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Chu ECP, Ng L. Dystonic Tremor as an Atypical Presentation of Cervical Radiculopathy. Cureus 2024; 16:e51441. [PMID: 38298318 PMCID: PMC10829058 DOI: 10.7759/cureus.51441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 02/02/2024] Open
Abstract
Cervical radiculopathy often presents with neck pain, sensory disturbances, or motor weakness. This case report describes an atypical presentation of cervical radiculopathy manifesting as dystonic tremor and brachialgia, which has been documented only once previously. A 46-year-old, right-handed, male delivery worker presented with severe neck pain that gradually evolved into a dystonic tremor and sharp aching pain across his right shoulder. Despite medical intervention, his symptoms persisted, leading him to seek chiropractic care. Physical examination and diagnostic tests revealed degenerative osteophytes, causing bilateral foraminal impingement and narrowing. As orthopedic interventions only provide temporary relief, the patient opted for conservative chiropractic management, which led to a remarkable reduction in pain and complete resolution of the dystonic tremor and brachialgia. This case demonstrates that cervical disc prolapse may manifest with dystonic tremor due to excruciating radiculopathy. Additionally, it emphasizes the potential benefits of chiropractic care in managing such atypical presentations and underscores the need for further research on the mechanisms and management of such cases.
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Affiliation(s)
- Eric Chun-Pu Chu
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
| | - Lucina Ng
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
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Mishra A, Pandey S. Clinical Features, Neuroimaging, and Levodopa-Responsiveness in Holmes' Tremor: A Video-Based Case-Series with a Review of the Literature. Mov Disord Clin Pract 2022; 9:805-815. [PMID: 35937478 PMCID: PMC9346238 DOI: 10.1002/mdc3.13501] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/27/2022] [Accepted: 06/04/2022] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Holmes' tremor (HT) is a low-frequency tremor characterized by a combination of rest, posture, and action components. We are reporting the clinical features, neuroimaging findings, and levodopa responsiveness in 12 patients with HT. CASES The majority of the patients were male (11/12). Dystonia was observed in 10 patients and the remaining two patients had head tremor, a "forme-fruste" of cervical dystonia. The underlying etiologies were vascular (n = 8), head trauma (n = 2), and tumor resection (n = 2). Neuroimaging showed isolated involvement of the midbrain in four, thalamus in two, and basal ganglia and cerebellum in one patient each. A combination of the lesion (thalamus and cerebellum = 2; cerebellopontine angle = 1, and cortical/subcortical = 1) was present in four patients. Levodopa responsiveness was seen in 75% of patients including one with levodopa-induced dyskinesia. LITERATURE REVIEW Of 139 patients from 49 studies, levodopa was tried in 123 patients. Improvement with levodopa was seen in 71 patients (57.72%). No improvement with levodopa was observed in 33 patients (26.82%) and details regarding therapeutic response were unavailable in 19 patients (15.44%). CONCLUSIONS Dystonia is an important clinical manifestation of HT. Levodopa responsiveness seen in the majority of the patients is consistent with the hypothesis that nigrostriatal pathway damage is crucial for the pathophysiology of HT.
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Affiliation(s)
- Anumeha Mishra
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and ResearchNew DelhiIndia
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and ResearchNew DelhiIndia
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Abstract
Tremor is the most commonly encountered movement disorder in clinical practice. A wide range of pathologies may manifest with tremor either as a presenting or predominant symptom. Considering the marked etiological and phenomenological heterogeneity, it would be desirable to develop a classification of tremors that reflects their underlying pathophysiology. The tremor task force of the International Parkinson Disease and Movement Disorders Society has worked toward this goal and proposed a new classification system. This system has remained a prime topic of scientific communications on tremor in recent times. The new classification is based on two axes: 1. based on the clinical features, history, and tremor characteristics and 2. based on the etiology of tremor. In this article, we discuss the key aspects of the new classification, review various tremor syndromes, highlight some of the controversies in the field of tremor, and share the potential future perspectives.
