1
|
Lalli S, Albanese A. Dystonic Tremor: Time to Change. Mov Disord Clin Pract 2024; 11:605-612. [PMID: 38659164 PMCID: PMC11145119 DOI: 10.1002/mdc3.14010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/21/2024] [Accepted: 02/13/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The term dystonic tremor is being increasingly used in neurological publications despite uncertainties about its meaning. We provide here a historical reconstruction from its original introduction in 1984 to help distinguish dystonia from essential tremor. METHODS A comprehensive Pubmed search of MeSH terms "dystonia", "tremor", and "essential tremor" provided the information base for reconstructing historical usage of the term "dystonic tremor". RESULTS Over the years, this expression was enriched of additional meanings and sided by companion descriptors, such as tremor associated with dystonia. Dystonic tremor has been considered characteristically coarse, jerky, irregular, directional and asymmetrical. These characteristics, however, are not included in the most recent definitions of tremor. The relationship between tremor and dystonia is not easy to untangle, as the two phenomena are often recognized in association. Tremor and dystonia experts have developed different visions of dystonic tremor that have been variably implemented. There are currently two independent consensus definitions, which are not coincident and imply different pathophysiological interpretations. CONCLUSIONS This historical reappraisal highlights that usage of the expression dystonic tremor has evolved over time to lose its original meaning. Notwithstanding inconsistencies of current definitions, its usage has steadily increased and it is time now to agree on an updated terminology.
Collapse
Affiliation(s)
- Stefania Lalli
- Department of NeurologyIRCCS Humanitas Research HospitalMilanoItaly
| | - Alberto Albanese
- Department of NeurologyIRCCS Humanitas Research HospitalMilanoItaly
| |
Collapse
|
2
|
Dogan H, Bilen S, Ergin Beton O. Executive dysfunction accompanying essential tremor. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:128-133. [PMID: 34874215 DOI: 10.1080/23279095.2021.2002865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Essential tremor (ET) is one of the most common neurological diseases. New evidence suggest that ET is associated with cognitive disorders other than motor symptoms. We aimed to investigate executive dysfunctions, which are comorbid cognitive deficiencies that may accompany ET. The study was conducted as an observational, case-control study in the Neurology Department of Ankara City Hospital in a 3-month period. The "Fahn-Tolosa-Marin Tremor Evaluation Scale" was used to rate tremor severity. Both patients and control group were subjected to the Mini Mental Test, followed by the Stroop TBAG test (TBAG is composed of the first letters of "TUBİTAK Temel Bilimler Araştırma Grubu," which means Scientific and Technological Research Council of Turkey Basic Sciences Research Group), word fluency (category fluency), phonemic fluency (K), and abstract thinking (binary similarities, proverb interpretation) tests. Both the patient and the control group consisted of 20 women and 20 men, with age, gender, and educational background compatible. Mean age of the patient group was 34.80 ± 13.23 years, while it was 34.95 ± 10.21 years in control group. In the ET group, statistically significant impairment was detected in the Stroop Test section 5 duration and error + correction number, category fluency, binary similarity, and phonemic fluency tests compared to the control group. There was a correlation between the severity of tremor and especially Stroop, category fluency, and binary similarity tests such that, as the severity of tremor increased, these test scores deteriorated. In ET patients, an impairment, accompanying tremor, may be present in executive functions that are a part of frontal lobe functions even in younger patients. This finding may suggest that impairment in the cerebellum-thalamus-frontal lobe connection may play a role in ET pathology.
Collapse
|
3
|
Albanese A. Clinical features of dystonia and the science of classification. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:1-20. [PMID: 37482389 DOI: 10.1016/bs.irn.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
This chapter describes advances in understanding the clinical features of dystonia since initial clinical recognition and its organization into a coherent and systematic clinical set. The clinical features of dystonia were at first considered an odd neurological movement disorder. Etymology of the word misleadingly underlined muscle tone. The main clinical features of dystonia were recognized gradually. They encompass dystonic movements, dystonic postures, alleviating maneuvers, overflow and mirroring. These features are observed in patients who present a variety of syndromes where dystonia occurs in isolation or combined with other movement disorders, or with other neurologic or systemic features. A large number of syndromic combinations is observed in the clinic and some of the syndomes are highlighted here. Practitioners are required to exert dedicated skills to recognize dystonia and correctly diagnose and classify their patients.
Collapse
Affiliation(s)
- Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Milano, Italy; Department of Neuroscience, Catholic University, Milano, Italy.
| |
Collapse
|
4
|
Louis ED. Commentary: Time trends in the incidence of essential tremor: Evidences from UK and France primary care data. Front Neurol 2023; 14:1136150. [PMID: 36741281 PMCID: PMC9895783 DOI: 10.3389/fneur.2023.1136150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
|
5
|
Louis ED. Essential tremor. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:389-401. [PMID: 37620080 DOI: 10.1016/b978-0-323-98817-9.00012-0] [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: 08/26/2023]
Abstract
Essential tremor (ET) is a chronic and progressive neurologic disease. Its central and defining clinical feature is a 4-12Hz kinetic tremor, that is, tremor that occurs during voluntary movements such as drinking from a cup or writing. Patients may also exhibit a range of other tremors-postural, rest, intention, additional motor features (e.g., mild gait ataxia, mild dystonia), as well as nonmotor features. The disease itself seems to be a risk factor for other degenerative diseases such as Alzheimer's disease and Parkinson's disease. Both genetic and toxic environmental factors have been explored as etiologic factors. In addition to a growing appreciation of the presence of clinical, etiologic, and pathologic heterogeneity, there is some support for the notion that ET itself may not be a single disease, but may be a family of diseases whose central defining feature is kinetic tremor of the arms, and which might more accurately be referred to as "the essential tremors." Recent research has increasingly placed the seat of the disease in the cerebellum and cerebellar system and identified a host of neurodegenerative changes within the cerebellum, indicating that this progressive disorder is likely degenerative.
Collapse
Affiliation(s)
- Elan D Louis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States.
| |
Collapse
|
6
|
Wagle Shukla A. Diagnosis and Treatment of Essential Tremor. Continuum (Minneap Minn) 2022; 28:1333-1349. [DOI: 10.1212/con.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
7
|
Antonazzo IC, Conti S, Rozza D, Fornari C, Eteve-Pitsaer C, Paris C, Gantzer L, Valentine D, Mantovani LG, Mazzaglia G. Time trends in the incidence of essential tremor: Evidences from UK and France primary care data. Front Neurol 2022; 13:987618. [PMID: 36203992 PMCID: PMC9531026 DOI: 10.3389/fneur.2022.987618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Although essential tremor (ET) is considered a common adult movement disorder, evidence on its incidence is still scant. This study aims at estimating ET incidence in two European countries, namely, the UK and France. Methods Incident cases of ET were identified within the Health Improvement Network (THIN®) database between 1st January 2014 and 31 December 2019. Yearly crude and standardized incidence rates (IR) were estimated across the study period for both countries. Poisson regression models were built to assess temporal trends in IRs and differences between sexes and age classes. Results In total, 4,970 and 4,905 incident cases of ET were identified in the UK and France, respectively. The yearly average crude IR (per 100,000 person-years) was 18.20 (95%CI: 15.09-21.32) in UK and 21.42 (17.83-25.00) in France, whereas standardized ones were 19.51 (18.97-20.01) and 19.50 (18.97-20.05). Regression analyses showed slightly increasing trends in both countries, higher incidence among males, and a significant increase with age. Yearly average IR increased from 3.96 (0.95-6.97) and 5.28 (1.12-9.44) in subjects aged <20 years to 49.27 (26.29-72.24) and 51.52 (30.19-72.86) in those aged >80 year in UK and France. Conclusions Standardized ET incidence was comparable in the UK and France, showing a slight increase in both countries, reporting a higher value among people aged 60 years and older. This study outlines the need to conduct future studies to estimate the burden of ET in terms of disease control and healthcare resource utilization.
Collapse
Affiliation(s)
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy,*Correspondence: Sara Conti
| | - Davide Rozza
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Carla Fornari
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | | | | | | | | | | | - Giampiero Mazzaglia
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
8
|
Yıldız Silahlı N, Türkdoğan D. Prevalence of Potential Essential Tremor Cases in Turkish Adolescents According to The WHIGET Classification. Turk Arch Pediatr 2022; 57:323-328. [PMID: 35781236 PMCID: PMC9131808 DOI: 10.5152/turkarchpediatr.2022.21218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/15/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Essential tremor is the most common movement disorder diagnosed during adolescence. However, there are insufficient data about its prevalence among adolescents. This study aims to determine the prevalence of potential essential tremor cases in Turkish adolescents. MATERIALS AND METHODS This cross-sectional study was carried out in Istanbul, Turkey. A total of 5 high schools were visited. In the first step, the authors provided 5559 students (aged 14-18) with clinical information about tremors and essential tremors in their classrooms. After that, a 12-item questionnaire filled by adolescents and parental consent forms were collected. The response rate was 78% (n = 4330). According to the questionnaire answers, adolescents who complained of experiencing tremors in any part of their body were clinically evaluated in the second step of the study. Lastly, a neurological examination to classify essential tremors based on the Washington Heights Inwood Genetic Study of Essential Tremor (1998) diagnostic criteria was conducted by a specialist. RESULTS The prevalence of tremor in the respondents aged 14-18 (median = 15) years was 1.2 % (n = 52/4330), and the prevalence of essential tremor was 0.41% (n = 18/4330). Male to female ratio for essential tremor was 5 : 1 (male = 15 and female = 1). Essential tremor cases were subclassified as following: 10 (55.5%) definite essential tremor, 3 (16.6%) probable essential tremor, and 5 (27.7%) possible essential tremor. CONCLUSION The data support the claim that essential tremor is a prevalent movement disorder in Turkish adolescents.
