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Amami P, Prioni S, Fusar Poli M, Pascuzzo R, Bocchi E, Golfrè Andreasi N, Devigili G, Cilia R, Rinaldo S, Levi V, Ghielmetti F, Grisoli M, Gemma M, DiMeco F, Eleopra R, Piacentini S. Pain related to MRgFUS: a merely minor transient adverse event? J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333401. [PMID: 38641369 DOI: 10.1136/jnnp-2024-333401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/29/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Paolo Amami
- Clinical Neuropsychology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Sara Prioni
- Clinical Neuropsychology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marco Fusar Poli
- Clinical Neuropsychology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Riccardo Pascuzzo
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Elisa Bocchi
- Clinical Neuropsychology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Nico Golfrè Andreasi
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Grazia Devigili
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Roberto Cilia
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Sara Rinaldo
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Vincenzo Levi
- Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Ghielmetti
- Medical Physics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marina Grisoli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marco Gemma
- Intensive Care and Neuroanesthesia Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco DiMeco
- Department of Neurological Surgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milano, Italy
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milano, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Sylvie Piacentini
- Clinical Neuropsychology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Gautam D, Venkatraman V, Horns J, Yang LZ, Lee HJ, Kassavetis P, Alshaikh J, Moretti P, Shofty B, Rahimpour S. Demographics of focused ultrasound thalamotomy for essential tremor and trends in deep brain stimulation surgery after its introduction in the USA. BMJ Neurol Open 2024; 6:e000582. [PMID: 38618151 PMCID: PMC11015248 DOI: 10.1136/bmjno-2023-000582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/31/2024] [Indexed: 04/16/2024] Open
Abstract
Background Essential tremor (ET) is a movement disorder that affects 4%-5% of adults >65 years. For patients with medically refractory ET, neurosurgical interventions such as deep brain stimulation (DBS) and unilateral MR-guided focused ultrasound thalamotomy (MRgFUS) are available. In this retrospective cohort study, we examined the demographics of patients with ET who have received MRgFUS and evaluated trends in DBS usage in the USA after the introduction of MRgFUS in 2016. Methods We used multiple databases to examine the demographics of patients who received DBS and MRgFUS, and trends in DBS. To assess the demographics, we queried the TriNetX database from 2003 to 2022 to identify patients diagnosed with ET and stratify them by DBS or MRgFUS treatment by using Current Procedural Terminology codes. Patient demographics were reported as frequencies and percentages. To examine the trends in DBS for ET, the yearly frequency of DBS procedures done for ET between 2012 and 2019 was extracted from the National Inpatient Sample (NIS) database, and breakpoint analysis was performed. Additionally, the yearly frequency of MRgFUS procedures for ET was obtained from Insightec Exlabate. Results Most of the patients (88.69%) in the cohort extracted from TriNetX database self-identified as white, followed by black or African American (2.40%) and Asian (0.52%). A higher percentage of black patients received MRgFUS treatment than DBS (4.10% vs 1.88%). According to the NIS database, from 2012 to 2020, 13 525 patients received DBS for ET. Conclusion This study provides an overview of the characteristics of patients who undergo DBS or MRgFUS. We found notable differences in sex and race among patients who underwent each treatment type. Additionally, until at least the beginning of 2020, the number of DBS procedures for ET was not negatively affected after the introduction of MRgFUS.
