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Bugalho P, Meira B, Pinho A, Ventura R, Magriço M, Serôdio M, Krupka D, Ferreira VM. REM sleep behavior disorder and Prodromal Parkinson's Disease in patients with Essential Tremor. Sleep Med X 2024; 8:100118. [PMID: 39099610 PMCID: PMC11295997 DOI: 10.1016/j.sleepx.2024.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/14/2024] [Accepted: 07/03/2024] [Indexed: 08/06/2024] Open
Abstract
Several studies suggested the presence of non-motor symptoms in Essential Tremor (ET), including REM sleep behavioral disorder (RBD). RBD is an essential criterion for Prodromal Parkinson's Disease (PPD), suggesting a link between ET and PD. Our objective was to assess the prevalence and features of ET patients with RBD and PDD. RBD was diagnosed by questionnaire screening, followed by polysomnography. PPD risk factors and prodromic markers were assessed with a structured protocol. Patients were characterized regarding tremor features. ET patients with RBD (ET-RBD) and PPD (ET-PPD) were compared to patients without RBD (ET-nonRBD) and without PPD (ET-nonPPD), respectively. ET-RBD patients were also compared with a group of isolated RBD (iRBD) regarding PPD features. We assessed a total of 64 ET patients. Five (8.3 %) and 4 (6.3 %) had criteria for RBD and PPD, respectively. ET-RBD patients did not differ from ET-nonRBD except for a higher prevalence of PPD. There were no significant differences between ET-RBD and iRBD (n = 12) groups. ET-PPD had a higher prevalence of positive DaT-Scans and RBD compared to ET-nonPPD. Three ET-RBD patients had PPD and 3 ET-PPD had RBD. Both RBD and PPD are more frequent in ET patients than in general aged population but not related with specific tremor features. ET-RBD patients did not differ significantly from iRBD patients, a group prone to develop PD. These data suggest a link between ET and PD and are in accordance with studies showing an increase incidence of lewy-body pathology and PD in ET populations.
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Affiliation(s)
- Paulo Bugalho
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
- NOVA Medical School, Portugal
| | - Bruna Meira
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - André Pinho
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Rita Ventura
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Marta Magriço
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Miguel Serôdio
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Danna Krupka
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Vítor Mendes Ferreira
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Peng J, Yang J, Li J, Lei D, Li N, Suo X, Duan L, Chen C, Zeng Y, Xi J, Jiang Y, Gong Q, Peng R. Disrupted Brain Functional Network Topology in Essential Tremor Patients With Poor Sleep Quality. Front Neurosci 2022; 16:814745. [PMID: 35360181 PMCID: PMC8960629 DOI: 10.3389/fnins.2022.814745] [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: 11/14/2021] [Accepted: 01/14/2022] [Indexed: 11/30/2022] Open
Abstract
Sleep disturbances, especially poor quality of sleep (QoS), are common among essential tremor (ET) patients and may have adverse effects on their quality of life, but the etiology driving the poor QoS in these individuals remains inadequately understood. Few data are available on the neuroimaging alterations of ET with poor QoS. Thirty-eight ET patients with poor QoS (SleET), 48 ET patients with normal QoS (NorET), and 80 healthy controls (HCs) participated in this study. All subjects underwent a 3.0-T magnetic resonance imaging (MRI) scan for resting-state functional MRI data collection. Then, the whole-brain functional connectome was constructed by thresholding the partial correlation matrices of 116 brain regions. Graph theory and network-based statistical analyses were performed. We used a non-parametric permutation test for group comparisons of topological metrics. Partial correlation analyses between the topographical features and clinical characteristics were conducted. The SleET and NorET groups exhibited decreased clustering coefficients, global efficiency, and local efficiency and increased the characteristic path length. Both of these groups also showed reduced nodal degree and nodal efficiency in the left superior dorsolateral frontal gyrus, superior frontal medial gyrus (SFGmed), posterior cingulate gyrus (PCG), lingual gyrus, superior occipital gyrus, right middle occipital gyrus, and right fusiform gyrus. The SleET group additionally presented reduced nodal degrees and nodal efficiency in the right SFGmed relative to the NorET and HC groups, and nodal efficiency in the right SFGmed was negatively correlated with the Pittsburgh Sleep Quality Index score. The observed impaired topographical organizations of functional brain networks within the central executive network (CEN), default mode network (DMN), and visual network serve to further our knowledge of the complex interactions between tremor and sleep, adding to our understanding of the underlying neural mechanisms of ET with poor QoS.