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Affiliation(s)
- Abhishek Lenka
- Department of Neurology, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States
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Druzhinina OA, Zhukova NG, Shperling LP. [Non-motor conditions in patients with cervical dystonia]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:7-13. [PMID: 33244951 DOI: 10.17116/jnevro20201201017] [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: 11/17/2022]
Abstract
OBJECTIVE To study non-motor conditions in people with diabetes in comparison with patients with cervicalgia. MATERIAL AND METHODS The study included 170 people. The main group consisted of 120 respondents with cervical dystonia (CD) aged 27 to 82 years. The diagnosis of CD was based on the Clinical guidelines for the diagnosis and treatment of dystonia adopted by the European Federation of Neurological Societies, the Society for Movement Disorders and the All-Russian Society of Neurologists. The control group included 50 patients, aged 25 to 82 years, with pain in the cervical spine due to muscle-tonic and myofascial syndromes. A Visual Analogue scale, the Hospital Anxiety and Depression Scale (HADS), the Multidimensional Fatigue Inventory (MFI-20), the Pittsburgh Sleep Quality Index (PSQI) were administered to study the asthenic syndrome in all patients. RESULTS AND CONCLUSION Pain, anxiety, depression, asthenic syndrome, insomnia are statistically significant non-motor conditions in patients with CD compared with patients with cervicalgia. CD significantly affects the physical and psychological aspects, worsening the quality of life of these patients. The following gender differences are identified: in women with CD, non-motor disorders (anxiety, depression, general and physical asthenia, insomnia) are significantly more pronounced and the quality of life is significantly reduced compared to men with CD. For the successful treatment of CD, a multimodal approach is needed that provides the treatment of not only motor, but also non-motor disorders. Early detection and treatment of comorbid conditions is an important step in the treatment of CD.
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Affiliation(s)
| | - N G Zhukova
- Siberian State Medical University, Tomsk, Russia
| | - L P Shperling
- Regional Center for Extrapyramidal Diseases with Botulinum Therapy Room, Novosibirsk, Russia
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Schneider N, Potschka H, Reese S, Wielaender F, Fischer A. Imepitoin for treatment of idiopathic head tremor syndrome in dogs: A randomized, blinded, placebo-controlled study. J Vet Intern Med 2020; 34:2571-2581. [PMID: 33159484 PMCID: PMC7694850 DOI: 10.1111/jvim.15955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/18/2020] [Accepted: 10/21/2020] [Indexed: 12/14/2022] Open
Abstract
Background Idiopathic head tremor syndrome is a paroxysmal movement disorder of unknown etiology. Spontaneous remission may occur, but owners may request treatment in severely affected dogs with continued episodes. Controlled studies of the disease are not available. Hypothesis/Objectives A drug with gamma amino butyric acid‐ergic and anxiolytic effects will decrease head tremor episodes. Animals Twenty‐four dogs with severe nonremitting head tremor and presumptive clinical diagnosis of idiopathic head tremor syndrome. Methods Prospective, blinded, placebo‐controlled clinical trial to compare imepitoin with placebo in dogs with frequent episodes of idiopathic head tremor. Evaluation of efficacy used the quotient T2/T1 that represented prolongation of the head tremor‐free period compared to a 3‐month baseline. A dog was considered a responder if tremors subsided or if the head tremor‐free period was 3× longer than the longest period during baseline (T2/T1 ≥ 3). Sample size calculations considered a large effect of imepitoin on T2/T1 (Cohen's d = 0.8). Results There were no responders in the placebo group (0/12). In the imepitoin group, the responder rate was 17% (2/12; P = .18) with T2/T1 3.8 and 4.0. Mean T2/T1 was 1.0 ± 1.4 in the imepitoin and 0.4 ± 0.4 in the placebo group (P = .37). Conclusion and Clinical Importance Imepitoin did not result in a significant overall benefit. Future studies should focus on treatment of subgroups with a common pathophysiology and similar comorbidities.