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Affiliation(s)
- Diwas Gautam
- University of Utah Health, Salt Lake City, Utah, USA
| | | | - Joshua Horns
- Department of Surgery, Surgical Population Analysis Core, University of Utah Health, Salt Lake City, Utah, USA
| | - Lexie Zidanyue Yang
- Department of Biostatistics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hui-Jie Lee
- Department of Biostatistics, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Jumana Alshaikh
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Paolo Moretti
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Ben Shofty
- Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Shervin Rahimpour
- Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA
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3
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Affiliation(s)
| | - Lucy Kinton
- Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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4
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Paulo DL, Johnson GW, Doss DJ, Allen JH, González HFJ, Shults R, Li R, Ball TJ, Bick SK, Hassell TJ, D'Haese PF, Konrad PE, Dawant BM, Narasimhan S, Englot DJ. Intraoperative physiology augments atlas-based data in awake deep brain stimulation. J Neurol Neurosurg Psychiatry 2023; 95:86-96. [PMID: 37679029 DOI: 10.1136/jnnp-2023-331248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/25/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is commonly performed with patients awake to perform intraoperative microelectrode recordings and/or macrostimulation testing to guide final electrode placement. Supplemental information from atlas-based databases derived from prior patient data and visualised as efficacy heat maps transformed and overlaid onto preoperative MRIs can be used to guide preoperative target planning and intraoperative final positioning. Our quantitative analysis of intraoperative testing and corresponding changes made to final electrode positioning aims to highlight the value of intraoperative neurophysiological testing paired with image-based data to optimise final electrode positioning in a large patient cohort. METHODS Data from 451 patients with movement disorders treated with 822 individual DBS leads at a single institution from 2011 to 2021 were included. Atlas-based data was used to guide surgical targeting. Intraoperative testing data and coordinate data were retrospectively obtained from a large patient database. Medical records were reviewed to obtain active contact usage and neurologist-defined outcomes at 1 year. RESULTS Microelectrode recording firing profiles differ per track, per target and inform the locations where macrostimulation testing is performed. Macrostimulation performance correlates with the final electrode track chosen. Centroids of atlas-based efficacy heat maps per target were close in proximity to and may predict active contact usage at 1 year. Overall, patient outcomes at 1 year were improved for patients with better macrostimulation response. CONCLUSIONS Atlas-based imaging data is beneficial for target planning and intraoperative guidance, and in conjunction with intraoperative neurophysiological testing during awake DBS can be used to individualize and optimise final electrode positioning, resulting in favourable outcomes.
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Affiliation(s)
- Danika L Paulo
- Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Graham W Johnson
- Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Derek J Doss
- Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jackson H Allen
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Hernán F J González
- Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Neurosurgery, UCSD, La Jolla, California, USA
| | - Robert Shults
- Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rui Li
- Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, USA
| | - Tyler J Ball
- Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah K Bick
- Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Travis J Hassell
- Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Pierre-François D'Haese
- Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
| | - Peter E Konrad
- Neurosurgery, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
| | - Benoit M Dawant
- Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Saramati Narasimhan
- Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dario J Englot
- Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Purrer V, Upadhyay N, Borger V, Schmeel C, Boecker H, Wüllner U. Structural and functional alterations in the gustatory network underlie taste disturbances after lesional tremor therapy with MRgFUS. J Neurol Neurosurg Psychiatry 2023; 94:1072-1074. [PMID: 37321839 DOI: 10.1136/jnnp-2023-331324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Veronika Purrer
- Department of Neurology, University Hospital Bonn, Bonn, Germany
- German Center of Neurodegenerative Diseases, Bonn, Germany
| | - Neeraj Upadhyay
- German Center of Neurodegenerative Diseases, Bonn, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Carsten Schmeel
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Henning Boecker
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Department of Diagnostic and Interventional Radiology, German Centre of Neurodegenerative Diseases, Bonn, Germany
| | - Ullrich Wüllner
- Department of Neurology, University Hospital Bonn, Bonn, Germany
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6
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Stoker TB. Bilateral hypertrophic olivary degeneration in symptomatic palatal tremor. Pract Neurol 2023; 23:346-347. [PMID: 36759175 DOI: 10.1136/pn-2022-003678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Thomas B Stoker
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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7
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Yamamoto K, Sarica C, Elias GJB, Boutet A, Germann J, Loh A, Joel SE, Bigioni L, Gwun D, Gramer R, Li SX, Zemmar A, Vetkas A, Algarni M, Devenyi G, Chakravarty M, Hynynen K, Scantlebury N, Schwartz ML, Lozano AM, Fasano A. Ipsilateral and axial tremor response to focused ultrasound thalamotomy for essential tremor: clinical outcomes and probabilistic mapping. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328459. [PMID: 35995551 DOI: 10.1136/jnnp-2021-328459] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 05/25/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND MR-guided focused ultrasound (MRgFUS) thalamotomy has been shown to be a safe and effective treatment for essential tremor (ET). OBJECTIVE To investigate the effects of MRgFUS in patients with ET with an emphasis on ipsilateral-hand and axial tremor subscores. METHODS Tremor scores and adverse effects of 100 patients treated between 2012 and 2018 were assessed at 1 week, 3, 12, and 24 months. A subgroup analysis of ipsilateral-hand tremor responders (defined as patients with ≥30% improvement at any time point) and non-responders was performed. Correlations and predictive factors for improvement were analysed. Weighted probabilistic maps of improvement were generated. RESULTS Significant improvement in axial, contralateral-hand and total tremor scores was observed at all study visits from baseline (p<0.0001). There was no significant improvement in ipsilateral subscores. A subset of patients (n=20) exhibited group-level ipsilateral-hand improvement that remained significant through all follow-ups (p<0.001). Multivariate regression analysis revealed that higher baseline scores predict better improvement in ipsilateral-hand and axial tremor. Probabilistic maps demonstrated that the lesion hotspot for axial improvement was situated more medially than that for contralateral improvement. CONCLUSION MRgFUS significantly improved axial, contralateral-hand and total tremor scores. In a subset of patients, a consistent group-level treatment effect was observed for ipsilateral-hand tremor. While ipsilateral improvement seemed to be less directly related to lesion location, a spatial relationship between lesion location and axial and contralateral improvement was observed that proved consistent with the somatotopic organisation of the ventral intermediate nucleus. TRIAL REGISTRATION NUMBERS NCT01932463, NCT01827904, and NCT02252380.