Collapse
Affiliation(s)
| | - Dilşad Türkdoğan
- Department of Pediatric Neurology, Medical School of Marmara University, İstanbul, Tukey
| |
Collapse
|
9
|
Epidemiology of pediatric essential tremor in the United States: a systematic literature review from 2010 to 2020. Tremor Other Hyperkinet Mov (N Y) 2022; 12:11. [PMID: 35531121 PMCID: PMC9029662 DOI: 10.5334/tohm.681] [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: 01/06/2022] [Accepted: 03/05/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Methods: Results: Discussion:
Collapse
|
10
|
Strasser L, Wilson M, Healy S, Doja A. Tremor Presenting in Infants and Children Aged <2 Years. J Child Neurol 2022; 37:298-302. [PMID: 35040697 DOI: 10.1177/08830738211070120] [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] [Indexed: 11/17/2022]
Abstract
Objectives: To examine the clinical features, course, and management of children at age <2 years with tremor. Methods:Retrospective chart review of all patients aged <2 years presenting to a tertiary care neurology clinic between 2005 and 2019. Descriptive and inferential statistics were used. Results: We identified 29 children with tremor presenting at age <2 years. The mean age at onset, diagnosis and follow-up was 3.22 months (SD 3.63), 6.97 months (SD 5.44), and 10.83 months (SD 5.29), respectively. Tremor was more noticeable surrounding eating, sleep, or extreme emotions. The tremor did not interfere with development or require pharmacologic treatment in any patient. At follow-up, 31% had complete resolution of their tremor with the rest being stable or improved. Patients with resolved tremor were statistically more likely to have a younger age of diagnosis (F = 3.895, P = .033), no medical history (P = .029, χ2 = 7.112), and leg tremor (P = .028, χ2 = 7.143). Conclusion: Tremor with onset at age <2 years follows a benign course, with many patients requiring no treatment and outgrowing the disorder.
Collapse
Affiliation(s)
- Lauren Strasser
- 27338Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Mitchell Wilson
- Department of Neurology, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sarah Healy
- 27338Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,CHEO Research Institute, Ottawa, Ontario, Canada
| | - Asif Doja
- 27338Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,CHEO Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
11
|
Kumar S, Goyal L, Singh S. Tremor and Rigidity in Patients with Parkinson's Disease: Emphasis on Epidemiology, Pathophysiology and Contributing Factors. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 21:596-609. [PMID: 34620070 DOI: 10.2174/1871527320666211006142100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/04/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
Parkinson's disease (PD) is the second most prominent neurodegenerative movement disorder after Alzheimer's disease, involving 2-3% of the population aged above 65 years. This is mainly triggered by the depletion of dopaminergic neurons located in substantia nigra pars compacta (SNpc) in the region of basal ganglia. At present, diagnosis for symptoms of PD is clinical, contextual, unspecified and therapeutically incomprehensive. Analysis of various causes of PD is essential for an accurate examination of the disease. Among the different causes, such as tremors and rigidity, unresponsiveness to the current treatment approach contributes to mortality. In the present review article, we describe various key factors of pathogenesis and physiology associated with tremors and rigidity necessary for the treatment of PI (postural instability) in patients with PD. Additionally, several reports showing early tremor and rigidity causes, particularly age, cortex lesions, basal ganglia lesions, genetic abnormalities, weakened reflexes, nutrition, fear of fall, and altered biomechanics, have been explored. By summarizing the factors that contribute to the disease, histopathological studies can assess rigidity and tremor in PD. With a clear understanding of the contributing factors, various prospective studies can be done to assess the incidence of rigidity and tremors.
Collapse
Affiliation(s)
- Shivam Kumar
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga-142001 Punjab, India
| | - Lav Goyal
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga-142001 Punjab, India
| | - Shamsher Singh
- Neuropharmacology Division, Department of Pharmacology, ISF College of Pharmacy, Moga-142001 Punjab, India
| |
Collapse
|
12
|
Abstract
Essential tremor (ET) is one of the most common movement disorders, with a reported >60 million affected individuals worldwide. The definition and underlying pathophysiology of ET are contentious. Patients present primarily with motor features such as postural and action tremors, but may also have other non-motor features, including cognitive impairment and neuropsychiatric symptoms. Genetics account for most of the ET risk but environmental factors may also be involved. However, the variable penetrance and challenges in validating data make gene-environment analysis difficult. Structural changes in cerebellar Purkinje cells and neighbouring neuronal populations have been observed in post-mortem studies, and other studies have found GABAergic dysfunction and dysregulation of the cerebellar-thalamic-cortical circuitry. Commonly prescribed medications include propranolol and primidone. Deep brain stimulation and ultrasound thalamotomy are surgical options in patients with medically intractable ET. Further research in post-mortem studies, and animal and cell-based models may help identify new pathophysiological clues and therapeutic targets and, together with advances in omics and machine learning, may facilitate the development of precision medicine for patients with ET.
Collapse
|
13
|
Mild cognitive impairment, dementia and risk of mortality in essential tremor: A longitudinal prospective study of elders. J Neurol Sci 2021; 428:117563. [PMID: 34274879 DOI: 10.1016/j.jns.2021.117563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/09/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is evidence that the risk of mortality is increased in patients with essential tremor (ET), however, there are few longitudinal, prospective data on the predictors of mortality in ET. There is also evidence that ET is associated with cognitive impairment; yet, it is unknown whether this is associated with elevated risk of mortality. METHODS In a longitudinal, prospective study of 194 elders with ET, an extensive neuropsychological test battery was performed at three time points: baseline, 18 months, and 36 months, and cognitive diagnoses (normal, mild cognitive impairment [MCI], and dementia) were assigned during consensus conferences. We used Cox proportional hazards models to estimate hazard ratios (HR) for death. RESULTS The mean baseline age was 79.1 ± 9.7 years. During follow-up, 52 (26.8%) died. In initial univariate models, a variety of baseline factors were associated with increased risk of mortality, including demographic variables (i.e., older age), cognitive variables and gait and balance variables. In the final multivariate Cox model, baseline dementia (HR = 2.66, p = 0.006), older baseline age (HR = 1.18, p < 0.001), and more reported falls at baseline (HR = 1.10, p < 0.001) were independently associated with increased risk of mortality. Amnestic MCI was marginally associated with increased risk of mortality (HR = 1.93, p = 0.08) in primary analyses and significantly (p < 0.05) in several sensitivity analyses. CONCLUSIONS In this longitudinal, prospective study, baseline dementia resulted in a 2- to 3-times increase in risk of mortality in ET, further highlighting the clinical significance of cognitive impairment, specifically dementia, in this population.
Collapse
|
14
|
Gallagher VT, Obolsky MA, Soble JR. "Benign" tremor? A serial case report of 2.5 year progression from mild cognitive impairment to amnestic dementia following deep brain stimulator placement for essential tremor. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:1280-1287. [PMID: 33232620 DOI: 10.1080/23279095.2020.1848837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Essential tremor (ET) is a prevalent neurological disorder with associated neuropsychological sequalae. Although cognitive deficits associated with ET are traditionally conceptualized as attention, processing speed, and executive impairments attributed to underlying frontal-subcortical dysfunction, emerging literature highlights the elevated frequency of progressive amnestic memory impairments in patients with ET. This case study centers around a 75-year-old woman with a 15-year history of ET who underwent deep brain stimulation (DBS) as well as three neuropsychological evaluations, one pre-surgically and two post-surgically at one and two-years post successful DBS surgery. Neuropsychological evaluation results revealed circumscribed mild and variable memory deficits pre-surgically and one-year post-surgically, However, two-years post-DBS, reliable change indices revealed significant declines in verbal/visual memory, consistent with an amnestic presentation, in addition to executive functions, aspects of higher-level language abilities, and overall IQ. This case study adds to a growing literature identifying a subset of ET patients with a neurodegenerative cognitive trajectory characterized by progressive, amnestic memory impairment. The case also highlights the importance of serial monitoring of cognition beyond the pre-surgical DBS workup to monitor for clinically significant decline(s).
Collapse
Affiliation(s)
- Virginia T Gallagher
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Maximillian A Obolsky
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Psychology, Roosevelt University, Chicago, IL, USA
| | - Jason R Soble
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
| |
Collapse
|
15
|
Ng ASL, Lim WK, Xu Z, Ong HL, Tan YJ, Sim WY, Ng EYL, Teo JX, Foo JN, Lim TCC, Yu WY, Chan LL, Lee HY, Chen Z, Lim EW, Ting SKS, Prakash KM, Tan LCS, Yi Z, Tan EK. NOTCH2NLC GGC Repeat Expansions Are Associated with Sporadic Essential Tremor: Variable Disease Expressivity on Long-Term Follow-up. Ann Neurol 2020; 88:614-618. [PMID: 32495371 DOI: 10.1002/ana.25803] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/27/2022]
Abstract
We screened 662 subjects comprising 462 essential tremor (ET) subjects (285 sporadic, 125 with family history, and 52 probands from well-characterized ET pedigrees) and 200 controls and identified pathogenic NOTCH2NLC GGC repeat expansions in 4 sporadic ET patients. Two patients were followed up for >1 decade; one with 90 repeats remained an ET phenotype that did not evolve after 40 years, whereas another patient with 107 repeats developed motor symptoms and cognitive impairment after 8 to 10 years. Neuroimaging in this patient revealed severe leukoencephalopathy; diffusion-weighted imaging hyperintensity in the corticomedullary junction and skin biopsy revealed intranuclear inclusions suggestive of intranuclear inclusion body disease (NIID). No GGC repeats of >60 units were detected in familial ET cases and controls, although 4 ET patients carried 47 to 53 "intermediate" repeats. NOTCH2NLC GGC repeat expansions can be associated with sporadic ET. Carriers presenting with a pure ET phenotype may or may not convert to NIID up to 4 decades after initial tremor onset. ANN NEUROL 2020;88:614-618.