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Affiliation(s)
- Nina Schneider
- Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Heidrun Potschka
- Institute of Pharmacology, Toxicology, and Pharmacy, LMU Munich, Munich, Germany
| | - Sven Reese
- Department of Veterinary Sciences, Faculty of Veterinary Medicine, LMU Munich, Munich, Germany
| | | | - Andrea Fischer
- Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
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The Problem of Questionable Dystonia in the Diagnosis of 'Essential Tremor-Plus'. Tremor Other Hyperkinet Mov (N Y) 2020; 10:27. [PMID: 32864186 PMCID: PMC7427675 DOI: 10.5334/tohm.539] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In a recent consensus statement on tremor, the task force of the International Parkinson and Movement Disorder Society proposed a new term, ‘essential tremor-plus (ET-plus)’ which includes patients with the characteristics of essential tremor (ET) and additional soft neurological signs of uncertain significance such as questionable dystonic posturing. The clinical interpretation of questionable dystonia has been left to the investigator. The consensus statement also stated that the ET-plus syndrome does not include other clearly defined syndromes like dystonic tremor. However, the boundary between questionable dystonia and definite dystonia is not distinct leading to diagnostic uncertainty in a clinical setting. A similar case may be classified as ET-plus by one observer and dystonic tremor by another. Following the new definition, many studies have reclassified their ET cohort, and they have highlighted the problem of defining questionable dystonia in the diagnosis of ET plus. ET-plus is likely to be a mixture of patients that actually have dystonia and those that don’t, and clinically all we can do is to be suspicious that there might be dystonia. For example, it is not clear whether we should consider spooning and index finger pointing as a sign of questionable or definite dystonia. There are major research and possible therapeutic implications of questionable dystonia in the diagnosis of ET-plus. The concept of ET-plus is extremely difficult to implement without definite guidelines. The resolution will need a biomarker such as physiology or imaging.
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Chen Q, Vu JP, Cisneros E, Benadof CN, Zhang Z, Barbano RL, Goetz CG, Jankovic J, Jinnah HA, Perlmutter JS, Appelbaum MI, Stebbins GT, Comella CL, Peterson DA. Postural Directionality and Head Tremor in Cervical Dystonia. Tremor Other Hyperkinet Mov (N Y) 2020; 10:tre-10-745. [PMID: 32015932 PMCID: PMC6988138 DOI: 10.7916/tohm.v0.745] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/17/2019] [Indexed: 12/21/2022] Open
Abstract
Background Although abnormal head and neck postures are defining features of cervical dystonia (CD), head tremor (HT) is also common. However, little is known about the relationship between abnormal postures and HT in CD. Methods We analyzed clinical data and video recordings from 185 patients enrolled by the Dystonia Coalition. We calculated the likelihood of their HT and HT type ("regular" vs. "jerky") given directionality of abnormal head postures, disease duration, sex, and age. Results Patients with retrocollis were more likely to have HT than patients with anterocollis (X2 (1, N = 121) = 7.98, p = 0.005). There was no difference in HT likelihood given left or right turning in laterocollis and rotation. Patients with HT had longer disease duration (t(183) = 2.27, p = 0.024). There was no difference in age between patients with and without HT. In a logistic regression model, anterocollis/retrocollis direction (X2 (1, N = 121) = 6.04, p = 0.014), disease duration (X2 (1, N = 121) = 7.28, p = 0.007), and the interaction term between age and disease duration (X2 (1, N = 121) = 7.77, p = 0.005) collectively contributed to HT likelihood. None of the postural directionality or demographic variables were associated with differential likelihood of having regular versus jerky HT. Discussion We found that HT is more likely for CD patients with a specific directionality in their predominant posture. Our finding that CD patients with longer disease duration have a higher likelihood of HT also raises the question of whether HT becomes more likely over time in individual patients.