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Affiliation(s)
- Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Jurgen Germann
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Luca Bigioni
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Dave Gwun
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert Gramer
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Ajmal Zemmar
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
- Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Artur Vetkas
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Neurosurgery, University of Tartu, Tartu, Tartumaa, Estonia
| | - Musleh Algarni
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Gabriel Devenyi
- Cerebral Imaging Center, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Mallar Chakravarty
- Cerebral Imaging Center, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Kullervo Hynynen
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Nadia Scantlebury
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael L Schwartz
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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Alshimemeri S, Vargas-Méndez D, Chen R, Lipsman N, Schwartz ML, Lozano AM, Fasano A. Functional tremor developing after successful MRI-guided focused ultrasound thalamotomy for essential tremor. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-327524. [PMID: 35473713 DOI: 10.1136/jnnp-2021-327524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/14/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe a case of functional tremor occurring after a successful MR-guided focused ultrasound thalamotomy (MRgFUS) for essential tremor. METHODS A 71-year-old right-handed man with essential tremor was referred to us for consideration of deep brain stimulation surgery for worsening bilateral upper limb tremor after a successful left MRgFUS for essential tremor. RESULTS On clinical exam, signs compatible with a functional tremor were noted, including entertainability and suppressibility. Electrophysiological studies were consistent with essential tremor and superimposed tremor fulfilling the laboratory-supported criteria for functional tremor. DISCUSSION We describe the first reported case of a functional movement disorder occurring after successful MRgFUS procedure for essential tremor. Recognising this entity and its development after such therapeutic interventions is essential to avoid further unnecessary invasive therapies.
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Affiliation(s)
- Sohaila Alshimemeri
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, UHN, Toronto Western Hospital, Toronto, Ontario, Canada
- Neurology Unit, Department of Medicine, King Saud University, Riyadh, Riyadh Province, Saudi Arabia
| | - Daniel Vargas-Méndez
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, UHN, Toronto Western Hospital, Toronto, Ontario, Canada
- Division of Neurology, Clinica de Merida, Merida, Yucatan, Mexico
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, UHN, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of surgery, University of Toronto, Toronto, Ontario, Canada
| | - M L Schwartz
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of surgery, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, UHN, Toronto Western Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
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Abstract
Tremor is a common neurological condition in clinical practice; yet, few syndromes are widely recognised and discussed in the literature. As a result, there is an overdiagnosis of well-known causes, such as essential tremor. Many important unusual syndromes should be considered in the differential diagnosis of patients with tremor. The objective of this review is to provide broad clinical information to aid in the recognition and treatment of various unusual tremor syndromes in the adult and paediatric populations. The review comprised of a comprehensive online search using PubMed, Ovid database and Google Scholar to identify the available literature for each unusual tremor syndrome. The review includes fragile X-associated tremor/ataxia syndrome, spinocerebellar ataxia type 12, tremors caused by autosomal recessive cerebellar ataxias, myorhythmia, isolated tongue tremor, Wilson's disease, slow orthostatic tremor, peripheral trauma-induced tremor, tardive tremor and rabbit syndrome, paroxysmal tremors (hereditary chin tremor, bilateral high-frequency synchronous discharges, head tremor, limb-shaking transient ischaemic attack), bobble-head doll syndrome, spasmus nutans and shuddering attacks. Rare tremors generally present with an action tremor and a variable combination of postural and kinetic components with resting tremors less frequently seen. The phenomenology of myorhythmia is still vague and a clinical definition is proposed. The recognition of these entities should facilitate the correct diagnosis and guide the physician to a prompt intervention.
