical OT, clinical and electrophysiological overlap may occur. Primary and secondary causes are identified, similar to classical OT. Further exploration to clarify these slow OT subtypes, clinically and neurophysiologically, is proposed.
Collapse
Affiliation(s)
- Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - John Caviness
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
22
|
Freitas ME, Ruiz-Lopez M, Dalmau J, Erro R, Privitera M, Andrade D, Fasano A. Seizures and movement disorders: phenomenology, diagnostic challenges and therapeutic approaches. J Neurol Neurosurg Psychiatry 2019; 90:920-928. [PMID: 30796133 DOI: 10.1136/jnnp-2018-320039] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
Seizures and movement disorders (MDs) are distinct neurological conditions presenting with abnormal movements. Despite sharing an overlap in phenomenology, these movements have different origins. In order to explore the overlaps and the narrow boundaries between these two conditions, we performed a review of the literature to explore the risk of seizures in MDs. We discussed the mimics and chameleons including MDs that look like seizure (eg, paroxysmal dyskinesia, status dystonicus) and seizures that look like MDs (eg, epilepsia partialis continua, nocturnal frontal lobe epilepsy). Additionally, we examined the therapeutic challenges as well as the anatomical and chemical pathways relevant in the interplay between epilepsy and MDs. Finally, we proposed an algorithm to guide clinicians towards the final diagnosis of conditions characterised by the co-occurrence of MDs and seizures.
Collapse
Affiliation(s)
- Maria Eliza Freitas
- Medicine, McMaster University Division of Neurology, Hamilton, Ontario, Canada
| | - Marta Ruiz-Lopez
- Service of Neurology, Fundación Jimenez Diaz University Hospital, Madrid, Spain
| | - Josep Dalmau
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, UCL Institute of Neurology, Baronissi, Italy
| | - Michael Privitera
- Epilepsy Center, University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA
| | | | - Alfonso Fasano
- Neurology, Krembil Brain Institute; Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Disease, Toronto, Ontario, Canada
| |
Collapse
|
23
|
Neuropathology and pathogenesis of extrapyramidal movement disorders: a critical update. II. Hyperkinetic disorders. J Neural Transm (Vienna) 2019; 126:997-1027. [DOI: 10.1007/s00702-019-02030-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/14/2019] [Indexed: 12/14/2022]
|
24
|
Mba SE, Musara A, Kalangu K, Nyamapfene B. An unusual presentation of bobble-head doll syndrome in a patient with hydranencephaly and Chiari 3 malformation. Childs Nerv Syst 2019; 35:879-882. [PMID: 30726525 DOI: 10.1007/s00381-019-04054-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/04/2019] [Indexed: 11/29/2022]
Abstract
Bobble-head doll syndrome is a rare movement disorder that is usually associated with lesions involving the third ventricle. It is characterised by stereotypical rhythmic up-and-down or side-to-side head movements. The pathophysiology and anatomical basis for this unusual manifestation is still a subject of intense scrutiny. The syndrome has never been described in a patient with both hydranencephaly and Chiari type 3 malformation. We describe a 2-year-old female patient who presented with congenital hydrocephalus, an occipital encephalocele and rhythmic bobbling of the head. Imaging investigation revealed a Chiari type 3 malformation and hydranencephaly. The patient was taken to theatre for a ventriculoperitoneal shunt insertion, and at day 3 post operatively, the patient had a markedly decreased head circumference and a decrease in the frequency of the bobbling of the head. A further review at 2 weeks showed that the bobbling of the head had ceased. Although the pathophysiology of bobble-head doll syndrome is yet to be fully understood, there has been postulation of either a third ventricular enlargement or a cerebellar dysfunction to explain bobble-head doll syndrome. Our case illustrates that the pathophysiology is most likely multifactorial as illustrated by the fact that by just addressing the high intracranial pressure with a shunt was sufficient to treat the condition.
Collapse
Affiliation(s)
- Serge Eddy Mba
- Department of Surgery, Division of Neurosurgery, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe.