Collapse
Affiliation(s)
- Adeline S L Ng
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore.,Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore
| | - Weng Khong Lim
- SingHealth/Duke-NUS Institute of Precision Medicine, Singapore.,Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore
| | - Zheyu Xu
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Helen L Ong
- Department of Clinical and Translational Research, Singapore General Hospital, Singapore
| | - Yi Jayne Tan
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Wei Ying Sim
- Department of Clinical and Translational Research, Singapore General Hospital, Singapore
| | - Ebonne Y L Ng
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Jing Xian Teo
- SingHealth/Duke-NUS Institute of Precision Medicine, Singapore
| | - Jia Nee Foo
- Human Genetics, Genome Institute of Singapore, Agency for Science, Technology, and Research, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Tchoyoson C C Lim
- Department of Neuroradiology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Wai-Yung Yu
- Department of Neuroradiology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Ling-Ling Chan
- Department of Radiology, Singapore General Hospital, Singapore
| | - Hwei-Yee Lee
- Department of Pathology, Tan Tock Seng Hospital, Singapore
| | - Zhiyong Chen
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Ee-Wei Lim
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Simon K S Ting
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Kumar M Prakash
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Louis C S Tan
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Zhao Yi
- Department of Clinical and Translational Research, Singapore General Hospital, Singapore
| | - Eng-King Tan
- Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore.,Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
| |
Collapse
|
16
|
Abstract
In a range of neurological conditions, including movement disorders, sex-related differences are emerging not only in brain anatomy and function, but also in pathogenesis, clinical features and response to treatment. In Parkinson disease (PD), for example, oestrogens can influence the severity of motor symptoms, whereas elevation of androgens can exacerbate tic disorders. Nevertheless, the real impact of sex differences in movement disorders remains under-recognized. In this article, we provide an up-to-date review of sex-related differences in PD and the most common hyperkinetic movement disorders, namely, essential tremor, dystonia, Huntington disease and other chorea syndromes, and Tourette syndrome and other chronic tic disorders. We highlight the most relevant clinical aspects of movement disorders that differ between men and women. Increased recognition of these differences and their impact on patient care could aid the development of tailored approaches to the management of movement disorders and enable the optimization of preclinical research and clinical studies.
Collapse
|
17
|
Abstract
ABSTRACT:Background: Essential tremor (ET) is reported to have a bimodal distribution of age at onset (AAO) with phenotypic variability based on the AAO. This study aims to explore the distribution of AAO based on mathematical modeling and ascertain the differences, if any, in the clinical features of groups. Methods: A chart review was conducted for 252 patients with ET diagnosed based on the Consensus statement of the Movement Disorder Society on Tremor. Finite mixture modeling was performed to identify groups of the cohort based on the AAO. Results: Three groups were defined: early onset (EO): AAO ≤ 22 years, n = 63, intermediate onset (IO): 23 ≤ AAO ≤ 35 years, n = 43, and late onset (LO): AAO ≥ 36 years, n = 146. There were no significant differences related to family history or responsiveness to alcohol. The EO group had significantly higher prevalence of upper limb and lower limb tremor. Head tremor and voice tremor was more prevalent in the IO and LO groups. Cerebellar signs showed a significant increase with an increase in AAO. Conclusions: ET shows significant phenotypic variability based on the AAO. Patients with an early AAO are more likely to develop an appendicular tremor, whereas the probability of axial tremor and cerebellar signs increases with increasing AAO.
Collapse
|
18
|
Zubair A, Cersonsky TEK, Kellner S, Huey ED, Cosentino S, Louis ED. What Predicts Mortality in Essential Tremor? A Prospective, Longitudinal Study of Elders. Front Neurol 2018; 9:1077. [PMID: 30581416 PMCID: PMC6292933 DOI: 10.3389/fneur.2018.01077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/26/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: Essential tremor (ET) is among the most common neurologic diseases. Although in the past it was considered a benign condition, recent research has demonstrated increased risk of mortality. To date, however, no studies have examined predictors of mortality in ET. Methods: In a longitudinal, prospective study of 141 elders with ET, we used Cox proportional-hazards models to estimate hazard ratios (HRs) for death. Results: The mean baseline age was 81.1 ± 8.8 years. During the follow-up interval, 27 (19.1%) died. Average time from baseline to death was 12.3 ± 8.7 months (range = 0.3–31.2). In univariate Cox regression models, older age (HR = 1.16, p < 0.001), lower Montreal Cognitive Assessment score (HR = 0.88, p = 0.004), higher Clinical Dementia Rating (CDR) score (HR = 4.53, p < 0.001), higher score on the Geriatric Depression scale (GDS) (HR = 1.07, p = 0.048), less balance confidence (HR = 0.98, p = 0.006), more falls (HR = 1.11, p = 0.003), and more tandem mis-steps (HR = 1.53, p = 0.004) were associated with increased risk of mortality. In the final multivariate Cox model, older age (HR = 1.14, p = 0.005), higher CDR score (HR = 3.80, p = 0.002) and higher GDS (HR = 1.11, p = 0.01) were independently associated with increased risk of mortality. Conclusions: This study highlights several independent predictors of mortality in elderly ET; clinicians should consider screening for depressive symptoms, assessing cognition and tracking CDR scores, and assessing balance while evaluating patients with ET.
Collapse
Affiliation(s)
- Adeel Zubair
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Tess E K Cersonsky
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Sarah Kellner
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Edward D Huey
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, United States.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Stephanie Cosentino
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, United States
| |
Collapse
|
19
|
Daneault JF. Could Wearable and Mobile Technology Improve the Management of Essential Tremor? Front Neurol 2018; 9:257. [PMID: 29725318 PMCID: PMC5916972 DOI: 10.3389/fneur.2018.00257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/03/2018] [Indexed: 11/13/2022] Open
Abstract
Essential tremor (ET) is the most common movement disorder. Individuals exhibit postural and kinetic tremor that worsens over time and patients may also exhibit other motor and non-motor symptoms. While millions of people are affected by this disorder worldwide, several barriers impede an optimal clinical management of symptoms. In this paper, we discuss the impact of ET on patients and review major issues to the optimal management of ET; from the side-effects and limited efficacy of current medical treatments to the limited number of people who seek treatment for their tremor. Then, we propose seven different areas within which mobile and wearable technology may improve the clinical management of ET and review the current state of research in these areas.
Collapse
Affiliation(s)
- Jean-Francois Daneault
- Motor Behavior Laboratory, Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, United States
| |
Collapse
|
20
|
Abstract
Essential tremor (ET) is one of the most common neurologic disorders, and genetic factors are thought to contribute significantly to disease etiology. There has been a relative lack of progress in understanding the genetic etiology of ET. This could reflect a number of factors, including the presence of substantial phenotypic and genotypic heterogeneity. Thus, a meticulous approach to phenotyping is important for genetic research. A lack of standardized phenotyping across studies and patient centers likely has contributed to the relative lack of success of genomewide association studies in ET. To dissect the genetic architecture of ET, whole-genome sequencing will likely be of value. This will allow specific hypotheses about the mode of inheritance and genetic architecture to be tested. A number of approaches still remain unexplored in ET genetics, including the contribution of copy number variants, uncommon moderate-effect alleles, rare variant large-effect alleles (including Mendelian and complex/polygenic modes of inheritance), de novo and gonadal mosaicism, epigenetic changes, and noncoding variation.
Collapse
Affiliation(s)
- Lorraine N Clark
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, United States
| | - Elan D Louis
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York; and Departments of Neurology and of Chronic Disease Epidemiology and Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, United States.
| |
Collapse
|
21
|
Abstract
Essential tremor (ET) is a progressive and highly prevalent neurologic disease. Along with the tremors, mild to moderate gait ataxia and other signs of cerebellar dysfunction may occur (i.e., subtle saccadic eye movement abnormalities and abnormalities of motor timing) as well as cognitive features, some of which may be due to cerebellar dysfunction. Numerous neuroimaging studies indicate the presence of functional, metabolic, and structural abnormalities in the cerebellum of a patient with ET. In tandem with these clinical and imaging studies, which were gathering increasing support for the notion that the cerebellum and/or cerebellar systems seemed to be at the root of ET, a growing postmortem literature is for the first time beginning to identify microscopic abnormalities in the ET brain, most of which are centered on the Purkinje cells and connected neuronal populations, and are likely to be degenerative. In terms of treatment, most of these pharmacotherapeutic agents serve to enhance GABAergic neurotransmission, further bolstering the notion that ET may very well be a disorder with a primary Purkinje cell dysfunction resulting in reduced cerebellar cortical inhibition. Similarly, the interruption of presumably abnormal cerebellar outflow pathways to the thalamus is the mechanism of deep-brain stimulation surgery, which is highly effective in treating ET.