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Affiliation(s)
- Robert J Ure
- Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Sanveer Dhanju
- Faculty of Science, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Anthony E Lang
- Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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10
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Sajonz BEA, Mädler B, Herberhold S, Paus S, Allert N, Coenen VA. Stimulation induced hypogeusia in thalamic deep brain stimulation for tremor: an underestimated yet common side effect. J Neurol Neurosurg Psychiatry 2016; 87:565-7. [PMID: 25901034 DOI: 10.1136/jnnp-2015-310368] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/30/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Bastian E A Sajonz
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg (iBr), Germany Department of Neurosurgery, Freiburg University Medical Center, Freiburg (iBr), Germany
| | - Burkhard Mädler
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg (iBr), Germany
| | | | - Sebastian Paus
- Department of Neurology, University of Bonn, Bonn, Germany
| | - Niels Allert
- Neurological Rehabilitation Center Godeshoehe, Bonn, Germany
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg (iBr), Germany
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11
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Erro R, Schneider SA, Stamelou M, Quinn NP, Bhatia KP. What do patients with scans without evidence of dopaminergic deficit (SWEDD) have? New evidence and continuing controversies. J Neurol Neurosurg Psychiatry 2016; 87:319-23. [PMID: 25991401 DOI: 10.1136/jnnp-2014-310256] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 05/04/2015] [Indexed: 11/03/2022]
Abstract
The term SWEDD (scans without evidence for dopaminergic deficit) refers to the absence, rather than the presence, of an imaging abnormality in patients clinically presumed to have Parkinson's disease (PD). However, such a term has since been widely used in the medical literature, even as a diagnostic label. While many authors have suggested that different disorders of PD lookalikes may account for a proportion of SWEDD cases, others have claimed that some of them may have a benign subtype of PD. Thus, there has been ensuing controversy and confusion and the use of this term continues without clarity of what it represents. We have systematically reviewed all the studies involving patients with SWEDD with the aim of shedding light on what these patients actually have. It becomes clear from this systematic review that while most 'SWEDD' cases are due to a clinical misdiagnosis of PD, there exists a small proportion of patients with SWEDD who may have PD on the basis of a positive levodopa response, clinical progression, imaging and/or genetic evidence. The latter challenge the seemingly incontrovertible relationship between dopaminergic tracer binding and the diagnosis of nigrostriatal parkinsonism, particularly PD. Patients with SWEDD are unlikely to reflect a single clinical entity and we suggest that the term SWEDD should be abandoned.
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Affiliation(s)
- Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK Dipartimento di Scienze Neurologiche e del Movimento, Università di Verona, Verona, Italy
| | - Susanne A Schneider
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK Department of Neurology, University Kiel, Kiel, Germany
| | - Maria Stamelou
- Second Department of Neurology, University of Athens, Greece; Movement Disorders Department, Hygeia Hospital, Athens, Greece Department of Neurology, Philipps University Marburg, Germany
| | - Niall P Quinn
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK
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12
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Ganos C, Maugest L, Apartis E, Gasca-Salas C, Cáceres-Redondo MT, Erro R, Navalpotro-Gómez I, Batla A, Antelmi E, Degos B, Roze E, Welter ML, Mestre T, Palomar FJ, Isayama R, Chen R, Cordivari C, Mir P, Lang AE, Fox SH, Bhatia KP, Vidailhet M. The long-term outcome of orthostatic tremor. J Neurol Neurosurg Psychiatry 2016; 87:167-72. [PMID: 25770124 DOI: 10.1136/jnnp-2014-309942] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/16/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Orthostatic tremor is a rare condition characterised by high-frequency tremor that appears on standing. Although the essential clinical features of orthostatic tremor are well established, little is known about the natural progression of the disorder. We report the long-term outcome based on the largest multicentre cohort of patients with orthostatic tremor. METHODS Clinical information of 68 patients with clinical and electrophysiological diagnosis of orthostatic tremor and a minimum follow-up of 5 years is presented. RESULTS There was a clear female preponderance (76.5%) with a mean age of onset at 54 years. Median follow-up was 6 years (range 5-25). On diagnosis, 86.8% of patients presented with isolated orthostatic tremor and 13.2% had additional neurological features. At follow-up, seven patients who initially had isolated orthostatic tremor later developed further neurological signs. A total 79.4% of patients reported worsening of orthostatic tremor symptoms. These patients had significantly longer symptom duration than those without reported worsening (median 15.5 vs 10.5 years, respectively; p=0.005). There was no change in orthostatic tremor frequency over time. Structural imaging was largely unremarkable and dopaminergic neuroimaging (DaTSCAN) was normal in 18/19 cases. Pharmacological treatments were disappointing. Two patients were treated surgically and showed improvement. CONCLUSIONS Orthostatic tremor is a progressive disorder with increased disability although tremor frequency is unchanged over time. In most cases, orthostatic tremor represents an isolated syndrome. Drug treatments are unsatisfactory but surgery may hold promise.
