Issues Relating to Functional Disability in Essential Tremor

IntroductionEssential tremor (ET), a tremor disorder, is one of the most common movement disorders. Only oral drugs (propranolol, primidone, topiramate, etc）are still the first-line treatment recommended by the Food and Drug Administration. Propranolol is thought to potentially reduce upper limb action tremor. However, it has a poor effect on axial tremor symptoms, such as essential head tremor and voice tremor. Studies have shown that tremor severity develops over time, possibly producing other clinical tremors and neurological soft signs (such as memory loss, gait abnormalities, balance disorders, etc), which further increases the difficulty of treating tremors. However, some recent studies provide emerging evidence for oral propranolol on subgroups of ET, which is based on the anatomical distribution of ET (lower extremities, head, sound, tongue, etc). This systematic review aims to synthesise these new data to improve the efficacy of propranolol in ET subgroups.Methods and analysisWe will search for randomised controlled trials from the PubMed, MEDLINE, EMBASE, Cochrane Library, UptoDate and PEDro databases from inception to June 2019. All data will be extracted independently by two reviewers and compared at the end of the review. The two reviewers will screen the study quality, and the Cochrane Collaboration’s tool in Review Manager (RevMan) V.5.3.3 will be used to evaluate risk of bias. Our primary outcome will be the functional disability component related to tremors, as measured by the Fahn-Tolosa-Marin Tremor Rating Scale subscales B and C. Secondary outcomes will include severity of tremors and quality of life. Narrative and meta-analytical syntheses are planned.Ethics and disseminationPublished aggregated data will be used in this review analysis and therefore no ethical approval is required. The results will be published in peer-reviewed journals, and proliferation activities will include diverse social stakeholders, non-academic groups and patients.PROSPERO registration numberCRD42018112580

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Does Cup-Grip Type Affect Tremor among People with Essential Tremor?

Sensors ◽

10.3390/s21237797 ◽

2021 ◽

Vol 21 (23) ◽

pp. 7797

Author(s):

Navit Roth ◽

Sara Rosenblum

Keyword(s):

Essential Tremor ◽

Functional Disability ◽

Supportive Therapy ◽

Vertical Direction ◽

Group Differences ◽

Triaxial Accelerometer ◽

Significant Group ◽

Actual Performance ◽

Tremor Suppression ◽

Spiral Drawing

Essential tremor (ET) is a movement disorder that may cause functional disability in daily activities, such as drinking from a cup or drawing. This study aims to characterize effects of varied cup-grip types and measured axes on the actual performance of people with ET and find correlations between cup-grip type and measured axes, and spiral drawing measures. Participants (20 with ET and 18 controls) held a cup of water in a steady position in three grip types and drew a spiral. The cup acceleration was measured by the cup triaxial accelerometer, analyzed in X, Y and Z axes (directions); deviation of the measured acceleration from the desired steady position acceleration was computed. Significant group differences were found for outcome measures in all grip types. Among participants with ET, significantly higher measured values were found in the cup’s horizontal plane (X and Y axes) compared to the vertical direction (Z axis) and for on-the-handle versus around-the-cup grips in the X and Y axes. Significant correlations were found between this grip’s measures and spiral-drawing actual performance measures, indicating the measurement axis and grip type may affect actual performance. These findings may support the future development of assistive devices for tremor suppression and personalized supportive therapy.

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Essential tremor: functional disability vs. subjective impairment

Age-associated Neurological Diseases ◽

10.1007/978-3-7091-9135-4_16 ◽

1991 ◽

pp. 105-110

Author(s):

E. Auff ◽

A. Doppelbauer ◽

E. Fertl

Keyword(s):

Essential Tremor ◽

Functional Disability

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Focused Ultrasound Thalamotomy for Essential Tremor in the Setting of a Ventricular Shunt: Technical Report

Operative Neurosurgery ◽

10.1093/ons/opz013 ◽

2019 ◽

Vol 17 (4) ◽

pp. 376-381 ◽

Cited By ~ 1

Author(s):

Andrew I Yang ◽

Hanane Chaibainou ◽

Sumei Wang ◽

Frederick L Hitti ◽

Brendan J McShane ◽

...