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Affiliation(s)
- Jiaxin Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Yang
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China
| | - Junying Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Du Lei
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China
| | - Nannan Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xueling Suo
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China
| | - Liren Duan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chaolan Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Zeng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Xi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiyong Gong
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Qiyong Gong,
| | - Rong Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Rong Peng,
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Phenotypic Features of Isolated Essential Tremor, Essential Tremor Plus, and Essential Tremor-Parkinson's Disease in a Movement Disorders Clinic. Tremor Other Hyperkinet Mov (N Y) 2021; 11:12. [PMID: 33828900 PMCID: PMC8015706 DOI: 10.5334/tohm.581] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Patients with essential tremor were initially considered to have isolated tremor, but additional motor and non-motor features have been increasingly recognized. The term “essential tremor plus” was adopted by the Task Force on Tremor of the International Parkinson and Movement Disorder Society to describe essential tremor patients with additional neurologic signs. Objectives: To characterize essential tremor patients and their phenotypes in a movement disorders clinic population in the context of the new tremor classification. Methods: Demographic, clinical, historical, treatment, and diagnostic data were retrospectively collected on 300 patients diagnosed by movement disorder experts with essential tremor. Patients were classified as having essential tremor, essential tremor plus, or essential tremor-Parkinson’s disease combination, and features between these groups were compared. Results: Of the 300 patients, 20.7% were classified as isolated essential tremor, 53.3% as essential tremor plus, and 26.0% as essential tremor-Parkinson’s disease. There was no significant difference in the duration of tremor symptoms. Essential tremor plus patients were more likely to have dystonia, tandem gait abnormalities, head tremor and greater tremor severity. Essential tremor-Parkinson’s disease patients were more likely to have RBD symptoms. There was no significant difference in cognitive impairment between essential tremor plus and essential tremor-Parkinson’s disease patients. Conclusions: Additional motor and non-motor features, including parkinsonism, are common in patients with essential tremor. Further studies are needed to clarify essential tremor phenotypes and to provide insights into possible subtypes. Highlights: 300 patients with essential tremor from a movement disorders clinic were re-classified based on the Movement Disorder Society Consensus Statement on the Classification of Tremors. Additional motor and non-motor features, including parkinsonism, were common, and only 20.7% of patients remained classified as isolated essential tremor.
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Abstract
PURPOSE OF THE REVIEW Patients diagnosed with essential tremor (ET) report frequent sleep complaints. This review focuses on the main findings of studies addressing sleep features in patients diagnosed with ET, updating previously reported information. Bad quality of sleep and excessive daytime somnolence are very frequent in patients with ET, although the effects of the drugs used for the therapy of ET could contribute to these complaints. REM sleep behavior disorder, restless legs, insomnia, and nocturia are frequent complaints as well. There is a lack of studies addressing polysomnographic features of ET.
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Gossard TR, McCarter SJ, Gorres E, Feemster JC, Timm PC, Teigen LN, Ralston CL, Westerland SM, Conway JP, Jagielski JT, Olson CD, Edgar LJ, Veum EL, Savica R, Boeve BF, Silber MH, St Louis EK. Quantitative REM Sleep without Atonia in Parkinson's Disease and Essential Tremor. Mov Disord Clin Pract 2020; 8:37-43. [PMID: 33426157 DOI: 10.1002/mdc3.13112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 11/08/2022] Open
Abstract
Background Rapid eye movement (REM) sleep behavior disorder (RBD) occurs occasionally in essential tremor (ET), but polysomnographic REM sleep without atonia (RSWA) analyses have been sparse. Objective To characterize the amount and distribution of polysomnographic RSWA, the electrophysiologic substrate of RBD, in patients with Parkinson's disease (PD) and ET. Methods We analyzed quantitative RSWA in 73 patients: PD (23), ET (23), and age-sex-matched controls (27). None had dream-enactment behavior history or received antidepressants. Phasic, tonic, "any," and phasic-burst duration RSWA measures were calculated in the submentalis (SM) and anterior tibialis (AT) muscles. The automated REM atonia index (RAI) was also determined. Statistical analysis was performed by Kruskal-Wallis rank-sum and Mann-Whitney tests. Results SM phasic RSWA was significantly greater for PD than ET patients and controls (12.5% ± 12.8% vs. 4.9% ± 6.7%, 3.9% ± 2.6%), as was SM "any" (13.54% ± 14.30% vs. 5.2% ± 7.6%, 4.2% ± 2.6%). RAI was significantly lower in PD than in ET and controls (0.78 ± 0.23 vs. 0.92 ± 0.09 vs. 0.90 ± 0.17, P ≤ 0.005), but no different between ET and controls. AT phasic and "any" RSWA was similar between the 3 groups. ET and control RSWA was similar in all measures. Two ET patients (8.7%) had SM RSWA similar to PD patients. Conclusions Elevated SM RSWA distinguished PD from ET in patients without dream-enactment symptoms and occurs frequently in PD patients, and in isolated tremor suggests underlying synucleinopathy. Prospective studies will further validate these findings.