Collapse
Affiliation(s)
- Elan D Louis
- Department of Neurology and Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, United States; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States.
| |
Collapse
|
22
|
Hopfner F, Deuschl G. Is essential tremor a single entity? Eur J Neurol 2017; 25:71-82. [DOI: 10.1111/ene.13454] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 09/01/2017] [Indexed: 12/18/2022]
Affiliation(s)
- F. Hopfner
- Department of Neurology; Universitätsklinikum Schleswig-Holstein; Kiel Campus Germany
- Christian-Albrechts Universität; Kiel Germany
| | - G. Deuschl
- Department of Neurology; Universitätsklinikum Schleswig-Holstein; Kiel Campus Germany
- Christian-Albrechts Universität; Kiel Germany
| |
Collapse
|
23
|
Lenka A, Benito-León J, Louis ED. Is there a Premotor Phase of Essential Tremor? Tremor Other Hyperkinet Mov (N Y) 2017; 7:498. [PMID: 29051842 PMCID: PMC5633681 DOI: 10.7916/d80s01vk] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/02/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Essential tremor (ET) is the most common tremor disorder. In addition to its hallmark feature, kinetic tremor of the upper limbs, patients may have a number of non-motor symptoms and signs (NMS). Several lines of evidence suggest that ET is a neurodegenerative disorder and certain NMS may antedate the onset of tremor. This article comprehensively reviews the evidence for the existence of a "premotor phase" of ET, and discusses plausible biological explanations and implications. METHODS A PubMed search in May 2017 identified articles for this review. RESULTS The existence of a premotor phase of ET gains support primarily from longitudinal data. In individuals who develop incident ET, baseline (i.e., premotor) evaluations reveal greater cognitive dysfunction, a faster rate of cognitive decline, and the presence of a protective effect of education against dementia. In addition, baseline evaluations also reveal more self-reported depression, antidepressant medication use, and shorter sleep duration in individuals who eventually develop incident ET. In cross-sectional studies, certain personality traits and NMS (e.g., olfactory dysfunction) also suggest the existence of a premotor phase. DISCUSSION There is preliminary evidence supporting the existence of a premotor phase of ET. The mechanisms are unclear; however, the presence of Lewy bodies in some ET brains in autopsy studies and involvement of multiple neural networks in ET as evident from the neuroimaging studies, are possible contributors. Most evidence is from a longitudinal cohort (Neurological Disorders of Central Spain: NEDICES); additional longitudinal studies are warranted to gain better insights into the premotor phase of ET.
Collapse
Affiliation(s)
- Abhishek Lenka
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Julian Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Elan D. Louis
- Division of Movement Disorders, Department of Neurology Yale School of Medicine, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Postural hand tremor and incident hypertension in young to middle-aged adults: the Bogalusa heart study. J Hypertens 2017; 34:1273-8. [PMID: 27136316 DOI: 10.1097/hjh.0000000000000963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hand tremor and blood pressure (BP) are both increased by adrenergic stimulation and reduced by β-blockade, indicating that they may share a common underlying pathophysiology. METHODS We prospectively examined the relationship between postural hand tremor and incident hypertension in a community-based cohort of 715 (184 blacks and 531 whites) adults without hypertension and not using medications to control tremor (e.g. β-blockers). At baseline, tremor was measured with participants holding a laser pointer aimed at a sheet of Polaroid film 8 feet away with arm outstretched for 8 s in a darkened room, and characterized by the width of the circle diameter encompassing all exposures and enumeration of exposure dots in the same area. Incident hypertension was defined as new elevation of BP (SBP ≥ 140 or DBP ≥ 90 mmHg, based on an average of six readings over two visits) or antihypertensive medication use. RESULTS During a median follow-up of 6.4 years, 198 (69 blacks and 129 whites) participants developed hypertension. Tremor measurements (by quartile) were positively associated with incident hypertension after adjustment for baseline demographics, lifestyle characteristics, and BP. There was significant interaction by race (P = 0.01). Among whites, tremor was positively associated with incident hypertension [hazard ratio highest vs. lowest quartile: 2.50 (95% confidence interval: 1.40-4.48) dot method and 3.24 (1.78-5.90) circular method; both P trend <0.01]. Among blacks, tremor was not associated with hypertension. CONCLUSION In this community-based cohort, postural hand tremor was strongly associated with the risk of incident hypertension among whites and merits further study as a potential indicator of risk for hypertension.
Collapse
|
26
|
Abstract
BACKGROUND Essential tremor (ET) is one of the most common movement disorders. The treatment is primarily based on pharmacological agents. Although primidone and propranolol are well established treatments in clinical practice, they can be ineffective in 25% to 55% of patients, and can produce serious adverse events in a large percentage of them. For these reasons, it may be worthwhile evaluating the treatment alternatives for ET. Zonisamide has been suggested as a potentially useful agent for the treatment of ET but there is uncertainty about its efficacy and safety. OBJECTIVES To assess the effect on functional abilities and the safety profile of zonisamide in adults with essential tremor (ET). SEARCH METHODS We carried out a systematic search, without language restrictions to identify all relevant trials. We searched CENTRAL, MEDLINE, Embase, NICE, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) to January 2017. We searched BIOSIS Citation Index (2000 to January 2017) for conference proceedings. We handsearched grey literature and examined the reference lists of identified studies and reviews. SELECTION CRITERIA We included all randomised controlled trials (RCTs) of zonisamide versus placebo or any other treatment. We included studies in which the diagnosis of ET was made according to accepted and validated diagnostic criteria. We excluded studies conducted in patients presenting secondary forms of tremor or reporting only neurophysiological parameters to assess outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently collected and extracted data using a data collection form. We assessed the risk of bias and the quality of evidence.We used inverse variance methods for continuous outcomes and measurement scales. We compared differences between treatment groups as mean differences. We combined results for dichotomous outcomes using Mantel-Haenszel methods and obtained risk differences to compare treatment groups. We used Review Manager 5 software for data management and analysis. MAIN RESULTS We only considered one study eligible for this review (20 participants). Assessments of risk of bias for most domains were unclear or low. Adverse events were only reported in participants from the zonisamide group, making it possible that they were aware of treatment group assignment. We are uncertain as to the effects of zonisamide on motor tasks (mean difference (MD) -0.00, 95% confidence interval (CI) -1.51 to 1.51, very low-quality evidence) and functional disabilities (MD -0.30, 95% CI -1.23 to 0.63, very low-quality evidence) when compared with placebo. Three participants in the zonisamide group (30%) and two participants in the placebo group (20%) discontinued the treatment and withdrew from the study for any reason (very low-quality evidence), however the increased risk of withdrawal in the zonisamide group was statistically non-significant (risk difference (RD) 0.1, 95% CI -0.28 to 0.48). Six participants in the zonisamide group (60%) and none of the participants in the placebo group (0%) developed adverse events (AEs), with a RD of 0.60 (95% CI 0.28 to 0.92; very low quality evidence). The most common AEs, experienced with zonisamide treatment, were headache, nausea, fatigue, sleepiness, and diarrhoea. Quality of life was not assessed in the study included. AUTHORS' CONCLUSIONS Based on currently available data, there is insufficient evidence to assess the efficacy and safety of zonisamide treatment for ET.
Collapse
Affiliation(s)
- Elisa Bruno
- University of CataniaDepartment GF Ingrassia, Section of NeurosciencesCataniaItaly95123
| | - Alessandra Nicoletti
- University of CataniaDepartment GF Ingrassia, Section of NeurosciencesCataniaItaly95123
| | - Graziella Filippini
- Fondazione IRCCS, Istituto Neurologico Carlo BestaScientific Directionvia Celoria, 11MilanItaly20133
| | - Graziella Quattrocchi
- University of CataniaDepartment GF Ingrassia, Section of NeurosciencesCataniaItaly95123
| | - Carlo Colosimo
- Terni University HospitalDepartment of NeurologyTerniItaly05100
| | - Mario Zappia
- University of CataniaDepartment GF Ingrassia, Section of NeurosciencesCataniaItaly95123
| | | |
Collapse
|
27
|
Bruno E, Nicoletti A, Quattrocchi G, Allegra R, Filippini G, Colosimo C, Zappia M. Topiramate for essential tremor. Cochrane Database Syst Rev 2017; 4:CD009683. [PMID: 28409827 PMCID: PMC6478240 DOI: 10.1002/14651858.cd009683.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Essential tremor (ET) is one of the most common movement disorders. The management is primarily based on pharmacological agents and in clinical practice propranolol and primidone are considered the first-line therapy. However, these treatments can be ineffective in 25% to 55% of people and are frequently associated with serious adverse events (AEs). For these reasons, it is worthwhile evaluating other treatments for ET. Topiramate has been suggested as a potentially useful agent for the treatment of ET but there is uncertainty about its efficacy and safety. OBJECTIVES To assess the efficacy and safety of topiramate in the treatment of ET. SEARCH METHODS We carried out a systematic search without language restrictions to identify all relevant trials in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (January 1966 to January 2017), Embase (January 1988 to January 2017), National Institute for Health and Care Excellence (1999 to January 2017), ClinicalTrials.gov (1997 to January 2017) and World Health Organization International Clinical Trials Registry Platform (ICTRP; 2004 to January 2017). We searched BIOSIS Citation Index (2000 to January 2017) for conference proceedings. We handsearched grey literature and the reference lists of identified studies and reviews. SELECTION CRITERIA We included all randomised controlled trials (RCTs) of topiramate versus placebo/open control or any other treatments. We included studies in which the diagnosis of ET was made according to accepted and validated diagnostic criteria. We excluded studies conducted in people presenting with secondary forms of tremor or reporting only neurophysiological parameters to assess outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently collected and extracted data using a data collection form. We assessed the risk of bias and the quality of evidence. We used a fixed-effect meta-analysis for data synthesis. MAIN RESULTS This review included three trials comparing topiramate to placebo (309 participants). They were all at high overall risk of bias. The quality of evidence ranged from very low to low. Compared to placebo, participants treated with topiramate showed a significant improvement in functional disability and an increased risk of withdrawal (risk ratio (RR) 1.78, 95% confidence interval (CI) 1.23 to 2.60). There were more AEs for topiramate-treated participants, particularly paraesthesia, weight loss, appetite decrease and memory difficulty. AUTHORS' CONCLUSIONS This systematic review highlighted the presence of limited data and very low to low quality evidence to support the apparent efficacy and the occurrence of treatment-limiting AEs in people with ET treated with topiramate. Further research to assess topiramate efficacy and safety on ET is needed.