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Affiliation(s)
- Christos Ganos
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Lucie Maugest
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France CRICM UPMC/INSERM UMR 1127 CNRS UMR7225 Brain and Spine Institute, Paris, France
| | - Emmanuelle Apartis
- CRICM UPMC/INSERM UMR 1127 CNRS UMR7225 Brain and Spine Institute, Paris, France Neurophysiology Unit, AP-HP, Saint-Antoine Hospital, Paris, France Pierre Marie Curie Paris-6 University, Paris, France
| | - Carmen Gasca-Salas
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Canada
| | - María T Cáceres-Redondo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Irene Navalpotro-Gómez
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK Department of Neurology, Hospital del Mar, Barcelona, Spain
| | - Amit Batla
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Elena Antelmi
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Bertrand Degos
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France Pierre Marie Curie Paris-6 University, Paris, France
| | - Emmanuel Roze
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France CRICM UPMC/INSERM UMR 1127 CNRS UMR7225 Brain and Spine Institute, Paris, France Pierre Marie Curie Paris-6 University, Paris, France
| | - Marie-Laure Welter
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France CRICM UPMC/INSERM UMR 1127 CNRS UMR7225 Brain and Spine Institute, Paris, France Pierre Marie Curie Paris-6 University, Paris, France
| | - Tiago Mestre
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Canada Parkinson's Disease and Movement Disorder Centre, division of Neurology, department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | - Francisco J Palomar
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Reina Isayama
- Department of Medicine, University of Toronto, Toronto, Canada Division of Brain, Imaging and Behavior-Systems Neuroscience, Toronto Western Research Institute, Toronto, Canada
| | - Robert Chen
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Canada Department of Medicine, University of Toronto, Toronto, Canada Division of Brain, Imaging and Behavior-Systems Neuroscience, Toronto Western Research Institute, Toronto, Canada
| | - Carla Cordivari
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Canada
| | - Susan H Fox
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Canada
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK
| | - Marie Vidailhet
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France CRICM UPMC/INSERM UMR 1127 CNRS UMR7225 Brain and Spine Institute, Paris, France Pierre Marie Curie Paris-6 University, Paris, France
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De Pablo-Fernandez E, Doherty KM, Holton JL, Revesz T, Djamshidian A, Limousin P, Bhatia KP, Warner TT, Lees AJ, Ling H. Concomitant fragile X-associated tremor ataxia syndrome and Parkinson's disease: a clinicopathological report of two cases. J Neurol Neurosurg Psychiatry 2015; 86:934-6. [PMID: 25476004 PMCID: PMC4516009 DOI: 10.1136/jnnp-2014-309460] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/13/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Eduardo De Pablo-Fernandez
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, UK
| | - Karen M Doherty
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, UK
| | - Janice L Holton
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, UK National Hospital for Neurology and Neurosurgery, Queen Square, UCL Hospitals NHS Foundation Trust, London, UK
| | - Tamas Revesz
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, UK
| | - Atbin Djamshidian
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
| | - Patricia Limousin
- National Hospital for Neurology and Neurosurgery, Queen Square, UCL Hospitals NHS Foundation Trust, London, UK Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK
| | - Kailash P Bhatia
- National Hospital for Neurology and Neurosurgery, Queen Square, UCL Hospitals NHS Foundation Trust, London, UK Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK
