Contralateral voluntary hand movement inhibits human parkinsonian tremor and variably influences essential tremor

Background and objectives: tremor is an unintentional and rhythmic movement of any part of the body that is a typical symptom of Essential Tremor (ET). ET impairs the quality of life of patients and is treated with pharmacotherapy. We investigated the tremor reduction efficacy of an innovative vibrational medical device (IMD) in ET patients. Materials and Methods: we conducted a prospective, single-center, single-arm, pragmatic study in ET patients with an extended safety study to evaluate the efficacy and safety of the Vilim Ball—a local hand-arm vibration device that produces vibrations in the frequency range of 8–18 Hz and amplitude from 0 to 2 mm. The primary endpoint was the decrease in the power spectrum after device use. The secondary endpoints were safety outcomes. Results: In total, 17 patients with ET were included in the main study, and no patients withdrew from the main study. The tremor power spectrum (m2/s3 Hz) was lower after the device use, represented as the mean (standard deviation): 0.106 (0.221); median (Md) 0.009 with the interquartile range; IQR, 0.087 vs. 0.042 (0.078); Md = 0.009 with the IQR 0.012; Wilcoxon signed-rank test V = 123; and p = 0.027. Seven patients reported that vibrational therapy was not effective. Two patients reported an increase in tremor after using the device. In the extended safety study, we included 51 patients: 31 patients with ET and 20 with Parkinsonian tremor, where 48 patients reported an improvement in tremor symptoms and 49 in function. No serious adverse events were reported, while two patients in the Parkinsonian tremor group reported a lack of efficacy of the proposed medical device. Conclusions: the device reduces essential tremor in some patients and is safe to use in ET.

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Tremor is attenuated during walking in essential tremor with resting tremor but not parkinsonian tremor

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2010.12.053 ◽

2011 ◽

Vol 18 (9) ◽

pp. 1224-1228 ◽

Cited By ~ 11

Author(s):

Kei Uchida ◽

Masaaki Hirayama ◽

Fumitada Yamashita ◽

Norio Hori ◽

Tomohiko Nakamura ◽

...

Keyword(s):

Essential Tremor ◽

Parkinsonian Tremor ◽

Resting Tremor

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Clinical and Electromyographic Examinations of Patients with Essential Tremor

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100052008 ◽

2000 ◽

Vol 27 (1) ◽

pp. 65-70 ◽

Cited By ~ 8

Author(s):

Ivan Milanov

Keyword(s):

Essential Tremor ◽

Neurological Examination ◽

Lower Limbs ◽

Electromyographic Activity ◽

Parkinsonian Tremor ◽

Historical Aspects ◽

Rest Tremor ◽

Different Types ◽

Antagonistic Muscles ◽

Alt Activity

ABSTRACT:Background:It is believed that no clinical differences exist among essential, familial and senile tremor, or between the tremor with synchronous or alternating electromyographic activity. The aim of this study was to evaluate the clinical and electromyographic findings in a large group of patients with different types of essential tremor.Methods:Two hundred and twenty patients with sporadic, familial or senile variants of essential tremor were examined. According to the electromyographic activity recorded from the antagonistic muscles, the patients were subdivided into a group with synchronous (SYN) and a group with alternating (ALT) activity. The historical aspects of the disease were noted, and a detailed neurological examination was performed.Results:A widespread tremor involving upper and lower limbs and 3-4 different anatomical regions was typical for familial tremor. It also had higher amplitude than the sporadic and senile tremor. ALT tremor had a higher amplitude and longer burst duration than SYN and more often involved lower limbs. Rest tremor was common in the ALT group. Overall, ALT tremor was more common than previously supposed.Conclusion:The familial and ALT tremors are more disabling than other types of essential tremor. Since electromyographic ALT activity is common in essential tremor, its presence does not reliably distinguish essential and Parkinsonian tremor.