Collapse
Affiliation(s)
- Elisa Bruno
- University of CataniaDepartment GF Ingrassia, Section of NeurosciencesCataniaItaly95123
| | - Alessandra Nicoletti
- University of CataniaDepartment GF Ingrassia, Section of NeurosciencesCataniaItaly95123
| | - Graziella Quattrocchi
- University of CataniaDepartment GF Ingrassia, Section of NeurosciencesCataniaItaly95123
| | - Roberta Allegra
- Policlinico Universitario G. Martino MessinaDepartment of Neurological SciencesVia Consolare ValeriaMessinaItaly90100
| | - Graziella Filippini
- Fondazione IRCCS, Istituto Neurologico Carlo BestaScientific Directionvia Celoria, 11MilanItaly20133
| | - Carlo Colosimo
- Terni University HospitalDepartment of NeurologyTerniItaly05100
| | - Mario Zappia
- University of CataniaDepartment GF Ingrassia, Section of NeurosciencesCataniaItaly95123
| | | |
Collapse
|
28
|
Kuo SH, Wang J, Tate WJ, Pan MK, Kelly GC, Gutierrez J, Cortes EP, Vonsattel JPG, Louis ED, Faust PL. Cerebellar Pathology in Early Onset and Late Onset Essential Tremor. CEREBELLUM (LONDON, ENGLAND) 2017; 16:473-482. [PMID: 27726094 PMCID: PMC5336493 DOI: 10.1007/s12311-016-0826-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Early onset and late onset essential tremor (ET) cases differ in several respects. Whether they differ with respect to cerebellar pathologic changes remains to be determined. We quantified a broad range of postmortem features (Purkinje cell (PC) counts, PC axonal torpedoes and associated axonal changes, heterotopic PCs, and hairy basket ratings) in 30 ET cases with age of tremor onset <50 years, 30 ET cases with age of tremor onset ≥50 years, and 30 controls (total n = 90). We also used two alternative age of onset cut-points (<40 vs. ≥40 years, and <60 vs. ≥60 years) to define early onset vs. late onset ET. We found that ET cases with tremor onset <50 years and tremor onset ≥50 years had similar PC counts (8.78 ± 1.70 vs. 8.86 ± 1.24, p = 0.839), PC axonal torpedo counts (17.87 ± 18.27 [median =13.00] vs. 12.90 ± 10.60 [median =9.0], p = 0.486) and associated axonal pathology (all p values >0.05), heterotopic PC counts (9.90 ± 11.55 [median =6.00] vs. 5.40 ± 5.10 [median =3.50], p = 0.092), and hairy basket ratings (1.95 ± 0.62 [median =2.00] vs. 2.05 ± 0.92 [median =2.00], p = 0.314). When using the age of onset cut-points of 40 or 60 years, results were similar. Early onset and late onset ET cases share similar cerebellar postmortem features. These data do not support the notion that these age-of-onset related forms of ET represent distinct clinical-pathological entities.
Collapse
Affiliation(s)
- Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Neurological Institute, Columbia University, New York, NY, 10032, USA.
| | - Jie Wang
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Basic and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - William J Tate
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Ming-Kai Pan
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Medical Research, National Taiwan University, Taipei, Taiwan
| | - Geoffrey C Kelly
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Jesus Gutierrez
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Etty P Cortes
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
- Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Jean-Paul G Vonsattel
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
- Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University, New York, NY, USA
| | - 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
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
29
|
Bruno E, Nicoletti A, Quattrocchi G, Filippini G, Colosimo C, Zappia M. Pregabalin for essential tremor. Cochrane Database Syst Rev 2016; 10:CD009682. [PMID: 27763691 PMCID: PMC6461190 DOI: 10.1002/14651858.cd009682.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Essential tremor is one of the most common movement disorders. Treatment primarily consists of pharmacological agents. While primidone and propranolol are well-established treatments in clinical practice, they may be ineffective in 25% to 55% of patients and can produce serious adverse events in a large percentage of them. For these reasons, it is worth evaluating the treatment alternatives for essential tremor. Some specialists have suggested that pregabalin could be a potentially useful agent, but there is uncertainty about its efficacy and safety. OBJECTIVES To assess the effects of pregabalin versus placebo or other treatment for essential tremor in adults. SEARCH METHODS We performed a systematic search without language restrictions to identify all relevant trials up to December 2015. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, NICE, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP). We handsearched grey literature and examined the reference lists of identified studies and reviews. SELECTION CRITERIA We included all randomised controlled trials (RCTs) of pregabalin versus placebo or any other treatments. We included studies in which the diagnosis of ET was made according to accepted and validated diagnostic criteria. We excluded studies conducted in patients presenting secondary forms of tremor or reporting only neurophysiological parameters to assess outcomes. DATA COLLECTION AND ANALYSIS Two reviewers independently collected and extracted data using a data collection form. We assessed the risk of bias of the body of evidence, and we used inverse variance methods to analyse continuous outcomes and measurement scales. We compared the mean difference between treatment groups, and we combined results for dichotomous outcomes using Mantel-Haenszel methods and risk differences We used Review Manager software for data management and analysis. MAIN RESULTS We only found one study eligible for this review (22 participants). We assessed the risk of bias for most domains as unclear. We graded the overall quality of evidence as very low. Compared to placebo, patients treated with pregabalin showed no significant improvement of motor tasks on the 36-point subscale of the Fahn-Tolosa-Marin Tremor Rating Scale (TRS) (MD -2.15 points; 95% CI -9.16 to 4.86) or on the 32-point functional abilities subscale of the TRS (MD -0.66 points; 95% CI -2.90 to 1.58).The limited evidence showed no difference in study withdrawal (Mantel-Haenszel RD -0.09; 95% CI -0.48 to 0.30) and presentation of adverse events between pregabalin and placebo (Mantel-Haenszel RD 0.18; 95% CI -0.13 to 0.50). AUTHORS' CONCLUSIONS The effects of pregabalin for treating essential tremor are uncertain because the quality of the evidence is very low. One small study did not highlight any effect of this treatment; however, the high risk of bias and the lack of other studies on this topic limit further conclusion.
Collapse
Affiliation(s)
- Elisa Bruno
- Department GF Ingrassia,Section of Neurosciences, University of Catania, Catania, Italy, 95123
| | | | | | | | | | | |
Collapse
|
30
|
Silva D, Matias C, Bourne S, Nagel S, Machado A, Lobel D. Effects of chronic alcohol consumption on long-term outcomes of thalamic deep brain stimulation for essential tremor. J Clin Neurosci 2016; 31:142-6. [PMID: 27401226 DOI: 10.1016/j.jocn.2016.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 03/08/2016] [Indexed: 11/28/2022]
Abstract
The prevalence of essential tremor (ET) is about 4% above 40years of age. Chronic alcohol consumption is present in around 20% of patients with ET. Our objective was to identify whether chronic alcohol consumption was associated with a negative effect on tremor outcome after thalamic deep brain stimulation (DBS) in ET patients. We conducted a retrospective chart review, from January 2005 to December 2012, from which 23 patients who had ventral intermediate nucleus (Vim)-DBS surgery for ET were identified. Seven patients had a positive history of chronic alcohol consumption. We defined as chronic alcohol users those patients with a habit of drinking alcohol every day in order to suppress tremor. In the overall group of 23 patients, there was a reduction in the median tremor score from 8 pre-operatively, to 1 post-operatively (p<0.0001). The alcohol consumers group experienced a reduction in the median tremor score from 6 pre-operatively to 0 post-operatively (p=0.03). The non-alcohol consumers group had a reduction in the median tremor score from 8 pre-operatively to 1.7 post-operatively (p<0.0001). Both groups of patients experienced significant benefit from thalamic DBS. A larger study may reveal statistically significant differences between subgroups.