| | - Thomas T Warner
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, UK National Hospital for Neurology and Neurosurgery, Queen Square, UCL Hospitals NHS Foundation Trust, London, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, UK
| | - Helen Ling
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, London, UK
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Baizabal-Carvallo JF, Kagnoff MN, Jimenez-Shahed J, Fekete R, Jankovic J. The safety and efficacy of thalamic deep brain stimulation in essential tremor: 10 years and beyond. J Neurol Neurosurg Psychiatry 2014; 85:567-72. [PMID: 24096713 DOI: 10.1136/jnnp-2013-304943] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) has proven to be a safe and effective therapy for refractory essential tremor, but information regarding long-term outcomes is lacking. OBJECTIVES We aimed to assess the long-term safety and efficacy of DBS in patients with essential tremor. METHODS Patients treated with DBS for essential tremor for at least 8 years were evaluated in the 'on' and 'off' state using the Fahn-Tolosa-Marin tremor rating scale, and their medical records were reviewed to assess complications related to this therapy. RESULTS We studied 13 patients (7 men): median age at evaluation 79 years (range 47-88), median age at electrode implantation 68 years (range 37-78) and mean time since electrode implantation 132.54±15.3 months (range 114-164). The difference between the 'off' and 'on' state on the motor items of the tremor rating scale was 41.9% (58.62 vs. 34.08, p<0.001) in the non-blinded and 37.2% (56.07 vs. 35.23, p<0.001) in the blinded rating. DBS provided a functional improvement of 31.7% in the 'on' state (15.07 vs. 22.07, p<0.001). A total non-blinded improvement in the tremor rating scale of 39% was observed in the 'on' state (49.15 vs. 80.69, p<0.001). Dysarthria and disequilibrium were common in patients with bilateral stimulation. A DBS-related surgery (electrode revision or internal pulse generator exchange) was necessary on average every 47.9 months to continue with the DBS therapy. CONCLUSIONS Thalamic DBS is a safe and effective therapy in patients with essential tremor followed for up to 13 years.
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Affiliation(s)
- José Fidel Baizabal-Carvallo
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, , Houston, Texas, USA
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Abstract
48, XXYY syndrome is a form of sex chromosome aneuploidy that affects between 1 in 18 000 to 1 in 40 000 males. It is not inherited and is diagnosed by karyotyping. It has similarities to 47, XXY Klinefelter's syndrome, with tall stature, micro-orchidism, hypergonadotropic hypogonadism and infertility in males. However, patients with 48, XXYY syndrome also commonly have dental problems, tremor, attention deficit disorder, learning difficulties, allergies and asthma. The tremor is typically reported as an intention tremor (in 71% of patients XXYY aged >20 years with 48), which becomes more common with age and worsens over time.
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Affiliation(s)
- Hazel Lote
- Department of Neurosciences, Imperial College London, Charing Cross Hospital Campus, London, UK
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TUTTLE WW, JANNEY CD, WILKERSON D, IMIG CJ. Effect of exercises of graded intensity on neuromuscular tremor as measured by a strain gauge technique. J Appl Physiol (1985) 2004; 3:732-5. [PMID: 14850403 DOI: 10.1152/jappl.1951.3.12.732] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Abstract
The pharmacological properties of a series of amino alcohols of the general formula RCH(NH2)ṁ(CH2)nṁC(OH)R2 have been studied The most striking action of these compounds is their ability to produce a sustained tremor, which is compared with those produced by other tremorogenic agents. The activities of various drugs as antagonists of the amino alcohol tremor are described.