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Affiliation(s)
- Thomas R Gossard
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA
| | - Stuart J McCarter
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,Department of Neurology Mayo Clinic College of Medicine and Science Rochester Minnesota USA
| | - Evan Gorres
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA
| | - John C Feemster
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA
| | - Paul C Timm
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA
| | - Luke N Teigen
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA
| | - Christy L Ralston
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,Cornell College Mount Vernon Iowa USA
| | - Sarah M Westerland
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA
| | - Jimmy P Conway
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,Luther College Decorah Iowa USA
| | - Jack T Jagielski
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,Luther College Decorah Iowa USA
| | - Carl D Olson
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,St. Olaf College Northfield Minnesota USA
| | - Liam J Edgar
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,St. Olaf College Northfield Minnesota USA
| | - Emma L Veum
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,Luther College Decorah Iowa USA
| | - Rodolfo Savica
- Department of Neurology Mayo Clinic College of Medicine and Science Rochester Minnesota USA.,Department of Health Science Research Mayo Clinic College of Medicine and Science Rochester Minnesota USA
| | - Brad F Boeve
- Department of Neurology Mayo Clinic College of Medicine and Science Rochester Minnesota USA
| | - Michael H Silber
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,Department of Neurology Mayo Clinic College of Medicine and Science Rochester Minnesota USA
| | - Erik K St Louis
- Division of Pulmonary and Critical Care Medicine Mayo Center for Sleep Medicine Scottsdale Arizona USA.,Department of Neurology Mayo Clinic College of Medicine and Science Rochester Minnesota USA
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Wang XX, Feng Y, Li X, Zhu XY, Truong D, Ondo WG, Wu YC. Prodromal Markers of Parkinson's Disease in Patients With Essential Tremor. Front Neurol 2020; 11:874. [PMID: 32982913 PMCID: PMC7477377 DOI: 10.3389/fneur.2020.00874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/09/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Essential tremor (ET) is manifested as an isolated syndrome of bilateral upper limb action tremor. Parkinson's disease (PD) is the second most common neurodegenerative disease, with typical motor symptoms of bradykinesia, rigidity, and resting tremor. ET-PD describes the new-onset of PD in ET patients. Recently, numerous studies on epidemiology, genetics, pathology, clinical features, and neuroimaging studies are challenging the idea that ET is an isolated disease, suggesting that patients with ET have the tendency to develop PD. Methods: In this review article, we collected recent findings that reveal prodromal markers of PD in patients with ET. Results: Substantia nigra hyperechogenicity serves as a prodromal marker for predicting the development of PD in patients with ET and provides a reference for therapeutic strategies. Additional potential markers include other neuroimaging, clinical features, heart rate, and genetics, whereas others lack sufficient evidence. Conclusion: In consideration of the limited research of PD in patients with ET, we are still far from revealing the prodromal markers. However, from the existing follow-up studies on ET patients, Substantia nigra hyperechogenicity may enable further exploration of the relationship between ET and PD and the search for pathogenesis-based therapies.