Collapse
Affiliation(s)
- Danilo Silva
- Center for Neurological Restoration, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, OH 44124, USA.
| | - Caio Matias
- Center for Neurological Restoration, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Sarah Bourne
- Center for Neurological Restoration, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Sean Nagel
- Center for Neurological Restoration, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Andre Machado
- Center for Neurological Restoration, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Darlene Lobel
- Center for Neurological Restoration, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, OH 44124, USA
| |
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
Albanese A, Sorbo FD. Dystonia and Tremor: The Clinical Syndromes with Isolated Tremor. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:319. [PMID: 27152246 PMCID: PMC4850743 DOI: 10.7916/d8x34xbm] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 02/21/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dystonia and tremor share many commonalities. Isolated tremor is part of the phenomenological spectrum of isolated dystonia and of essential tremor. The occurrence of subtle features of dystonia may allow one to differentiate dystonic tremor from essential tremor. Diagnostic uncertainty is enhanced when no features of dystonia are found in patients with a tremor syndrome, raising the question whether the observed phenomenology is an incomplete form of dystonia. METHODS Known forms of syndromes with isolated tremor are reviewed. Diagnostic uncertainties between tremor and dystonia are put into perspective. RESULTS The following isolated tremor syndromes are reviewed: essential tremor, head tremor, voice tremor, jaw tremor, and upper-limb tremor. Their varied phenomenology is analyzed and appraised in the light of a possible relationship with dystonia. DISCUSSION Clinicians making a diagnosis of isolated tremor should remain vigilant for the detection of features of dystonia. This is in keeping with the recent view that isolated tremor may be an incomplete phenomenology of dystonia.
Collapse
Affiliation(s)
- Alberto Albanese
- Istituto Clinico Humanitas, Rozzano, Italy; Istituto di Neurologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | | |
Collapse
|
33
|
Bruno E, Nicoletti A, Quattrocchi G, Filippini G, Zappia M, Colosimo C. Alprazolam for essential tremor. Cochrane Database Syst Rev 2015; 2015:CD009681. [PMID: 26638213 PMCID: PMC7387361 DOI: 10.1002/14651858.cd009681.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Essential tremor (ET) is one of the most common movement disorders. Treatment is based primarily on pharmacological agents. On this basis, although primidone and propranolol are well-established treatments in clinical practice, they could be ineffective in 25% to 55% of patients and can produce serious adverse events (AEs) in a large percentage of individuals. For these reasons, evaluating treatment alternatives for ET may be a worthwhile pursuit. Alprazolam has been suggested as a potentially useful agent for treatment of individuals with ET, but its efficacy and safety are uncertain. OBJECTIVES PrimaryTo assess the efficacy and safety of alprazolam in the treatment of individuals with ET. SecondaryTo examine effects of alprazolam treatment on the quality of life of people with ET. SEARCH METHODS We carried out a systematic search without language restrictions to identify all relevant trials. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (January 1966 to September 2015), EMBASE (January 1988 to September 2015), the National Institute for Health and Care Excellence (NICE) (1999 to September 2015), ClinicalTrials.gov (1997 to September 2015) and the World Health Organiza tion (WHO) International Clinical Trials Registry Platform (ICTRP) (2004 to September 2015). We handsearched grey literature and examined the reference lists of identified studies and reviews. SELECTION CRITERIA We included all randomised controlled trials (RCTs) of alprazolam versus placebo or any other treatment. We included studies in which ET was diagnosed according to accepted and validated diagnostic criteria. We excluded studies that included patients presenting with secondary forms of tremor or reporting only neurophysiological parameters for the pur p ose of assessing outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently collected and extracted data using a data collection form. We assessed risk of bias and the body of evidence. We used inverse variance methods for continuous outcomes and measurement scales. We compared differences between treatment groups as mean differences. We used Review Manager software for management and analysis of data. MAIN RESULTS We included in this review one trial that compared alprazolam versus placebo (24 participants). It was judged to have high overall risk of bias. We graded the overall quality of evidence as very low. Compared with those given placebo, participants treated with alprazolam showed a significant reduction in tremor severity (mean difference (MD) -0.75, 95% confidence interval (CI) -0.83 to -0.67). Nine alprazolam-treated participants (75%) developed AEs, mainly represented by sedation (50%), constipation (17%) and dry mouth (9%). No participants in the alprazolam group and no p articipants in the placebo group discontinued treatment and dropped out of the study. AUTHORS' CONCLUSIONS Currently available data reveal evidence insufficient for assessment of the efficacy and safety of alprazolam treatment for individuals with ET.
Collapse
Affiliation(s)
- Elisa Bruno
- Department GF Ingrassia,Section of Neurosciences, University of Catania, Catania, Italy, 95123
| | | | | | | | | | | |
Collapse
|
34
|
Ghanouni P, Pauly KB, Elias WJ, Henderson J, Sheehan J, Monteith S, Wintermark M. Transcranial MRI-Guided Focused Ultrasound: A Review of the Technologic and Neurologic Applications. AJR Am J Roentgenol 2015; 205:150-9. [PMID: 26102394 PMCID: PMC4687492 DOI: 10.2214/ajr.14.13632] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This article reviews the physical principles of MRI-guided focused ultra-sound and discusses current and potential applications of this exciting technology. CONCLUSION MRI-guided focused ultrasound is a new minimally invasive method of targeted tissue thermal ablation that may be of use to treat central neuropathic pain, essential tremor, Parkinson tremor, and brain tumors. The system has also been used to temporarily disrupt the blood-brain barrier to allow targeted drug delivery to brain tumors.
Collapse
Affiliation(s)
- Pejman Ghanouni
- Stanford University, Department of Radiology, Division of Body MRI, Stanford, CA
| | - Kim Butts Pauly
- Stanford University, Departments of Radiology and Electrical Engineering and Bioengineering, Stanford, CA
| | - W. Jeff Elias
- University of Virginia, Department of Neurosurgery, Charlottesville, VA
| | - Jaimie Henderson
- Stanford University, Department of Neurosurgery and Neurology and Neurological Sciences, Stanford, CA
| | - Jason Sheehan
- University of Virginia, Department of Neurosurgery, Charlottesville, VA
| | | | - Max Wintermark
- Stanford University, Department of Radiology, Division of Neuroradiology, Stanford, CA
| |
Collapse
|
35
|
News and controversies regarding essential tremor. Rev Neurol (Paris) 2015; 171:415-25. [DOI: 10.1016/j.neurol.2015.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/01/2015] [Accepted: 02/02/2015] [Indexed: 01/08/2023]
|
36
|
Gamma knife stereotactic radiosurgical thalamotomy for intractable tremor: A systematic review of the literature. Radiother Oncol 2015; 114:296-301. [DOI: 10.1016/j.radonc.2015.01.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/07/2015] [Accepted: 01/25/2015] [Indexed: 02/07/2023]
|
37
|
Louis ED, Ottman R. How many people in the USA have essential tremor? Deriving a population estimate based on epidemiological data. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:259. [PMID: 25157323 PMCID: PMC4137360 DOI: 10.7916/d8tt4p4b] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/21/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Essential tremor (ET) is often reported to be among the most prevalent movement disorders, yet the precise number of cases in the USA is not known. The goal of the current analyses was to use published data from epidemiological studies to derive an estimate of the number of people currently residing in the USA who have ET. METHODS A PubMed search was conducted to identify population-based prevalence studies of ET. The methodology of 34 identified studies was assessed. Then the three most methodologically rigorous studies were selected, and age-specific prevalence data were abstracted. US census data from 2012 were used to determine the population in the USA by 10-year age categories. RESULTS Using data from three studies, estimates of the number of ET cases (2012) ranged from 6.38 to 7.63 million (mean = 7.01 million). This corresponds to approximately 2.2% of the US population. DISCUSSION Knowing the number of ET cases in the USA is important in terms of estimating the medical burden on communities and society, and providing an objective metric on which to base health resource planning.
Collapse
Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA ; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, 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
| | - Ruth Ottman
- 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 ; Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| |
Collapse
|
38
|
Rajput AH, Rajput A. Medical treatment of essential tremor. J Cent Nerv Syst Dis 2014; 6:29-39. [PMID: 24812533 PMCID: PMC3999812 DOI: 10.4137/jcnsd.s13570] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/10/2014] [Accepted: 03/12/2014] [Indexed: 11/05/2022] Open
Abstract
Essential tremor (ET) is the most common pathological tremor characterized by upper limb action-postural tremor (PT)/kinetic tremor (KT). There are no specific neuropathological or biochemical abnormalities in ET. The disability is consequent to amplitude of KT, which may remain mild without handicap or may become disabling. The most effective drugs for sustained tremor control are propranolol and primidone. Symptomatic drug treatment must be individualized depending on the circumstances that provoke the tremor-related disability. Broad guidelines for treatment are discussed in this review. Patients may be treated intermittently only on stressful occasions with propranolol, clonazepam, or primidone monotherapy, or an alcoholic drink. Those with persistently disabling tremor need continued treatment.