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BECK E, DANIEL PM, PARRY HB. DEGENERATION OF THE CEREBELLAR AND HYPOTHALAMONEUROHYPOPHYSIAL SYSTEMS IN SHEEP WITH SCRAPIE; AND ITS RELATIONSHIP TO HUMAN SYSTEM DEGENERATIONS. Brain 1996; 87:153-76. [PMID: 14152208 DOI: 10.1093/brain/87.1.153] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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SERENY G, KALANT H. COMPARATIVE CLINICAL EVALUATION OF CHLORDIAZEPOXIDE AND PROMAZINE IN TREATMENT OF ALCOHOL-WITHDRAWAL SYNDROME. Br Med J 1996; 1:92-7. [PMID: 14218487 PMCID: PMC2165069 DOI: 10.1136/bmj.1.5427.92] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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SPIEGEL EA, WYCIS HT, SZEKELY EG, SOLOFF L, ADAMS J, GILDENBERG P, ZANES C. STIMULATION OF FOREL'S FIELD DURING STEREOTAXIC OPERATIONS IN THE HUMAN BRAIN. ACTA ACUST UNITED AC 1996; 16:537-48. [PMID: 14189791 DOI: 10.1016/0013-4694(64)90045-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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PRICK JJ. [THE SIGNIFICANCE OF STEREOTAXIC FREEZING OF FIXED THALAMIC NUCLEI IN THE TREATMENT OF INVOLUNTARY RHYTHMIC TREMORS]. Ned Tijdschr Geneeskd 1965; 109:1325-8. [PMID: 14329625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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KISSEN MD. MANAGEMENT OF PSYCHOMOTOR AGITATION IN ACUTE ALCOHOLISM: A DOUBLE-BLIND STUDY USING CHLORDIAZEPOXIDE. Dis Nerv Syst 1965; 26:364-8. [PMID: 14315072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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HAWORTH JC, MCRAE KN. THE NEUROLOGICAL AND DEVELOPMENTAL EFFECTS OF NEONATAL HYPOGLYCEMIA: A FOLLOW-UP OF 22 CASES. Can Med Assoc J 1965; 92:861-5. [PMID: 14282940 PMCID: PMC1928006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Twenty-two infants in whom hypoglycemia (blood sugar less than 20 mg./100 ml.) was noted during the first few days of life were followed up when eight to 30 months of age. In eight such symptoms as muscular tremors, cyanosis, apneic spells and convulsions were associated with the hypoglycemia; five of these had abnormal central nervous system signs and retarded development. One other had possible impairment of development and another had a recurrence of hypoglycemia after having been well for four years. Fourteen of the 22 infants had no symptoms associated with the hypoglycemia, and on follow-up only two of these showed possible impairment. The rest were normal.This preliminary study suggests that hypoglycemia associated with neurological symptoms in the newborn period carries a poor prognosis with respect to permanent neurological damage. Asymptomatic hypoglycemia may have a relatively good prognosis.
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SKILLMAN JS. IRRITABILITY OF NEWBORN INFANTS: EFFECT OF DIURETICS ADMINISTERED DURING LAST TRIMESTER OF PREGNANCY. J Am Osteopath Assoc 1965; 64:712-6. [PMID: 14257534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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ITO M. [QUANTITATIVE AND QUALITATIVE MEASUREMENT OF RIGIDITY AND TREMOR IN PARKINSONISM]. Nihon Geka Hokan 1965; 34:389-417. [PMID: 14310154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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MEZAN IS, SIRAKOV AA. STUDY OF VOLUNTARY MUSCULAR CONTRACTIONS IN PARKINSONISM. Arch Phys Med Rehabil 1965; 46:250-4. [PMID: 14271052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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TABARY JC, TARDIEU C, TARDIEU G. [POSTURAL TREMOR IN THE NORMAL SUBJECT. STUDY OF MAINTENANCE OF POSITION]. J Physiol (Paris) 1965; 57:313-24. [PMID: 14335888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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THORDARSON O, GUDMUNDSSON G, BJARNASON O, JOHANNESSON T. [METHYL CHLORIDE POISONING]. Nord Med 1965; 73:150-4. [PMID: 14250206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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46
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STORROW HA. THE CASE OF THE TREMULOUS MAN. ADDICTION TO SEDATIVES AND HYPNOTICS. J Ky Med Assoc 1965; 63:112-3. [PMID: 14257661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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PETELIN LS. [APROPOS OF THE CLASSIFICATION AND PATHOGENESIS OF HYPERKINESIAS]. Zh Nevropatol Psikhiatr Im S S Korsakova 1965; 65:179-86. [PMID: 14270050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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KOHATA N, TSUKUE I, NOMURA S. [THE EFFECT OF DIAZEPAM ON BRAIN WAVE, MINOR TREMOR AND FLICKER TEST]. No To Shinkei 1965; 17:87-91. [PMID: 14286935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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50
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