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Affiliation(s)
- Qiyu Chen
- Institute for Neural Computation, University of California, San Diego, La Jolla, CA, USA
| | - Jeanne P. Vu
- Institute for Neural Computation, University of California, San Diego, La Jolla, CA, USA
| | - Elizabeth Cisneros
- Institute for Neural Computation, University of California, San Diego, La Jolla, CA, USA
| | - Casey N. Benadof
- Institute for Neural Computation, University of California, San Diego, La Jolla, CA, USA
| | - Zheng Zhang
- Institute for Neural Computation, University of California, San Diego, La Jolla, CA, USA
| | | | - Christopher G. Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Hyder A. Jinnah
- Departments of Neurology and Human Genetics, Emory University, Atlanta, GA, USA
| | - Joel S. Perlmutter
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Departments of Psychiatry, Radiology, Neurobiology, Physical Therapy, and Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Mark I. Appelbaum
- Department of Psychology, University of California, San Diego, La Jolla, CA, USA
| | - Glenn T. Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Cynthia L. Comella
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - David A. Peterson
- Institute for Neural Computation, University of California, San Diego, La Jolla, CA, USA
- Computational Neurobiology Laboratory, Salk Institute for Biological Studies, La Jolla, CA, USA
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Zhang M, Li W, Hu L, Chen L, Yang L, Zhang T, Shen H, Peng Y, Gao S, Chen Z, Wang T, Zhao Z. Oral propranolol for treatment of the subgroups of essential tremor: a systematic review and meta-analysis protocol. BMJ Open 2020; 10:e032096. [PMID: 31948986 PMCID: PMC7044890 DOI: 10.1136/bmjopen-2019-032096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/21/2019] [Accepted: 12/04/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Essential tremor (ET), a tremor disorder, is one of the most common movement disorders. Only oral drugs (propranolol, primidone, topiramate, etc)are still the first-line treatment recommended by the Food and Drug Administration. Propranolol is thought to potentially reduce upper limb action tremor. However, it has a poor effect on axial tremor symptoms, such as essential head tremor and voice tremor. Studies have shown that tremor severity develops over time, possibly producing other clinical tremors and neurological soft signs (such as memory loss, gait abnormalities, balance disorders, etc), which further increases the difficulty of treating tremors. However, some recent studies provide emerging evidence for oral propranolol on subgroups of ET, which is based on the anatomical distribution of ET (lower extremities, head, sound, tongue, etc). This systematic review aims to synthesise these new data to improve the efficacy of propranolol in ET subgroups. METHODS AND ANALYSIS We will search for randomised controlled trials from the PubMed, MEDLINE, EMBASE, Cochrane Library, UptoDate and PEDro databases from inception to June 2019. All data will be extracted independently by two reviewers and compared at the end of the review. The two reviewers will screen the study quality, and the Cochrane Collaboration's tool in Review Manager (RevMan) V.5.3.3 will be used to evaluate risk of bias. Our primary outcome will be the functional disability component related to tremors, as measured by the Fahn-Tolosa-Marin Tremor Rating Scale subscales B and C. Secondary outcomes will include severity of tremors and quality of life. Narrative and meta-analytical syntheses are planned. ETHICS AND DISSEMINATION Published aggregated data will be used in this review analysis and therefore no ethical approval is required. The results will be published in peer-reviewed journals, and proliferation activities will include diverse social stakeholders, non-academic groups and patients. PROSPERO REGISTRATION NUMBER CRD42018112580.
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Affiliation(s)
- Manyu Zhang
- Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Wei Li
- Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Lan Hu
- Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Li Chen
- Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Liu Yang
- Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Tian Zhang
- Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Hui Shen
- Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Yanan Peng
- Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Shijun Gao
- Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Zhibin Chen
- Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Tan Wang
- Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Zhenqiang Zhao
- Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
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Forman CR, Svane C, Kruuse C, Gracies JM, Nielsen JB, Lorentzen J. Sustained involuntary muscle activity in cerebral palsy and stroke: same symptom, diverse mechanisms. Brain Commun 2019; 1:fcz037. [PMID: 33033798 PMCID: PMC7531180 DOI: 10.1093/braincomms/fcz037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 12/12/2022] Open
Abstract
Individuals with lesions of central motor pathways frequently suffer from sustained
involuntary muscle activity. This symptom shares clinical characteristics with dystonia
but is observable in individuals classified as spastic. The term spastic dystonia has been
introduced, although the underlying mechanisms of involuntary activity are not clarified
and vary between individuals depending on the disorder. This study aimed to investigate
the nature and pathophysiology of sustained involuntary muscle activity in adults with
cerebral palsy and stroke. Seventeen adults with cerebral palsy (Gross Motor Function
Classification System I–V), 8 adults with chronic stroke and 14 control individuals
participated in the study. All individuals with cerebral palsy or stroke showed increased
resistance to passive movement with Modified Ashworth Scale >1. Two-minute surface EMG
recordings were obtained from the biceps muscle during attempted rest in three positions
of the elbow joint; a maximally flexed position, a 90-degree position and a maximally
extended position. Cross-correlation analysis of sustained involuntary muscle activity
from individuals with cerebral palsy and stroke, and recordings of voluntary isometric
contractions from control individuals were performed to examine common synaptic drive. In
total, 13 out of 17 individuals with cerebral palsy and all 8 individuals with stroke
contained sustained involuntary muscle activity. In individuals with cerebral palsy, the
level of muscle activity was not affected by the joint position. In individuals with
stroke, the level of muscle activity significantly (P < 0.05)
increased from the flexed position to the 90 degree and extended position. Cumulant
density function indicated significant short-term synchronization of motor unit activities
in all recordings. All groups exhibited significant coherence in the alpha (6–15 Hz), beta
(16–35 Hz) and early gamma band (36–60 Hz). The cerebral palsy group had lower alpha band
coherence estimates, but higher gamma band coherence estimates compared with the stroke
group. Individuals with increased resistance to passive movement due to cerebral palsy or
stroke frequently suffer sustained involuntary muscle activity, which cannot exclusively
be described by spasticity. The sustained involuntary muscle activity in both groups
originated from a common synaptic input to the motor neuron pool, but the generating
mechanisms could differ between groups. In cerebral palsy it seemed to originate more from
central mechanisms, whereas peripheral mechanisms likely play a larger role in stroke. The
sustained involuntary muscle activity should not be treated simply like the spinal stretch
reflex mediated symptom of spasticity and should not either be treated identically in both
groups.