| | - Aaron Musara
- Department of Surgery, Division of Neurosurgery, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe
| | - Kazadi Kalangu
- Department of Surgery, Division of Neurosurgery, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe
| | - Brighton Nyamapfene
- Department of Surgery, Division of Neurosurgery, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe
| |
Collapse
|
25
|
Orthostatic tremor as the only manifestation of thyrotoxicosis following cerebral angiography. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2017.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
26
|
Abstract
SUMMARYTardive dyskinesia is a common iatrogenic neurological and neurobehavioural syndrome associated with the use of antidopaminergic medication, especially antipsychotics. Prior to the introduction of the newer antipsychotics in the 1990s, it was one of the major areas of psychiatric research but interest waned as the new drugs were reputed to have a reduced liability to extrapyramidal adverse effects in general, a claim now discredited by numerous pragmatic research studies. Early small-scale short-term prevalence studies were presented as evidence to support the assumption that patients on the newer drugs did indeed have a lower prevalence of tardive dyskinesia but recent large-scale review of studies with patients exposed for longer suggest that things have not changed. This article presents a clinical overview of a complex and varied syndrome in terms of its phenomenology, epidemiology and risk factors; a companion article will consider treatment. This overview aims to highlight tardive dyskinesia once again, especially to practitioners who have trained in an environment where this was considered mainly in historical terms.LEARNING OBJECTIVES•Understand the complex phenomenology comprising the syndrome of tardive dyskinesia•Appreciate recent data on prevalence and incidence with the newer antipsychotics•Be aware of risk factors when recommending antipsychotic (and other antidopaminergic) drugsDECLARATION OF INTERESTNone.
Collapse
|
27
|
|
28
|
Patel K, Tappuni A. Rare presentation of essential lingual myoclonus. Neurol Clin Pract 2018; 8:352-353. [DOI: 10.1212/cpj.0000000000000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/28/2018] [Indexed: 11/15/2022]
|
29
|
|
30
|
Abstract
BACKGROUND Tremor is a symptom of many diseases and can constitute a disease of its own: essential tremor. OBJECTIVE The genetics of essential tremor and differential diagnosis of monogenic diseases with the symptom tremor. MATERIAL AND METHODS Literature search and search of clinical genetics databases, e.g. OMIM, GeneReviews, MDSGene and the German Neurological Society (DGN) guidelines. RESULTS The genetics of essential tremor remain unresolved in spite of large, adequately powered studies. Tremor is a symptom of differential diagnostic value in many movement disorders. A slight tremor might have been missed or not reported in many descriptions of movement disorders. CONCLUSION Progress in the genetics of essential tremor probably requires a more detailed phenotyping allowing stratification into phenotypically defined subgroups. Tremor should always be included in the examination and description of movement disorders even if tremor is not a cardinal symptom. Tremor might be helpful in the differential diagnosis of hereditary dystonia, hereditary ataxia, spastic paraplegia and other movement disorders.
Collapse
Affiliation(s)
- G Kuhlenbäumer
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
| | - F Hopfner
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| |
Collapse
|
31
|
[Rare tremor syndromes]. DER NERVENARZT 2018; 89:386-393. [PMID: 29327098 DOI: 10.1007/s00115-017-0477-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is a group of uncommon sporadic tremor syndromes, which are only partially taken into account in the current classification of tremor. Their knowledge is of diagnostic and therapeutic relevance and they should be considered in the differential diagnosis of frequent tremor syndromes. OBJECTIVE Differential diagnostics and treatment of uncommon tremor syndromes. METHOD Literature search (PubMed, Google Scholar). RESULTS Holmes tremor, myorhythmia, palatal tremor, limb-shaking transient ischemic attack (TIA), tardive tremor, neuropathic tremor, tremor induced by peripheral trauma and orthostatic tremor syndrome are described. CONCLUSION Uncommon sporadic tremor syndromes are mainly symptomatic with various underlying neurological or systemic pathologies. Their recognition accelerates the diagnostic process and has therapeutic relevance.
Collapse
|
32
|
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.
Collapse
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.
| |
Collapse
|
33
|
Fasano A, Lang AE, Espay AJ. What is "essential" about essential tremor? A diagnostic placeholder. Mov Disord 2017; 33:58-61. [PMID: 29272067 DOI: 10.1002/mds.27288] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/08/2017] [Indexed: 01/29/2023] Open
Affiliation(s)
- Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| |
Collapse
|
34
|
Dave A, Hawley J. Fragile X–tremor/ataxia syndrome: five areas of new development. FUTURE NEUROLOGY 2017. [DOI: 10.2217/fnl-2017-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Fragile X–tremor/ataxia syndrome is a relatively newly discovered movement disorder usually affecting patients over the age of 50 who have a FMR1 gene with 55–200 CGG repeats. Patients present with tremor and ataxia and possibly executive dysfunction and peripheral neuropathy. Fragile X–tremor/ataxia syndrome patients have several unique MRI findings including white matter lesions of the middle cerebellar peduncle and splenium of the corpus callosum. The genetics and treatment of this condition are co-developing rapidly as we search for more therapeutic modalities to offer these patients. We will present the latest information available regarding this fascinating syndrome and provide our hypothesis regarding the future focus of research.