Collapse
Affiliation(s)
- Ali H Rajput
- University of Saskatchewan, Canada
- Saskatoon Health Region, Canada
| | - Alex Rajput
- University of Saskatchewan, Canada
- Saskatoon Health Region, Canada
| |
Collapse
|
39
|
Wintermark M, Huss DS, Shah BB, Tustison N, Druzgal TJ, Kassell N, Elias WJ. Thalamic connectivity in patients with essential tremor treated with MR imaging-guided focused ultrasound: in vivo fiber tracking by using diffusion-tensor MR imaging. Radiology 2014; 272:202-9. [PMID: 24620914 DOI: 10.1148/radiol.14132112] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To use diffusion-tensor (DT) magnetic resonance (MR) imaging in patients with essential tremor who were treated with transcranial MR imaging-guided focused ultrasound lesion inducement to identify the structural connectivity of the ventralis intermedius nucleus of the thalamus and determine how DT imaging changes correlated with tremor changes after lesion inducement. MATERIALS AND METHODS With institutional review board approval, and with prospective informed consent, 15 patients with medication-refractory essential tremor were enrolled in a HIPAA-compliant pilot study and were treated with transcranial MR imaging-guided focused ultrasound surgery targeting the ventralis intermedius nucleus of the thalamus contralateral to their dominant hand. Fourteen patients were ultimately included. DT MR imaging studies at 3.0 T were performed preoperatively and 24 hours, 1 week, 1 month, and 3 months after the procedure. Fractional anisotropy (FA) maps were calculated from the DT imaging data sets for all time points in all patients. Voxels where FA consistently decreased over time were identified, and FA change in these voxels was correlated with clinical changes in tremor over the same period by using Pearson correlation. RESULTS Ipsilateral brain structures that showed prespecified negative correlation values of FA over time of -0.5 or less included the pre- and postcentral subcortical white matter in the hand knob area; the region of the corticospinal tract in the centrum semiovale, in the posterior limb of the internal capsule, and in the cerebral peduncle; the thalamus; the region of the red nucleus; the location of the central tegmental tract; and the region of the inferior olive. The contralateral middle cerebellar peduncle and bilateral portions of the superior vermis also showed persistent decrease in FA over time. There was strong correlation between decrease in FA and clinical improvement in hand tremor 3 months after lesion inducement (P < .001). CONCLUSION DT MR imaging after MR imaging-guided focused ultrasound thalamotomy depicts changes in specific brain structures. The magnitude of the DT imaging changes after thalamic lesion inducement correlates with the degree of clinical improvement in essential tremor.
Collapse
Affiliation(s)
- Max Wintermark
- From the Department of Radiology, Neuroradiology Division (M.W., N.T., T.J.D.), Department of Neurosurgery (D.S.H., N.K., W.J.E.), and Department of Neurology (B.B.S.), University of Virginia, 1215 Lee St, New Hospital, 1st Floor, Room 1011, Charlottesville, VA 22908-0170; and Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (M.W.)
| | | | | | | | | | | | | |
Collapse
|
40
|
Wintermark M, Druzgal J, Huss DS, Khaled MA, Monteith S, Raghavan P, Huerta T, Schweickert LC, Burkholder B, Loomba JJ, Zadicario E, Qiao Y, Shah B, Snell J, Eames M, Frysinger R, Kassell N, Elias WJ. Imaging findings in MR imaging-guided focused ultrasound treatment for patients with essential tremor. AJNR Am J Neuroradiol 2013; 35:891-6. [PMID: 24371027 DOI: 10.3174/ajnr.a3808] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging-guided focused sonography surgery is a new stereotactic technique that uses high-intensity focused sonography to heat and ablate tissue. The goal of this study was to describe MR imaging findings pre- and post-ventralis intermedius nucleus lesioning by MR imaging-guided focused sonography as a treatment for essential tremor and to determine whether there was an association between these imaging features and the clinical response to MR imaging-guided focused sonography. MATERIALS AND METHODS Fifteen patients with medication-refractory essential tremor prospectively gave consent; were enrolled in a single-site, FDA-approved pilot clinical trial; and were treated with transcranial MR imaging-guided focused sonography. MR imaging studies were obtained on a 3T scanner before the procedure and 24 hours, 1 week, 1 month, and 3 months following the procedure. RESULTS On T2-weighted imaging, 3 time-dependent concentric zones were seen at the site of the focal spot. The inner 2 zones showed reduced ADC values at 24 hours in all patients except one. Diffusion had pseudonormalized by 1 month in all patients, when the cavity collapsed. Very mild postcontrast enhancement was seen at 24 hours and again at 1 month after MR imaging-guided focused sonography. The total lesion size and clinical response evolved inversely compared with each other (coefficient of correlation = 0.29, P value = .02). CONCLUSIONS MR imaging-guided focused sonography can accurately ablate a precisely delineated target, with typical imaging findings seen in the days, weeks, and months following the treatment. Tremor control was optimal early when the lesion size and perilesional edema were maximal and was less later when the perilesional edema had resolved.
Collapse
Affiliation(s)
- M Wintermark
- From the Departments of Radiology, Neuroradiology Division (M.W., J.D., P.R., T.H., L.C.S., B.B., Y.Q.)
| | - J Druzgal
- From the Departments of Radiology, Neuroradiology Division (M.W., J.D., P.R., T.H., L.C.S., B.B., Y.Q.)
| | - D S Huss
- Neurosurgery (D.S.H., M.A.K., S.M., J.J.L., R.F., N.K., W.J.E.)
| | - M A Khaled
- Neurosurgery (D.S.H., M.A.K., S.M., J.J.L., R.F., N.K., W.J.E.)
| | - S Monteith
- Neurosurgery (D.S.H., M.A.K., S.M., J.J.L., R.F., N.K., W.J.E.)
| | - P Raghavan
- From the Departments of Radiology, Neuroradiology Division (M.W., J.D., P.R., T.H., L.C.S., B.B., Y.Q.)
| | - T Huerta
- From the Departments of Radiology, Neuroradiology Division (M.W., J.D., P.R., T.H., L.C.S., B.B., Y.Q.)
| | - L C Schweickert
- From the Departments of Radiology, Neuroradiology Division (M.W., J.D., P.R., T.H., L.C.S., B.B., Y.Q.)
| | - B Burkholder
- From the Departments of Radiology, Neuroradiology Division (M.W., J.D., P.R., T.H., L.C.S., B.B., Y.Q.)
| | - J J Loomba
- Neurosurgery (D.S.H., M.A.K., S.M., J.J.L., R.F., N.K., W.J.E.)
| | | | - Y Qiao
- From the Departments of Radiology, Neuroradiology Division (M.W., J.D., P.R., T.H., L.C.S., B.B., Y.Q.)
| | - B Shah
- Neurology (B.S.), University of Virginia, Charlottesville, Virginia
| | - J Snell
- Focused Ultrasound Surgery Foundation (J.S., M.E.), Charlottesville, Virginia
| | - M Eames
- Focused Ultrasound Surgery Foundation (J.S., M.E.), Charlottesville, Virginia
| | - R Frysinger
- Neurosurgery (D.S.H., M.A.K., S.M., J.J.L., R.F., N.K., W.J.E.)
| | - N Kassell
- Neurosurgery (D.S.H., M.A.K., S.M., J.J.L., R.F., N.K., W.J.E.)
| | - W J Elias
- Neurosurgery (D.S.H., M.A.K., S.M., J.J.L., R.F., N.K., W.J.E.)
| |
Collapse
|
41
|
Louis ED. 'Essential tremor' or 'the essential tremors': is this one disease or a family of diseases? Neuroepidemiology 2013; 42:81-9. [PMID: 24335621 DOI: 10.1159/000356351] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 10/10/2013] [Indexed: 12/14/2022] Open
Abstract
There is accumulating evidence that the entity referred to as 'essential tremor' (ET) is not a single disease. It may be a family of diseases better referred to as 'the ETs'. This review will summarize the following evidence: (1) the presence of etiological heterogeneity; (2) the heterogeneity of findings in postmortem studies, thus suggesting several diseases; (3) the recent discussion that age of onset may be an important marker of disease heterogeneity; (4) the clinical expansion of the concept of ET in recent years to include a broader range of tremor phenomenology, other motor features (gait ataxia), other involuntary movements (dystonia), and nonmotor features (cognitive problems, psychiatric problems), some of which could be primary; (5) the heterogeneity of pharmacological response profiles and clinical progression, and (6) the association of ET with Parkinson's disease, Alzheimer's disease, and possibly progressive supranuclear palsy, with the possibility that some ET patients are more predisposed to develop one of these. © 2013 S. Karger AG, Basel.
Collapse
Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, N.Y., USA
| |
Collapse
|
42
|
Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, Lorenzo-Betancor O, Pastor P, Agúndez JAG. Update on genetics of essential tremor. Acta Neurol Scand 2013; 128:359-71. [PMID: 23682623 DOI: 10.1111/ane.12148] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2013] [Indexed: 12/25/2022]
Abstract
Despite the research, few advances in the etiopathogenesis on essential tremor (ET) have been made to date. The high frequency of positive family history of ET and the observed high concordance rates in monozygotic compared with dizygotic twins support a major role of genetic factors in the development of ET. In addition, a possible role of environmental factors has been suggested in the etiology of ET (at least in non-familial forms). Although several gene variants in the LINGO1 gene may increase the risk of ET, to date no causative mutated genes have been identified. In this review, we summarize the studies performed on families with tremor, twin studies, linkage studies, case-control association studies, and exome sequencing in familial ET.
Collapse
Affiliation(s)
- F. J. Jiménez-Jiménez
- Section of Neurology; Hospital Universitario del Sureste; Arganda del Rey Madrid Spain
| | - H. Alonso-Navarro
- Section of Neurology; Hospital Universitario del Sureste; Arganda del Rey Madrid Spain
| | - E. García-Martín
- Department of Biochemistry and Molecular Biology; University of Extremadura; Cáceres Spain
- AMGenomics; Edificio Tajo, Avda. de la Universidad s/n; Cáceres Spain
| | - O. Lorenzo-Betancor
- Neurogenetics Laboratory; Division of Neurosciences; Center for Applied Medical Research (CIMA); University of Navarra; Pamplona Spain
- Department of Neurology; Clínica Universidad de Navarra; University of Navarra School of Medicine; Pamplona Spain
| | - P. Pastor
- Neurogenetics Laboratory; Division of Neurosciences; Center for Applied Medical Research (CIMA); University of Navarra; Pamplona Spain
- Department of Neurology; Clínica Universidad de Navarra; University of Navarra School of Medicine; Pamplona Spain
- CIBERNED; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas; Instituto de Salud Carlos III; Madrid Spain
| | - J. A. G. Agúndez
- AMGenomics; Edificio Tajo, Avda. de la Universidad s/n; Cáceres Spain
- Department of Pharmacology; University of Extremadura; Cáceres Spain
| |
Collapse
|
43
|
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.
