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Gironell A, Marín-Lahoz J, Póveda S. Essential Tremor: Update of Therapeutic Strategies. Med Clin (Barc) 2024; 162:599-605. [PMID: 38553256 DOI: 10.1016/j.medcli.2023.12.013] [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: 10/31/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 06/18/2024]
Abstract
In the last decades there has been progress in the treatment of essential tremor (TE) especially in the surgical field and to a lesser extent in the pharmacological field. We carry out a review of the currently available treatments. The first intervention is the use of non-pharmacological and non-surgical strategies (general advice, occupational therapy, speech therapy, psychotherapy). With discrete advances, the pharmacological treatment is not very satisfactory. Only 30-60% of patients have a positive response, and in these the anti-tremor effectiveness is 40-60%. The first-line drugs are still propranolol and primidone. In cases with severe tremor we will consider a surgical option, the method of choice being thalamotomy using high-intensity focused ultrasound. In the future we must continue to study the pathophysiology of TE, develop drugs specifically designed for TE and improve the technology of available invasive techniques.
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Affiliation(s)
- Alexandre Gironell
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - Juan Marín-Lahoz
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España; Grupo de Neurociencias, IIS Aragón, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España
| | - Santiago Póveda
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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Meng L, Jin M, Zhu X, Ming D. Peripherical Electrical Stimulation for Parkinsonian Tremor: A Systematic Review. Front Aging Neurosci 2022; 14:795454. [PMID: 35197841 PMCID: PMC8859162 DOI: 10.3389/fnagi.2022.795454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
Parkinsonian tremor is one of the most common motor disorders in patients with Parkinson's disease (PD). Compared to oral medications and brain surgery, electrical stimulation approaches have emerged as effective and non-invasive methods for tremor reduction. The pathophysiology, detection and interventions of tremors have been introduced, however, a systematic review of peripherical electrical stimulation approaches, methodologies, experimental design and clinical outcomes for PD tremor suppression is still missing. Therefore, in this paper, we summarized recent studies on electrical stimulation for tremor suppression in PD patients and discussed stimulation protocols and effectiveness of different types of electrical stimulation approaches in detail. Twenty out of 528 papers published from 2010 to 2021 July were reviewed. The results show that electrical stimulation is an efficient intervention for tremor suppression. The methods fall into three main categories according to the mechanisms: namely functional electrical stimulation (FES), sensory electrical stimulation (SES) and transcutaneous electrical nerve stimulation (TENS). The outcomes of tremor suppression were varied due to various stimulation approaches, electrode locations and stimulation parameters. The FES method performed the best in tremor attenuation where the efficiency depends mainly by the control strategy and accuracy of tremor detection. However, the mechanism underlying tremor suppression with SES and TENS, is not well-known. Current electrical stimulation approaches may only work for a number of patients. The potential mechanism of tremor suppression still needs to be further explored.
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Affiliation(s)
- Lin Meng
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Mengyue Jin
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Xiaodong Zhu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Xiaodong Zhu
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- Department of Biomedical Engineering, Tianjin University, Tianjin, China
- *Correspondence: Dong Ming
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Bhidayasiri R, Maytharakcheep S, Phumphid S, Maetzler W. Improving functional disability in patients with tremor: A clinical perspective of the efficacies, considerations, and challenges of assistive technology. J Neurol Sci 2022; 435:120197. [DOI: 10.1016/j.jns.2022.120197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/06/2021] [Accepted: 02/17/2022] [Indexed: 11/24/2022]
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Chitambira B, McConaghy C. Use of optokinetic chart stimulation to restore mobility and reduce ataxia in a patient with pseudo-Cushing ataxia. BMJ Case Rep 2018; 2018:bcr-2018-225346. [PMID: 30139786 DOI: 10.1136/bcr-2018-225346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 61-year-old patient was admitted to hospital after a fall. She presented with bilateral muscle weakness and severe ataxia. She was unable to maintain sitting balance or place feet on the floor and was unable to tolerate hoist transfers due to the severity of her ataxia. Nursing and physiotherapy staff found it difficult to sit her out of bed. Her physiotherapy intervention changed to optokinetic chart stimulation (OKCS) and sensory interaction for balance. After treatment for 5 days, her intention tremor fully resolved. At discharge, she was mobile with a wheeled zimmer walking frame and supervision of one person. At follow-up after 8 months, she was independently mobile without any walking aid in and around her house. She was going out shopping with her son. For recovery from ataxia, it is recommended that further research on restorative intervention at the nervous system level be carried out.