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Affiliation(s)
| | - Christian Svane
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology, Neurovascular Research Unit, Herlev Gentofte Hospital, 2730 Herlev Gentofte, Denmark
| | - Jean-Michel Gracies
- EA 7377 BIOTN, Université Paris-Est Creteil, Hospital Albert Chenevier-Henri Mondor, Service de Rééducation Neurolocomotrice, APHP, Créteil, France
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen, Denmark.,Elsass Institute, 2830 Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen, Denmark.,Elsass Institute, 2830 Charlottenlund, Denmark
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Gövert F, Becktepe J, Deuschl G. [The new tremor classification of the International Parkinson and Movement Disorder Society : Update on frequent tremors]. DER NERVENARZT 2019; 89:376-385. [PMID: 29442146 DOI: 10.1007/s00115-018-0489-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tremor is one of the most frequent movement disorders. The recently published new classification of the Movement Disorder Society separates the clinical description of tremor syndromes as so-called axis 1 symptom constellations from the etiologies of tremor (axis 2). The same tremor syndromes can therefore be combined with different causes and vice versa. The terminology used in this classification is precisely defined and thereby also the necessary language for medical communication. Frequent tremor syndromes, such as enhanced physiologic tremor, dystonic and parkinsonian tremor as well as focal tremors and task and position-specific tremors are discussed with respect to the phenomenology, and current therapy.
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Affiliation(s)
- F Gövert
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität zu Kiel, Arnold-Heller Str. 3, 24105, Kiel, Deutschland.
| | - J Becktepe
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität zu Kiel, Arnold-Heller Str. 3, 24105, Kiel, Deutschland
| | - G Deuschl
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität zu Kiel, Arnold-Heller Str. 3, 24105, Kiel, Deutschland
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11
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Merola A, Dwivedi AK, Shaikh AG, Tareen TK, Da Prat GA, Kauffman MA, Hampf J, Mahajan A, Marsili L, Jankovic J, Comella CL, Berman BD, Perlmutter JS, Jinnah HA, Espay AJ. Head tremor at disease onset: an ataxic phenotype of cervical dystonia. J Neurol 2019; 266:1844-1851. [PMID: 31028543 DOI: 10.1007/s00415-019-09341-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/21/2019] [Accepted: 04/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cervical dystonia (CD) can present with head tremor. It is unclear whether ataxic features are differentially associated with this phenotype at onset of CD. OBJECTIVES We sought to evaluate: (1) the demographic features of CD patients with (Tr-CD) and without head tremor (nTr-CD) at onset, and (2) the differential ataxic features between these CD subtypes. METHODS For the first objective, we compared demographic data in Tr-CD versus nTr-CD subtypes in the entire cohort of CD subjects enrolled in the Dystonia Coalition Natural History and Biorepository studies (n = 1608). For the second objective, we rated the standardized videos from consecutively enrolled Tr-CD subjects (n = 50) and age-, gender-, and disease duration-matched nTr-CD subjects (n = 50) for ataxia severity scoring using the Scale for the Assessment and Rating of Ataxia (SARA) and the International Cooperative Ataxia Rating Scale (ICARS); and for dystonia severity using the Toronto Western Spasmodic Torticollis Rating Scale section-I (TWSTRS) and the Global Dystonia Rating Scale (GDRS). RESULTS Of 1,608 subjects, 18.1% (n = 291) were classified as Tr-CD and 81.9% (n = 1317) as nTr-CD. The Tr-CD cohort was older, predominantly female, and had longer disease duration than the nTr-CD cohort (p = 0.01). Compared to nTr-CD, Tr-CD subjects had worse generalized ataxia, speech, and gait and posture scores. High ataxia severity with low dystonia severity distinguished Tr-CD from nTr-CD with high accuracy (area under the curve, 0.91 (95% CI 0.85-0.97). CONCLUSIONS Head tremor at disease onset represents a clinically distinguishable subtype of cervical dystonia affecting predominantly older women, with worse ataxia and milder dystonia than the non-tremulous dystonic phenotype.