Keyword(s):

Essential Tremor ◽

Focused Ultrasound ◽

Functional Disability ◽

Rating Scale ◽

Controlled Trial ◽

Normal Pressure ◽

Acoustic Energy ◽

Maximum Temperature ◽

Hand Tremor ◽

First Case

Abstract BACKGROUND A recent randomized controlled trial of magnetic resonance imaging (MRI)-guided focused ultrasound (FUS) for essential tremor (ET) demonstrated safety and efficacy. Patients with ventricular shunts may be good candidates for FUS to minimize hardware-associated infections. OBJECTIVE To demonstrate feasibility of FUS in this subset of patients. METHODS A 74-yr-old male with medically refractory ET, and a right-sided ventricular shunt for normal pressure hydrocephalus, underwent FUS to the right ventro-intermedius (VIM) nucleus. The VIM nucleus was directly targeted using deterministic tractography. Clinical outcomes were measured using the Clinical Rating Scale for Tremor. RESULTS Shunt components required 6% of the total ultrasound transducer elements to be shut off. Eight therapeutic sonications were delivered (maximum temperature, 64°), leading to a 90% improvement in hand tremor and a 100% improvement in functional disability at the 3-mo follow-up. No complications were noted. CONCLUSION This is the first case of FUS thalamotomy in a patient with a shunt. Direct VIM targeting and achievement of therapeutic temperatures with acoustic energy is feasible in this subset of patients.

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Stimulation of the subthalamic region for essential tremor

Journal of Neurosurgery ◽

10.3171/jns.2004.101.1.0048 ◽

2004 ◽

Vol 101 (1) ◽

pp. 48-54 ◽

Cited By ~ 92

Author(s):

Puneet Plaha ◽

Nikunj K. Patel ◽

Steven S. Gill

Keyword(s):

Essential Tremor ◽

Upper Limb ◽

Functional Disability ◽

Rating Scale ◽

Related Complication ◽

Content Type ◽

The Mean ◽

Fine Print ◽

Deep Brain

Object. The goal of this study was to determine the safety and efficacy of bilateral subthalamic region stimulation in the treatment of essential tremor (ET). Methods. Following induction of general anesthesia, four patients with disabling tremor that had proved to be refractory to pharmacotherapy underwent magnetic resonance imaging—guided deep brain stimulation (DBS) of the bilateral subthalamic region. Tremor was assessed by applying the Fahn-Tolosa-Marín Tremor Rating Scale at baseline and again at the 12-month follow-up examination. Following surgery the total tremor score improved by 80.1% (from a baseline mean score of 63 ± 15.1 to a score of 11.8 ± 3.9 at 12 months postoperatively). There was a significant improvement (p < 0.0001) in the mean tremor score of the upper limb (postural and action component) from a baseline score of 3 ± 0.9 to a score of 0.5 ± 0.5 at 12 months postoperatively. In two patients with Score 4 head tremor complete arrest of the tremor was observed at 12 months. Motor function scores of the upper limb for drawing spirals, pouring water, and drawing lines improved significantly (p < 0.05) by 66.7, 76.9, and 58.3%, respectively. Handwriting improved by 68%, but this gain was not significant. The mean activities of daily living score at baseline was 20 ± 3.2; there was an 88.8% improvement in this score to 2.3 ± 1.5 at the 12-month evaluation. The voltage required for effective tremor control was low (mean 1.8 ± 0.2 V) and, along with the other parameters of DBS (frequency and pulse width), did not change significantly over the 12-month period. Tolerance to the action component of tremor was not seen. There was no procedural or stimulation-related complication. Conclusions. Bilateral subthalamic region stimulation is effective in arresting tremor and head titubation, as well as functional disability in ET. Complications like dysarthria and disequilibrium were not seen. These patients required low voltages of stimulation and did not develop a tolerance to the treatment.

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