Collapse
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
| | | |
Collapse
|
44
|
Abstract
BACKGROUND AND PURPOSE Tremor occurs in 10-85% of patients with focal dystonia as so-called dystonic tremor or tremor associated with dystonia. The aim of this study was to assess the incidence and to characterize parameters of tremor accompanying focal and segmental dystonia. MATERIAL AND METHODS One hundred and twenty-three patients with diagnosis of focal and segmental dystonia together with 51 healthy controls were included in the study. For each participant, clinical examination and objective assessment (accelerometer, electromyography, graphic tablet) of hand tremor was performed. Frequency and severity of tremor were assessed in three positions: at rest (rest tremor); with hands extended (postural tremor); during 'finger-to-nose' test and during Archimedes spiral drawing (kinetic tremor). Based on the mass load test, type of tremor was determined as essential tremor type or enhanced physiological type. RESULTS The incidence of tremor was significantly higher in dystonic patients as compared to controls (p = 0.0001). In clinical examination, tremor was found in 50% of dystonic patients, and in instrumental assessment in an additional 10-20%. The most frequent type of tremor was postural and kinetic tremor with 7 Hz frequency and featured essential tremor type. In the control group, tremor was detected in about 10% of subjects as 9-Hz postural tremor of enhanced physiological tremor type. No differences were found between patients with different types of dystonia with respect to the tremor incidence, type and parameters (frequency and severity). No correlations between tremor severity and dystonia severity were found either.
Collapse
|
45
|
Dhand A, Birdi S, Rajput AH. Frequency of respiratory disorders and bradycardia in essential tremor - consideration of treatment. Parkinsonism Relat Disord 2012; 4:7-10. [PMID: 18591082 DOI: 10.1016/s1353-8020(98)00005-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Essential tremor (ET) is a common movement disorder and the prevalence rate increases with age. The most frequently prescribed and perhaps the most effective drugs for symptomatic treatment of ET are beta-blocking drugs such as propranolol. Some beta blockers are contraindicated in respiratory disorders (RD) and in cardiac conditions such as bradycardia, the frequency of which is unknown in ET patients. We studied RD and bradycardia (BPM </= 60) in 100 consecutive ET patients. Thirty-seven patients had RD and/or bradycardia - 18 had RD only, 17 bradycardia only and two cases had both). Thirty-two of these cases could not be prescribed a beta-blocking drug and five tolerated less than the optimal dose of propranolol. Our data suggest that respiratory disorders may be more common in ET cases than expected in the general population.
Collapse
Affiliation(s)
- A Dhand
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N OW8
| | | | | |
Collapse
|
46
|
Columbia University Assessment of Disability in Essential Tremor (CADET): methodological issues in essential tremor research. Parkinsonism Relat Disord 2012; 6:17-23. [PMID: 18591147 DOI: 10.1016/s1353-8020(99)00028-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Essential tremor (ET) is one of the most prevalent neurological disorders, affecting between 0.4 and 3.9% of the population. As there have been few studies of the functional impact of ET, knowledge of this area is limited. One study relied on subjective reports of tremor severity while a second focused on issues relating to treatment. Knowledge about the functional impact of ET is important for the valid assessment of efficacy in therapeutic trials as well as the diagnosis of ET in genetic and epidemiological studies. In order to examine the issue of functional disability in ET in greater detail, we designed the Columbia University Assessment of Disability in Essential Tremor (CADET). The critical elements of the study design have not been consistently applied to ET research to date. We describe this novel study.
Collapse
|
47
|
Okubadejo NU, Bankole IA, Ojo OO, Ojini FI, Danesi MA. Prevalence of essential tremor in urban Lagos, Nigeria: a door-to-door community-based study. BMC Neurol 2012; 12:110. [PMID: 23017021 PMCID: PMC3488469 DOI: 10.1186/1471-2377-12-110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 09/19/2012] [Indexed: 11/10/2022] Open
Abstract
Background Essential tremor (ET) is one of the commonest movement disorders though the prevalence varies globally. There is paucity of data on ET prevalence in sub-Saharan Africa. The study aimed to determine the prevalence of ET in a Nigerian community. Methods This door-to-door survey was conducted in two stages. In Stage 1, 3000 randomly selected residents of an urban centre in Lagos, Nigeria, were screened using a questionnaire to detect symptoms of movement disorder. 234 participants who responded positively regarding presence of tremors were rescreened using an ET-specific questionnaire, a face-to-face interview and neurological examination. Diagnosis of ET was based on the Movement Disorders Society (MDS) consensus diagnostic criteria for ET. Results Of the 3000 participants, forty responded positively to the ET screening questionnaire, of which 36 (19 females and 17 males) had a final diagnosis of ET, giving a crude prevalence of 12 per 1000 (95% CI = 8.1- 15.9). Gender specific prevalence was 10.3 /1000 in males and 14.3/1000 in females. Age specific prevalence increased with advancing age in both sexes. Age adjusted prevalence (WHO New world population) was 23.8 per 1000. Conclusions We documented a high prevalence of ET in this study, with typical increasing prevalence with advancing age as previously reported in other populations.
Collapse
Affiliation(s)
- Njideka U Okubadejo
- Neurology Unit, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria.
| | | | | | | | | |
Collapse
|
48
|
Bermejo-Pareja F, Puertas-Martín V. Cognitive features of essential tremor: a review of the clinical aspects and possible mechanistic underpinnings. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2012; 2. [PMID: 23440004 PMCID: PMC3572680 DOI: 10.7916/d89w0d7w] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 05/08/2012] [Indexed: 01/10/2023]
Abstract
The classical concept of essential tremor (ET) as a monosymptomatic tremorogenic disorder has been questioned in the last decade as new evidence has been described. Clinical, neuroimaging, and pathological studies have described a probable structural basis (mainly in cerebellum) and evidence that ET is associated with subtle clinical cerebellar deficits and several non-motor clinical manifestations, such as cognitive and mood disorders. We performed literature searches in Medline, ISI Web of Knowledge, and PsycInfo databases. The aim of this review is to describe cognitive deficits associated with ET. First, we present a brief history of ET cognitive disorders presented. Second, we describe several clinical cross-sectional series demonstrating that ET is associated with mild cognitive deficits of attention, executive functions, several types of memory (working memory, immediate, short term, delayed, and possibly others) and, mood disorders (depression). Recent neuroimaging studies favor a cerebellar basis for these cognitive deficits. Population-based surveys confirm that mild cognitive dysfunction is not limited to severe ET cases, the entire ET group, including mild and undiagnosed cases, can be affected. Cohort studies indicated that ET cognitive deficits could be progressive and that ET patients had an increased risk of dementia. The mood and cognitive deficits in ET are in agreement with cognitive affective cerebellar syndrome described in patients with cerebellar disorders. New evidence, mainly from functional (neuroimaging) and prospective clinical studies would further bolster recent descriptions of ET clinical manifestations.
Collapse
Affiliation(s)
- Félix Bermejo-Pareja
- Head of the Neurology Department, University Hospital "12 de Octubre", Madrid, Spain ; Biomedical Research Network on Neurodegenerative Disorders (CIBERNED), Carlos III National Research Institute, Madrid, Spain ; Department of Biomedical Sciences (ANECA), Complutense University of Madrid, Spain
| | | |
Collapse
|
49
|
Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, Agúndez JAG. The relationship between Parkinson's disease and essential tremor: review of clinical, epidemiologic, genetic, neuroimaging and neuropathological data, and data on the presence of cardinal signs of parkinsonism in essential tremor. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2012; 2. [PMID: 23439992 PMCID: PMC3572635 DOI: 10.7916/d8fn14z6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/18/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND The possible relationship between essential tremor (ET) and Parkinson's disease (PD) has been controversial since the first description of PD. However, there is increasing evidence suggesting an overlap between these two disorders. The aim of this review is to examine the relationship between PD and ET, focusing on clinical, epidemiologic, genetic, neuroimaging, and neuropathological data, and the presence of cardinal parkinsonism symptoms in ET. METHODS We conducted a PubMed search for articles published between 1966 and November 2011 regarding the relationship between ET and PD and the presence of postural tremor in PD patients; the presence of rest tremor, rigidity, and slowed movements in ET patients is reviewed. RESULTS Clinical series, follow-up studies of ET patients, and case-control and genetic epidemiological studies indicate that ET is associated with increased risk for PD. Some neuroimaging studies and neuropathological reports suggest an association between the two diseases. ET patients show high prevalence of rest tremor, and at least seven studies described slowed movements (possibly related to cerebellar dysfunction and/or bradykinesia) in patients with ET. DISCUSSION There is reasonable epidemiological and clinical evidence to support a link between ET and PD, although it is not clear what factors predict ET patient risk for developing PD or, more rarely, of PD patients developing ET. Future multicentric and multidisciplinary studies including epidemiological, clinical, neuroimaging, genetic, and neuropathological assessments are required to understand these associations.
Collapse
|
50
|
Perception of Vocal Tremor During Sustained Phonation Compared With Sentence Context. J Voice 2012; 26:668.e1-9. [DOI: 10.1016/j.jvoice.2011.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 11/02/2011] [Indexed: 11/21/2022]
|