Collapse
Affiliation(s)
- Ajal Dave
- Department of Neurology, Walter Reed National Military Medical Center, America BLDG 19 4954 North Palmer Rd, Bethesda, MD 20889–5630, USA
| | - Jason Hawley
- Department of Neurology, Walter Reed National Military Medical Center, America BLDG 19 4954 North Palmer Rd, Bethesda, MD 20889–5630, USA
| |
Collapse
|
35
|
Jankovic J. An update on new and unique uses of botulinum toxin in movement disorders. Toxicon 2017; 147:84-88. [PMID: 28888928 DOI: 10.1016/j.toxicon.2017.09.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 02/01/2023]
Abstract
The therapeutic applications of botulinum toxin (BoNT) have grown manifold since its initial approval in 1989 by the US Food and Drug Administration (FDA) for the treatment of strabismus, blepharospasm, and other facial spasms. Although it is the most potent biologic toxin known to man, long-term studies have established its safety in the treatment of a variety of neurologic and non-neurologic disorders. This review focuses on some novel and uncommon uses of BoNT in the treatment of movement disorders, such as oromandibular dystonia, including bruxism, anterocollis, camptocormia, tremor, tics, tardive and levodopa-induced dyskinesia, and restless legs syndrome. Despite a paucity of randomized controlled trials and lack of FDA approval for these movement disorders, there is growing body of evidence that BoNT provides benefit to patients with these hyperkinetic movement disorders and that BoNT is a safe treatment when used by clinicians skilled in the administration of the drug for these conditions.
Collapse
Affiliation(s)
- Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States. http://www.jankovic.org
| |
Collapse
|
36
|
Larrosa Campo D, Ramón Carbajo C, García Urruzola F, Calleja Puerta S. Orthostatic tremor as the only manifestation of thyrotoxicosis following cerebral angiography. Neurologia 2017; 34:137-138. [PMID: 28712843 DOI: 10.1016/j.nrl.2017.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- D Larrosa Campo
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | - C Ramón Carbajo
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - F García Urruzola
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - S Calleja Puerta
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| |
Collapse
|
37
|
SCA 35 presenting as isolated treatment-resistant dystonic hand tremor. Parkinsonism Relat Disord 2017; 37:118-119. [PMID: 28214262 DOI: 10.1016/j.parkreldis.2017.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/11/2017] [Accepted: 01/29/2017] [Indexed: 11/21/2022]
|
38
|
Rossi M, Wilken M, Morisset P, Fariña S, Cerquetti D, Merello M. Facial tremors in patients with and without parkinsonism. Neurol Sci 2016; 37:1999-2002. [PMID: 27470304 DOI: 10.1007/s10072-016-2683-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/20/2016] [Indexed: 11/27/2022]
Abstract
Facial (lip and jaw) tremors can be an early sign of Parkinson's disease (PD), essential tremor and other parkinsonisms. Its response to acute dopaminergic therapy and further predictive clinical diagnosis has not been previously addressed. The aim of this study was to evaluate facial tremors response to acute dopaminergic therapy and further predictive value for clinical diagnosis. A retrospective review of medical records from patients with recent onset of facial tremor, with or without parkinsonism, submitted to acute levodopa challenge for clinical prediction of sustained long-term dopaminergic response was conducted. Twenty-eight out of 559 patients (5 %) had facial tremors, which responded to levodopa in 46 % of patients. Facial tremors response to acute levodopa challenge showed 92 % sensitivity and 93 % specificity to predict a final PD diagnosis. In PD patients, facial tremor magnitude of response to levodopa was not different from that of hand rest tremor (p = 0.8). Facial tremors, although infrequent, can be an early sign of PD. Positive response to acute levodopa challenge predicts long-term PD diagnosis.
Collapse
Affiliation(s)
- Malco Rossi
- Movement Disorders Section, Neuroscience Department, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, 1428, Ciudad Autónoma de Buenos Aires, Argentina
| | - Miguel Wilken
- Movement Disorders Section, Neuroscience Department, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, 1428, Ciudad Autónoma de Buenos Aires, Argentina
| | - Pierre Morisset
- Movement Disorders Section, Neuroscience Department, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, 1428, Ciudad Autónoma de Buenos Aires, Argentina
| | - Sofia Fariña
- Movement Disorders Section, Neuroscience Department, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, 1428, Ciudad Autónoma de Buenos Aires, Argentina
| | - Daniel Cerquetti
- Movement Disorders Section, Neuroscience Department, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, 1428, Ciudad Autónoma de Buenos Aires, Argentina
| | - Marcelo Merello
- Movement Disorders Section, Neuroscience Department, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, 1428, Ciudad Autónoma de Buenos Aires, Argentina.
- Argentine National Scientific and Technological Research Council (CONICET), Buenos Aires, Argentina.
| |
Collapse
|