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Tremors

10.2310/im.6352 ◽

2016 ◽

Author(s):

Alfonso Fasano ◽

Günther Deuschl

Keyword(s):

Movement Disorder ◽

Essential Tremor ◽

Involuntary Movement ◽

The Body ◽

Drug Induced ◽

Parkinsonian Tremor ◽

Dystonic Tremor ◽

Physiologic Tremor ◽

Disease Definition ◽

Holmes Tremor

Tremor is the most common movement disorder and denotes a rhythmic and involuntary movement of one or several regions of the body. This review covers disease definition, essential tremor, enhanced physiologic tremor, parkinsonian tremor, dystonic tremor, orthostatic tremor, cerebellar tremor, Holmes tremor, neuropathic tremor, palatal tremor, drug-induced and toxic tremors, functional tremor, rare tremor syndromes, tremorlike conditions, and treatment of tremor. Figures show action tremor assessment, the central nervous system circuits of tremor, magnetic resonance imaging findings in specific tremor conditions, general management of tremor patients, an algorithm for the treatment of parkinsonian tremor, and an algorithm for the treatment of dystonic tremor and primary writing tremor. Tables list types of tremor according to the condition of activation, tremor conditions in newborns and during childhood, clinical features of the most common tremor syndromes, motor signs other than tremor and nonmotor features of essential tremor patients, Movement Disorder Society consensus criteria for the diagnosis of essential tremor, genetic and environmental causes of essential tremor, causes of enhanced physiologic tremor, drugs and toxins known to cause tremor, paroxysmal tremors, pseudorhythmic myoclonus in the differential diagnosis of tremor, and pharmacologic management of essential tremor. Key words: essential tremor, movement disorder, pathologic tremor, physiologic tremor, tremor This review contains 6 highly rendered figures, 7 videos, 11 tables, and 163 references.

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Different effects of essential tremor and Parkinsonian tremor on multiscale dynamics of hand tremor

Clinical Neurophysiology ◽

10.1016/j.clinph.2021.04.017 ◽

2021 ◽

Author(s):

Dongning Su ◽

Fangzhao Zhang ◽

Zhu Liu ◽

Shuo Yang ◽

Ying Wang ◽

...

Keyword(s):

Essential Tremor ◽

Hand Tremor ◽

Parkinsonian Tremor ◽

Multiscale Dynamics

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Classifying sensory patterns and their effects on locomotion and tremor

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y81-099 ◽

1981 ◽

Vol 59 (7) ◽

pp. 645-655 ◽

Cited By ~ 11

Author(s):

R. B. Stein ◽

T. Gordon ◽

M. N. Oğuztöreli ◽

R. G. Lee

Keyword(s):

Essential Tremor ◽

Peripheral Nerves ◽

Sensory Input ◽

Neural Oscillations ◽

Neuromuscular System ◽

Step Cycle ◽

Parkinsonian Tremor ◽

Reflex Effect ◽

Sensory Activity

Methods are described for analyzing the patterns of sensory activity in peripheral nerves during unrestrained behaviour. In locomotion, nerves supplying ankle extensors and flexors typically show two bursts of sensory activity per step cycle. Variations in sensory input may be important in modulating the ongoing oscillation. Altered sensory input may also change the phase of an ongoing oscillation (as in human essential tremor) or may only have a transient reflex effect (as in Parkinsonian tremor). Various types of interactions can be analyzed using a model of the peripheral neuromuscular system and its central connections. In general, the following categories are suggested for sensory actions on neural oscillations: (1) modulation of (a) the amplitude or (b) the frequency; (2) resetting (i.e., a maintained change in the timing of an oscillation without changes in frequency); (3) repatterning an oscillation (a) over several cycles (e.g., gait changes in locomotion) or (b) within a cycle or two (e.g., the stumble corrective reaction); and (4) gating an oscillation on or off.

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Discrimination of Parkinsonian Tremor From Essential Tremor by Voting Between Different EMG Signal Processing Techniques

The Journal of Engineering Research [TJER] ◽

10.24200/tjer.vol11iss1pp11-22 ◽

2014 ◽

Vol 10 (2) ◽

pp. 11

Author(s):

A Hossen ◽

Z Al-Hakim ◽

M Muthuraman ◽

J Raethjen ◽

G Deuschl ◽

...

Keyword(s):