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Affiliation(s)
- Aristide Merola
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA.
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Biomedical Sciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center (TTUHSC), El Paso, TX, USA
| | - Aasef G Shaikh
- Department of Neurology, University Hospitals and Cleveland VA Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Tamour Khan Tareen
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Gustavo A Da Prat
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
- Departamento de Neurologia, Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina
| | - Marcelo A Kauffman
- Consultorio y Laboratorio de Neurogenética, Centro Universitario de Neurología "José María Ramos Mejía" y División Neurología, Hospital JM Ramos Mejía, Facultad de Medicina, UBA, and Programa de Medicina de Precision y Genomica Clinica, Instituto de Investigaciones en Medicina Traslacional, Facultad de Ciencias Biomédicas, Universidad Austral-CONICET, Buenos Aires, Argentina
| | - Jennie Hampf
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Abhimanyu Mahajan
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Luca Marsili
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, USA
| | | | - Brian D Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joel S Perlmutter
- Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Hyder A Jinnah
- Department of Neurology, Human Genetics and Pediatrics, Emory University, Atlanta, GA, USA
| | - Alberto J Espay
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
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Patel PN, Kabagambe EK, Starkweather JC, Keller M, Ahmed ZA, Gruber SC, Akins JS, Garrett CG, Francis DO. Defining differences in patient characteristics between spasmodic dysphonia and laryngeal tremor. Laryngoscope 2018; 129:170-176. [PMID: 30426500 DOI: 10.1002/lary.27245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 03/10/2018] [Accepted: 03/26/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare presenting characteristics of patients with adductor spasmodic dysphonia (ADSD), ADSD with laryngeal tremor (ADSD + LT), and laryngeal tremor without ADSD (LT). DESIGN Cross-sectional analysis. METHODS Patients treated for laryngeal movement disorders (1990-2016) were included. Analysis of variance and chi square tests measured differences in patient characteristics across the three disease groups. Using ADSD as the referent, multivariable logistic regression models were used to determine whether potential risk factors including patient demographics, family history, presence of potential inciting events prior to disease onset, and coprevalent movement disorders were associated with ADSD + LT or LT. RESULTS In all, 652 patients with ADSD (n = 377), ADSD + LT (n = 98), and LT (n = 177) were included. ADSD patients were significantly younger than those with ADSD + LT and LT (52.5 ± 13.4, 63.9 ± 11.3, and 69.3 ± 10.5 years, respectively; P < 0.001). Coprevalent movement disorders were more common in ADSD + LT (38.7%) and LT (57.1%) groups than in the ADSD group (11.5%; P < 0.001). Compared to ADSD, patients with ADSD + LT and LT were more likely to develop an additional movement disorder during follow-up. In multivariable analyses, increasing age, female gender, and having a movement disorder at presentation were associated with significantly greater odds of having ADSD + LT or LT when compared to ADSD. CONCLUSION ADSD + LT patients demonstrate intermediate gender composition and age distributions between those with ADSD and LT. These findings suggest that ADSD + LT may be a distinct phenotype in the spectrum of laryngeal movement disorders. LEVEL OF EVIDENCE 4 Laryngoscope, 129:170-176, 2019.
