Evaluation of rest tremor in different positions in Parkinson’s disease and essential tremor plus

We present clinical features and tremor characterization in a patient with Parkinson's disease (PD) as well as in two cases of essential tremor (ET) with some parkinsonian features but no evidence of dopaminergic terminal loss on 123I-FP-CIT Single Photon Emission Computed Tomography (SPECT). Relatively slow frequency rest tremor and bilateral upper extremity bradykinesia without decrementing amplitude were observed in the ET cases, with unilaterally decreased arm swing in case 3. Alternating rest tremor and re-emergent tremor with 13 second latency was confirmed in the PD case. Re-emergent tremor had alternating characteristics, which to our knowledge has not been previously reported. The ET cases had synchronous postural tremor. Alternating re-emergent tremor in PD provides further evidence for re-emergent tremor as an analogue of rest tremor in PD. Two cases of ET with synchronous postural tremor and one to two year history of parkinsonian features had no evidence of dopaminergic terminal loss up to 40 years after the initial onset of ET. Tremor synchronicity characterization can assist in differential diagnosis between the two disorders.

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RESEARCH OF UPPER LIMB BIOMECHANICS OF SUBJECTS WITH PARKINSON‘S DISEASE AND ESSENTIAL TREMMOR / SERGANČIŲJŲ PARKINSONO IR ESENCIALINIO TREMORO LIGA VIRŠUTINĖS GALŪNĖS BIOMECHANIKOS TYRIMAS

Mokslas - Lietuvos ateitis ◽

10.3846/mla.2013.93 ◽

2013 ◽

Vol 5 (6) ◽

pp. 587-590

Author(s):

Julius Griškevičius ◽

Jurgita Žižienė

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Essential Tremor ◽

Disease Progression ◽

Upper Limb ◽

Symptom Severity ◽

Clinical Symptoms ◽

Physical Exam ◽

Rest Tremor ◽

Biomechanical Evaluation

Parkinson’s disease (PD) is a common neurodegenerative diseasewith symptoms of bradykinesia, rest tremor, rigidity and posturalinstability. PL is diagnosed by a clinician who qualitativelyevaluates patient’s visible symptoms during a physical exam. Inaddition, differentiating PD from essential tremor (ET) can bechallenging because their clinical symptoms are similar. Oncediagnosed, only qualitative tools such as the UPDRS are availableto monitor symptom severity and disease progression. Thepurpose of this study is to evaluate the changes of biomechanicalparameters of upper limb of subjects diagnosed either PD or ET,estimate differences and compare them with healthy subjectsin facilitate a creation of an additional instrumental clinical assessmentof PD subjects via biomechanical evaluation of motorfunction tool and develop methods and indices for differentiatingPD from ET. Santrauka Parkinsono liga (PL) yra lėtinė progresuojanti neurologinė liga, kuri išoriškai pasireiškia galvos bei galūnių drebėjimu, judesių sulėtėjimu, sukaustymu ir eisenos pasikeitimu. Esencialinis tremoras – laipsniškai progresuojanti liga, kuriai būdingas nevalingas kūno dalies drebėjimas. Tai daug dažnesnė būklė negu PL judėjimo sutrikimas. Neretai ankstyvoje ligos stadijoje šios abi patologinės būklės yra painiojamos. Šio straipsnio tikslas yra įvertinti žmonių, sergančių Parkinsono liga ir esencialiniu tremoru, viršutinės galūnės biomechanikos parametrų pokyčius, skirtumus ir palyginti juos su sveiko žmogaus viršutinės galūnės biomechanika.

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Electrophysiologic characteristics of tremor in Parkinson?s disease and essential tremor

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20140006 ◽

2014 ◽

Vol 72 (4) ◽

pp. 301-306 ◽

Cited By ~ 3

Author(s):

Ederson Cichaczewski ◽

Renato P. Munhoz ◽

Joaquim M. Maia ◽

Percy Nohama ◽

Edison M. Nóvak ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Essential Tremor ◽

Average Frequency ◽

Rest Tremor ◽

Kinetic Tremor ◽

Tremor Analysis ◽

Rest Posture ◽

Similar Intensity

Tremor in essential tremor (ET) and Parkinson’s disease (PD) usually present specific electrophysiologic profiles, however amplitude and frequency may have wide variations. Objective: To present the electrophysiologic findings in PD and ET. Method: Patients were assessed at rest, with posture and action. Seventeen patients with ET and 62 with PD were included. PD cases were clustered into three groups: predominant rest tremor; tremor with similar intensity at rest, posture and during kinetic task; and predominant kinetic tremor. Results: Patients with PD presented tremors with average frequency of 5.29±1.18 Hz at rest, 5.79±1.39 Hz with posture and 6.48±1.34 Hz with the kinetic task. Tremor in ET presented with an average frequency of 5.97±1.1 Hz at rest, 6.18±1 Hz with posture and 6.53±1.2 Hz with kinetic task. Seven (41.2%) also showed rest tremor. Conclusion: The tremor analysis alone using the methodology described here, is not sufficient to differentiate tremor in ET and PD.

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