Signal Processing ◽

Essential Tremor ◽

Test Group ◽

The Body ◽

Soft Decision ◽

Test Set ◽

Parkinsonian Tremor ◽

Emg Signal ◽

Processing Techniques ◽

Signal Processing Techniques

Parkinson's disease (PD) and essential tremor (ET) are the two most common disorders that cause involuntary muscle shaking movements, or what is called "tremor”. PD is a neurodegenerative disease caused by the loss of dopamine receptors which control and adjust the movement of the body. On the other hand, ET is a neurological movement disorder which also causes tremors and shaking, but it is not related to dopamine receptor loss; it is simply a tremor. The differential diagnosis between these two disorders is sometimes difficult to make clinically because of the similarities of their symptoms; additionally, the available tests are complex and expensive. Thus, the objective of this paper is to discriminate between these two disorders with simpler, cheaper and easier ways by using electromyography (EMG) signal processing techniques. EMG and accelerometer records of 39 patients with PD and 41 with ET were acquired from the Hospital of Kiel University in Germany and divided into a trial group and a test group. Three main techniques were applied: the wavelet-based soft-decision technique, statistical signal characterization (SSC) of the spectrum of the signal, and SSC of the amplitude variation of the Hilbert transform. The first technique resulted in a discrimination efficiency of 80% on the trial set and 85% on the test set. The second technique resulted in an efficiency of 90% on the trial set and 82.5% on the test set. The third technique resulted in an 87.5% efficiency on the trial set and 65.5% efficiency on the test set. Lastly, a final vote was done to finalize the discrimination using these three techniques, and as a result of the vote, accuracies of 92.5%, 85.0% and 88.75% were obtained on the trial data, test data and total data, respectively.

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On the classification of tremor signals into dyskinesia, Parkinsonian tremor, and Essential tremor by using machine learning techniques

Biomedical Signal Processing and Control ◽

10.1016/j.bspc.2021.103430 ◽

2022 ◽

Vol 73 ◽

pp. 103430

Author(s):

Gabriel A.S. Ferreira ◽

João Lucas S. Teixeira ◽

Ana Lucia Z. Rosso ◽

Antonio Mauricio F.L. Miranda de Sá

Keyword(s):

Machine Learning ◽

Essential Tremor ◽

Machine Learning Techniques ◽

Parkinsonian Tremor ◽

Learning Techniques

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Deep brain stimulation for the treatment of parkinsonian, essential, and poststroke tremor: a suitable stimulation method and changes in effective stimulation intensity

Journal of Neurosurgery ◽

10.3171/jns.2004.101.2.0201 ◽

2004 ◽

Vol 101 (2) ◽

pp. 201-209 ◽

Cited By ~ 69

Author(s):

Takamitsu Yamamoto ◽

Yoichi Katayama ◽

Toshikazu Kano ◽

Kazutaka Kobayashi ◽

Hideki Oshima ◽

...

Keyword(s):

Essential Tremor ◽

Content Type ◽

Parkinsonian Tremor ◽

Stimulation Intensity ◽

Tremor Suppression ◽

Cathodal Stimulation ◽

Fine Print ◽

Deep Brain ◽

Stimulation Of

Object. The tremor-suppression effect resulting from long-term stimulation of the thalamic nucleus ventralis intermedius (Vim) and the nucleus ventralis oralis posterior (Vop) was examined in the treatment of parkinsonian, essential, and poststroke tremor. Methods. After identifying the accurate anterior border of the nucleus ventrocaudalis (Vc), deep brain stimulation (DBS) electrodes with four contacts were inserted into the Vim—Vop region at an angle of between 40 and 50° from the horizontal plane of the anterior commissure—posterior commissure line. Two distal contacts were placed on the Vim side and two proximal contacts on the Vop side. The best sites of stimulation and parameters of bipolar stimulation were selected in each case and follow-up examinations were conducted for at least 2 years. In all 15 cases of parkinsonian tremor (18 sides) and in 14 of 15 cases of essential tremor (24 of 25 sides), cathodal stimulation of the Vim side with anodal stimulation of the Vop side was determined to be the best choice to suppress the tremor. In poststroke tremor, however, six of 12 cases (six of 12 sides) were selected for cathodal stimulation of the Vop side with anodal stimulation of the Vim side. The average stimulation intensity 1 month after initiation of DBS was 1.61 V in cases of parkinsonian tremor, 1.99 V in cases of essential tremor, and 2.39 V in cases of poststroke tremor. A comparison of stimulation intensities required at 1 and 24 months after initiation of DBS revealed that the lowest effective stimulation intensity increased 24.2% in cases of parkinsonian tremor, 21% in cases of poststroke tremor, and 46.9% in cases of essential tremor. Suppression of tremor was achieved in all cases (42 cases, 55 sides) during a period of 2 years. Nevertheless, two cases of poststroke tremor required dual-lead stimulation at the unilateral Vim—Vop region from the start of DBS, and two cases of essential tremor and one case of poststroke tremor required a stimulation intensity that was high enough to evoke unpleasant paresthesia and slight motor contraction during the follow-up period. Conclusions. Effective stimulation sites and stimulation intensities differ in different kinds of tremor; Vim and Vop stimulation is necessary in many cases. Interactions of the Vim and Vop under the control of interconnected areas of the motor circuitry may play an important role in both the development and DBS-induced suppression of tremor.

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