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Affiliation(s)
- Priyesh N Patel
- Vanderbilt Voice Center, Department of Otolaryngology, Nashville, Tennessee
| | - Edmond K Kabagambe
- Vanderbilt Voice Center, Department of Otolaryngology, Nashville, Tennessee.,Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Matthew Keller
- Saint Louis University School of Medicine, St. Louis, Missouri
| | | | | | | | - C Gaelyn Garrett
- Vanderbilt Voice Center, Department of Otolaryngology, Nashville, Tennessee
| | - David O Francis
- Division of Otolaryngology, Wisconsin Surgical Outcomes Research, Department of Surgery, University of Wisconsin, Madison, Wisconsin, U.S.A
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Bhatia KP, Bain P, Bajaj N, Elble RJ, Hallett M, Louis ED, Raethjen J, Stamelou M, Testa CM, Deuschl G. Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord 2018; 33:75-87. [PMID: 29193359 PMCID: PMC6530552 DOI: 10.1002/mds.27121] [Citation(s) in RCA: 766] [Impact Index Per Article: 127.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 05/03/2017] [Accepted: 06/04/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Consensus criteria for classifying tremor disorders were published by the International Parkinson and Movement Disorder Society in 1998. Subsequent advances with regard to essential tremor, tremor associated with dystonia, and other monosymptomatic and indeterminate tremors make a significant revision necessary. OBJECTIVES Convene an international panel of experienced investigators to review the definition and classification of tremor. METHODS Computerized MEDLINE searches in January 2013 and 2015 were conducted using a combination of text words and MeSH terms: "tremor", "tremor disorders", "essential tremor", "dystonic tremor", and "classification" limited to human studies. Agreement was obtained using consensus development methodology during four in-person meetings, two teleconferences, and numerous manuscript reviews. RESULTS Tremor is defined as an involuntary, rhythmic, oscillatory movement of a body part and is classified along two axes: Axis 1-clinical characteristics, including historical features (age at onset, family history, and temporal evolution), tremor characteristics (body distribution, activation condition), associated signs (systemic, neurological), and laboratory tests (electrophysiology, imaging); and Axis 2-etiology (acquired, genetic, or idiopathic). Tremor syndromes, consisting of either isolated tremor or tremor combined with other clinical features, are defined within Axis 1. This classification scheme retains the currently accepted tremor syndromes, including essential tremor, and provides a framework for defining new syndromes. CONCLUSIONS This approach should be particularly useful in elucidating isolated tremor syndromes and syndromes consisting of tremor and other signs of uncertain significance. Consistently defined Axis 1 syndromes are needed to facilitate the elucidation of specific etiologies in Axis 2. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, United Kingdom
| | - Peter Bain
- Department of Neurosciences, Charing Cross Hospital, Imperial College London, United Kingdom
| | - Nin Bajaj
- Division of Neurology, Nottingham University Hospital, Nottingham, United Kingdom
| | - Rodger J. Elble
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Elan D. Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA, and Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Jan Raethjen
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian Albrechts University Kiel, Kiel, Germany
| | - Maria Stamelou
- Department of Neurology, Philipps University, Marburg, Germany; Department of Neurology, Attikon Hospital, University of Athens, Athens, Greece
| | | | - Guenther Deuschl
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian Albrechts University Kiel, Kiel, Germany
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Abstract
Literary reports on dystonia date back to post-Medieval times. Medical reports are instead more recent. We review here the early descriptions and the historical establishment of a consensus on the clinical phenomenology and the diagnostic features of dystonia syndromes. Lumping and splitting exercises have characterized this area of knowledge, and it remains largely unclear how many dystonia types we are to count. This review describes the history leading to recognize that focal dystonia syndromes are a coherent clinical set encompassing cranial dystonia (including blepharospasm), oromandibular dystonia, spasmodic torticollis, truncal dystonia, writer's cramp, and other occupational dystonias. Papers describing features of dystonia and diagnostic criteria are critically analyzed and put into historical perspective. Issues and inconsistencies in this lumping effort are discussed, and the currently unmet needs are critically reviewed.
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Affiliation(s)
- Alberto Albanese
- Department of Neurology, Humanitas Research Hospital, Milan, Italy
- Department of Neurology, Università Cattolica del Sacro Cuore, Milan, Italy
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