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Affiliation(s)
- Xi-Xi Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai General Hospital of Nanjing Medical University, Nanjing, China
| | - Ya Feng
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuan Li
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Ying Zhu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daniel Truong
- Orange Coast Memorial Medical Center, The Truong Neurosciences Institute, Fountain Valley, CA, United States.,Department of Neurosciences and Psychiatry, University of California, Riverside, Riverside, CA, United States
| | - William G Ondo
- Weill Cornell Medical School, Methodist Neurological Institute, Houston, TX, United States
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abstract
Highlights In the current review, we thoroughly reviewed 74 identified articles regarding genes and genetic loci that confer susceptibility to ET. Over 50 genes/genetic loci have been examined for possible association with ET, but consistent results failed to be reported raising the need for collaborative multiethnic studies. Background: Essential tremor (ET) is a common movement disorder, which is mainly characterized by bilateral tremor (postural and/or kinetic) in the upper limbs, with other parts of the body possibly involved. While the pathophysiology of ET is still unclear, there is accumulating evidence indicating that genetic variability may be heavily involved in ET pathogenesis. This review focuses on the role of genetic risk factors in ET susceptibility. Methods: The PubMed database was searched for articles written in English, for studies with humans with ET, controls without ET, and genetic variants. The terms “essential tremor” and “polymorphism” (as free words) were used during search. We also performed meta-analyses for the most examined genetic variants. Results: Seventy four articles concerning LINGO1, LINGO2, LINGO4, SLC1A2, STK32B, PPARGC1A, CTNNA3, DRD3, ALAD, VDR, HMOX1, HMOX2, LRRK1,LRRK2, GBA, SNCA, MAPT, FUS, CYPsIL17A, IL1B, NOS1, ADH1B, TREM2, RIT2, HNMT, MTHFR, PPP2R2B, GSTP1, PON1, GABA receptors and GABA transporter, HS1BP3, ADH2, hSKCa3 and CACNL1A4 genes, and ETM genetic loci were included in the current review. Results from meta-analyses revealed a marginal association for the STK32B rs10937625 and a marginal trend for association (in sensitivity analysis) for the LINGO1 rs9652490, with ET. Discussion: Quite a few variants have been examined for their possible association with ET. LINGO1 rs9652490 and STK32B rs10937625 appear to influence, to some extent, ET susceptibility. However, the conflicting results and the lack of replication for many candidate genes raise the need for collaborative multiethnic studies.
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Essential tremor: New advances. Clin Park Relat Disord 2019; 3:100031. [PMID: 34316617 PMCID: PMC8298793 DOI: 10.1016/j.prdoa.2019.100031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/30/2019] [Accepted: 12/18/2019] [Indexed: 01/15/2023] Open
Abstract
Background Essential Tremor (ET) is one of the most common movement disorders but many controversies still exist in regards to its definition and pathophysiology. In view of the recent published criteria by the Tremor Task Force of the International Parkinson's and Movement Disorders Society (IPMDS), we intended to analyze if this has changed our view of ET and if new developments have arisen since. Methods A Medline search for English-written articles was done on June 15, 2019 using the keyword "Essential Tremor". Publications from November 2017 (publication date of the new tremor classification) were taken into account. Reviews, letters and original studies relevant to the subject were selected and reviewed according to the following themes: clinical characteristics, epidemiology, genetics, pathology, biomarkers and treatment. Results Out of 132 publications the most relevant articles were selected and reviewed (total of 65 articles). The great majority of these studies focused on surgical treatments (new targets, new technologies) while relatively few articles addressed epidemiology, pathology and pathophysiology. Conclusions The use of the new classification is not commonly used still, excepting more recent studies on therapeutics. This is in keeping with diverse opinions and criticisms reported by the IPMDS task force members themselves. One important change has been validating ET as a heterogeneous condition and defining the ET-plus category. We propose a further sub-group classification derived from the new definition of ET-plus.
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Shalash AS, Mohamed H, Mansour AH, Elkady A, Elrassas H, Hamid E, Elbalkimy MH. Clinical Profile of Non-Motor Symptoms in Patients with Essential Tremor: Impact on Quality of Life and Age-Related Differences. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 9:tre-09-736. [PMID: 31867132 PMCID: PMC6898893 DOI: 10.7916/tohm.v0.736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 12/18/2022]
Abstract
Background Identifying the clinical phenotypes of non-motor symptoms (NMSs) of essential tremor (ET) among different populations is necessary due to their impact on the quality of life (QoL). This study aimed to investigate the clinical phenotype and impact of NMSs on QoL in Egyptian patients with ET. Methods Thirty ET patients were compared to 30 matched controls. Subjects were evaluated by the Fahn-Tolosa-Marin Tremor Rating Scale, Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment, Hamilton Anxiety Rating Scale, Beck Depression Inventory, Pittsburgh Sleep quality Index, and the Short Form 36 Health Survey Questionnaire. Both groups were divided into two subgroups of younger (<45 years, 14 patients) and older age (>45 years, 16 patients) groups, to investigate age-related differences. Results ET patients showed significantly worse cognition, depression, anxiety, sleep and NMSS domains (p < 0.001), compared to controls, that negatively affected and predicted QoL. Older patients had more cognitive impairment (p = 0.003) and worse sleep/fatigue (p = 0.032) and sexual functions (p = 0.006), compared to younger group. Discussion The study supports that NMSs are integral part of ET, negatively affect QoL, and similarly affect younger and older patients. Therefore, NMSs should be explored for proper care of ET patients.