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Affiliation(s)
- Benjamin Chitambira
- Department of Physiotherapy, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - Ciara McConaghy
- Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
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Li KY, Hsiao YP, Chen RS, Wu CY. Effects of Wrist Weights on Kinematic and Myographic Movement Characteristics During a Reaching Task in Individuals With Parkinson Disease. Arch Phys Med Rehabil 2017; 99:1303-1310. [PMID: 29274724 DOI: 10.1016/j.apmr.2017.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the kinematic and myographic effects of weighted wrist cuffs on individuals with Parkinson disease (PD) during a reaching task. DESIGN Cross-sectional study. SETTING Biomechanics research laboratory. PARTICIPANTS Individuals (N=39) with PD (n=19) and healthy age-matched control subjects (n=20). INTERVENTIONS Participants were instructed to reach and grasp a can at a distance of 80% of their arm length without a wrist cuff, while wearing separate 0.5- and 1.0-kg wrist cuffs, and subsequently without a wrist cuff. MAIN OUTCOME MEASURES Movement time, kinematic, and electromyographic data were recorded during all reach and grasp movements. Four end point coordinate strategy variables, 3 joint recruitment variables, and 2 co-contraction indices were derived from the raw data for analysis. RESULTS Significant interaction effects were found in the trunk and index finger movement time as the weight of the cuff increased from 0.5 to 1.0kg. The group of individuals with PD showed decreased movement times in both instances, whereas the control group showed increased movement times as the weight of the wrist cuff increased from baseline to 0.5 and 1.0kg. No group difference was observed in the co-contraction index of the upper arm and forearm. CONCLUSIONS Adoption of weighted wrist cuffs in the clinic should be cautiously undertaken because compensatory movements may be induced in the trunk of individuals with PD.
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Affiliation(s)
- Kuan-Yi Li
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Tao-yuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Movement Disorders Section, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Pei Hsiao
- Department of Rehabilitation and Treatment, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Rou-Shayn Chen
- Movement Disorders Section, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Tao-yuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Miocinovic S, Shoeb AH, Wang S, Byrd EA, Swann NC, Pathak A, Ostrem JL. Clinical Tremor Severity Estimation Using an Instrumented Eating Utensil. JOURNAL OF PARKINSONS DISEASE 2017; 7:755-759. [PMID: 28922166 DOI: 10.3233/jpd-160929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We demonstrate the feasibility of estimating clinical tremor scores using an eating utensil with motion-sensing and tremor-cancellation technology in thirteen patients with tremor. Three experts scored hand tremor using the modified Fahn- Tolosa-Marin (FTM) scale. A linear model was trained to estimate tremor severity using the recorded motion signals. The average neurologist FTM score was 1.6±0.7 for PD and 2.6±0.7 for ET patients. The average model score was 1.6±0.7 for PD and 2.6±0.6 for ET. Correlation coefficient between the clinical and model tremor scores was 0.91 (p < 0.001). Motion data from an instrumented eating utensil accurately derived tremor ratings enabling practical, objective daily monitoring.
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Affiliation(s)
| | - Ali H Shoeb
- Verily Life Sciences, Mountain View, CA, USA
| | - Sarah Wang
- Department of Neurology, University of California San Francisco, CA, USA
| | - Erica A Byrd
- Department of Neurology, University of California San Francisco, CA, USA
| | - Nicole C Swann
- Department of Neurosurgery, University of California San Francisco, CA, USA
| | | | - Jill L Ostrem
- Department of Neurology, University of California San Francisco, CA, USA
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Miller L, van Wijck F, Lamont L, Preston J, Hair M. Sensory dynamic orthoses in mild to moderate upper limb tremor in multiple sclerosis: a mixed methods feasibility study. Clin Rehabil 2016; 30:1060-1073. [PMID: 26396165 DOI: 10.1177/0269215515605356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the feasibility of conducting a Phase III randomized controlled trial evaluating sensory dynamic orthoses for upper limb tremor in multiple sclerosis. DESIGN Mixed methods: double blind randomized placebo controlled pilot study and semi-structured interviews. SETTING Rehabilitation centre. SUBJECTS A total of 21 people with multiple sclerosis with upper limb tremor. INTERVENTIONS Participants received a sensory dynamic orthosis sleeve or a non-compressive sleeve (placebo) that they wore eight hours a day, for nine weeks. MAIN MEASURES Outcomes were completed at baseline and nine weeks. The primary outcome measure was the Fahn-Tolosa-Marin (FAHN) Tremor Rating Scale. Secondary outcome measures included the: Action Research Arm Test, Canadian Occupational Performance Measure, Psychological Impact of Assistive Device Scale and the Nine-hole Peg Test. RESULTS Both sleeves were acceptable, although achieving a good fit was an issue. There were no significant between-group differences for the primary outcome measure. The median ± interquartile range change scores were 0.5 ±6.5 and 2 ±8 for the placebo and treatment group, respectively. The median ± interquartile range Canadian Occupational Performance Measure (performance subscale) demonstrated significant improvements ( p = 0.01) for the placebo group (1.1 ±1.65) compared with the treatment group (0 ±1.2). There was no between-group differences in the satisfaction subscale. The primary outcome measure was sensitive to detect change; however the Action Research Arm Test was not responsive in this study population. CONCLUSION Undertaking an randomized controlled trial would be feasible and a minimum of 200 participants would be needed for a fully powered, definitive randomized controlled trial.
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Affiliation(s)
- L Miller
- 1 NHS Ayrshire & Arran MS Service, Douglas Grant Rehabilitation Unit, Irvine, UK.,2 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - F van Wijck
- 2 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - L Lamont
- 1 NHS Ayrshire & Arran MS Service, Douglas Grant Rehabilitation Unit, Irvine, UK
| | - J Preston
- 1 NHS Ayrshire & Arran MS Service, Douglas Grant Rehabilitation Unit, Irvine, UK.,2 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - M Hair
- 3 Independent Statistics Consultant, Paisley, UK
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Abstract
This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is 'The trainee consistently demonstrates a knowledge of management approaches for specific impairments including spasticity, ataxia.'
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Affiliation(s)
- Jon Marsden
- School of Health Professions, Peninsula Allied Health Centre, Derriford Road, University of Plymouth, PL6 8BH, UK.
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O'Connor RJ, Kini MU. Non-pharmacological and non-surgical interventions for tremor: a systematic review. Parkinsonism Relat Disord 2011; 17:509-15. [PMID: 21632272 DOI: 10.1016/j.parkreldis.2010.12.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 12/21/2010] [Accepted: 12/22/2010] [Indexed: 11/19/2022]
Abstract
Tremor is a frequent disabling consequence of many neurological conditions. We performed a search of MEDLINE, CINAHL, EMBASE and the Cochrane Library to identify all primary research studies published up to November 2010 which investigated non-pharmacological and non-surgical treatments for tremor in humans. Neuromuscular physiotherapy, strength training and functional electrical stimulation show promise in their applicability and adaptability. Limb cooling may not be feasible for continuous management, but may be appropriate for specific tasks. Tremor-suppressing orthoses based on viscous materials, weighted splints and vibration therapies need further evaluation especially in the domiciliary setting and applied to improving personal activities of daily living. The evidence base for many rehabilitation interventions in tremor is poor. Future research should focus on high quality randomized controlled trials of non-pharmacological and non-surgical interventions which show promise.
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Affiliation(s)
- Rory J O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Molecular Medicine, University of Leeds, UK. R.J.O’
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Abstract
Tremor is the most common movement disorder presenting to an outpatient neurology practice and is defined as a rhythmical, involuntary oscillatory movement of a body part. The authors review the clinical examination, classification, and diagnosis of tremor. The pathophysiology of the more common forms of tremor is outlined, and treatment options are discussed. Essential tremor is characterized primarily by postural and action tremors, may be a neurodegenerative disorder with pathologic changes in the cerebellum, and can be treated with a wide range of pharmacologic and nonpharmacologic methods. Tremor at rest is typical for Parkinson's disease, but may arise independently of a dopaminergic deficit. Enhanced physiologic tremor, intention tremor, and dystonic tremor are discussed. Further differential diagnoses described in this review include drug- or toxin-induced tremor, neuropathic tremor, psychogenic tremor, orthostatic tremor, palatal tremor, tremor in Wilson's disease, and tremor secondary to cerebral lesions, such as Holmes' tremor (midbrain tremor). An individualized approach to treatment of tremor patients is important, taking into account the degree of disability, including social embarrassment, which the tremor causes in the patient's life.
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