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Affiliation(s)
- Ali S Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, EG
| | - Hadeer Mohamed
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, EG
| | - Alia H Mansour
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, EG
| | - Ahmed Elkady
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, EG
| | - Hanan Elrassas
- Okasha Institute of Psychiatry, Ain Shams University, Cairo, EG
| | - Eman Hamid
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, EG
| | - Mahmoud H Elbalkimy
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, EG
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Salsone M, Arabia G, Manfredini L, Quattrone A, Chiriaco C, Vescio B, Sturniolo M, Morelli M, Nistico' R, Novellino F, Gambardella A, Quattrone A. REM-Sleep Behavior Disorder in Patients With Essential Tremor: What Is Its Clinical Significance? Front Neurol 2019; 10:315. [PMID: 31068885 PMCID: PMC6491751 DOI: 10.3389/fneur.2019.00315] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/12/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: REM sleep behavior disorder (RBD) is an important risk factor for the dementia development and for the deterioration of autonomic functions in patients with Parkinson's Disease. RBD has also been reported in patients with Essential Tremor (ET). However, its clinical significance in ET remains still unknown. We aimed to investigate clinical, neuropsychological and cardiac autonomic scintigraphic differences between ET patients with and without RBD. Methods: To assess RBD symptoms, RBD Single-Question has been administered in a cohort of 55 patients with a clinical diagnosis of ET. Patients with clinical RBD underwent polysomnography (PSG) confirmation. All patients completed a battery of neuropsychological assessment of memory, executive function, attention, language, and visuospatial function. Cardiac MIBG scintigraphy was performed in order to measure the cardiac autonomic innervation. Results: Ten ET patients (18%) had a PSG-confirmed RBD (ETRBD+). Compared to ET patients without RBD (ETRBD−), significantly reduced scores on memory domain tests such as Rey auditory verbal learning test immediate recall (p = 0.015) and Rey auditory verbal learning test delayed recall (p = 0.004) and phonemic fluency test (p = 0.028) were present in ETRBD+. By contrast, no other significant clinical difference has emerged from the comparison between two ET groups. Similarly, ETRBD+ patients have cardiac MIBG tracer uptake in the normal value range as occurred in those with ETRBD−. Conclusions: This study improves the knowledge on clinical significance of RBD symptoms in ET patients. Our preliminary findings demonstrate that presence of RBD in ET is associated with neurocognitive impairment, but not with cardiac autonomic dysfunction. Further longitudinal studies are needed to investigate whether ET patients with RBD will develop a frank dementia over the time.
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Affiliation(s)
- Maria Salsone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Gennarina Arabia
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Lucia Manfredini
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Andrea Quattrone
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Carmelina Chiriaco
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | | | - Miriam Sturniolo
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Maurizio Morelli
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Rita Nistico'
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Fabiana Novellino
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | | | - Aldo Quattrone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.,Neuroscience Center, University Magna Graecia, Catanzaro, Italy
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11
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Tarakad A, Jankovic J. Essential Tremor and Parkinson's Disease: Exploring the Relationship. Tremor Other Hyperkinet Mov (N Y) 2019; 8:589. [PMID: 30643667 PMCID: PMC6329774 DOI: 10.7916/d8md0gvr] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/04/2018] [Indexed: 12/31/2022] Open
Abstract
Background There is longstanding controversy surrounding the possible link between essential tremor (ET) and Parkinson's disease (PD). Inconsistent and unreliable diagnostic criteria may in part account for some of the difficulties in defining the relationship between these two common movement disorders. Methods References for this systematic review were identified using PubMed with the search terms "essential tremor" AND "Parkinson's disease" with articles published in English between 1960 and September 2018 included. Results In this review we provide evidence that some patients diagnosed with ET have an increased risk of developing PD years or decades after onset of action tremor. There are several still unresolved questions about the link between the two disorders including lack of verifiable diagnostic criteria for the two disorders and marked overlap in phenomenology. Here we review clinical, epidemiologic, imaging, pathologic, and genetic studies that address the ET-PD relationship. Several lines of evidence support the association between ET and PD, including overlapping motor and non-motor features, relatively high prevalence of rapid eye movement sleep behavior disorder (26-43%) in ET patients, increased prevalence of PD in patients with longstanding antecedent ET, increased prevalence of ET in family members of patients with PD, and the presence of Lewy bodies in the brains of some ET patients (15-24%). Discussion There is a substantial body of evidence supporting the association between ET and PD within at least a subset of patients, although the nature and possible pathogenic mechanisms of the relationship are not well understood.
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Affiliation(s)
- Arjun Tarakad
- Parkinson’s Disease Center and Movement Disorders Clinic, Baylor College of Medicine Houston, TX, USA
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Baylor College of Medicine Houston, TX, USA
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