Tremors

10.2310/neuro.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.

Download Full-text

Tremors

10.2310/psych.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.

Download Full-text

Local Vibrational Therapy for Essential Tremor Reduction: A Clinical Study

Medicina ◽

10.3390/medicina56100552 ◽

2020 ◽

Vol 56 (10) ◽

pp. 552

Author(s):

Silvijus Abramavičius ◽

Mantas Venslauskas ◽

Antanas Vaitkus ◽

Vaidotas Gudžiūnas ◽

Ovidijus Laucius ◽

...

Keyword(s):

Power Spectrum ◽

Essential Tremor ◽

Medical Device ◽

The Body ◽

Rank Test ◽

Main Study ◽

Safety Study ◽

Serious Adverse Events ◽

Parkinsonian Tremor ◽

Device Use

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.

Download Full-text

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.

Download Full-text

Multitarget, dual-electrode deep brain stimulation of the thalamus and subthalamic area for treatment of Holmes' tremor

Journal of Neurosurgery ◽

10.3171/2014.1.jns12392 ◽

2014 ◽

Vol 120 (5) ◽

pp. 1025-1032 ◽

Cited By ~ 20

Author(s):

Kazutaka Kobayashi ◽

Yoichi Katayama ◽

Hideki Oshima ◽

Mitsuru Watanabe ◽

Koichiro Sumi ◽

...

Keyword(s):

Neural Network ◽

Deep Brain Stimulation ◽

Essential Tremor ◽

Brain Stimulation ◽

Rating Scale ◽

The Other ◽

Parkinsonian Tremor ◽

Holmes Tremor ◽

Dual Lead ◽

Deep Brain

Object Holmes' tremor (HT) is generally considered to be a symptomatic tremor associated with lesions of the cerebellum, midbrain, or thalamus. Deep brain stimulation (DBS) therapy for essential tremor and parkinsonian tremor has proved quite successful. In contrast, surgical treatment outcomes for HT have often been disappointing. The use of 2 ipsilateral DBS electrodes implanted in parallel within the thalamus for severe essential tremor has been reported. Since dual-lead stimulation within a single target can cover a wider area than single-lead stimulation, it produces greater effects. On the other hand, DBS of the subthalamic area (SA) was recently reported to be effective for refractory tremor. Methods The authors implanted 2 DBS electrodes (one at the nucleus ventralis oralis/nucleus ventralis intermedius and the other at the SA) in 4 patients with HT. For more than 2 years after implantation, each patient's tremor was evaluated using a tremor rating scale under the following 4 conditions of stimulation: “on” for both thalamus and SA DBS; “off” for both thalamus and SA DBS; “on” for thalamus and “off” for SA DBS; and “on” for SA and “off” for thalamus DBS. Results The tremor in all patients was improved for more than 2 years (mean 25.8 ± 3.5 months). Stimulation with 2 electrodes exerted greater effect on the tremor than did 1-electrode stimulation. Interestingly, in all patients progressive effects were observed, and in one patient treated with DBS for 1 year, tremor did not appear even while stimulation was temporarily switched off, suggesting irreversible improvement effects. The presence of both resting and intentional/action tremor implies combined destruction of the pallidothalamic and cerebellothalamic pathways in HT. A larger stimulation area may thus be required for HT patients. Multitarget, dual-lead stimulation permits coverage of the wide area needed to suppress the tremor without adverse effects of stimulation. Some reorganization of the neural network may be involved in the development of HT because the tremor appears several months after the primary insult. The mechanism underlying the absence of tremor while stimulation was temporarily off remains unclear, but the DBS may have normalized the abnormal neural network. Conclusions The authors successfully treated patients with severe HT by using dual-electrode DBS over a long period. Such DBS may offer an effective and safe treatment modality for intractable HT.

Download Full-text

HEMICHOREA-HEMIBALLISM IN VARIOUS CONDITIONS: SERIAL CASE REPORTS

MNJ (Malang Neurology Journal) ◽

10.21776/ub.mnj.2021.007.01.15 ◽

2021 ◽

Vol 7 (1) ◽

pp. 74-79

Author(s):

Neila Raisa ◽

Sri Budhi Rianawati ◽

Shahdevi Nandar Kurniawan ◽

Fahimma F ◽

Mulika Ade Fitria Nikmahtustsani

Keyword(s):

Movement Disorder ◽

Metabolic Diseases ◽

Clinical Course ◽

Case Reports ◽

Involuntary Movement ◽

The Body ◽

Focal Lesions ◽

Admission Data ◽

Underlying Disorder ◽

Secondary Causes

Introduction: Hemichorea-hemiballism (HCHB) is an uncommon movement disorder involved unilateral extremities characterized by irregular, poorly patterned, a continual hyperkinetic involuntary movement disorder in the proximal or distal parts of the body. The acute development of HCHB depends on focal lesions on the contralateral basal ganglia and subthalamic nuclei. Various conditions such as cerebrovascular, neurodegenerative, neoplastic, immunologic, infectious, and metabolic diseases are known as secondary causes of HCHB. This paper aims to compare and discuss the HCHB in various etiologies. Case Reports: Here, we reported 5 cases of HCHB induced by non-ketotic hyperosmolar hyperglycemia (NKKH), thrombotic stroke, and toxoplasmosis cerebral. We compare the admission data, clinical course, imaging, treatment, and outcome of every case. Conclusion: Various hypotheses have been proposed to explain the pathophysiology of HCHB due to these conditions. Principally, the main management for these cases is to determine the etiology and correct the underlying disorder

Download Full-text

Self-injurious behaviour in movement disorders: systematic review

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-322569 ◽

2020 ◽

Vol 91 (7) ◽

pp. 712-719

Author(s):

Jan-Frederik Fischer ◽

Tina Mainka ◽

Yulia Worbe ◽

Tamara Pringsheim ◽

Kailash Bhatia ◽

...

Keyword(s):

Systematic Review ◽

Movement Disorder ◽

Movement Disorders ◽

The Body ◽

Tic Disorders ◽

Physical Injury ◽

Review Of The Literature ◽

Drug Induced ◽

Behavioural Interventions ◽

Brain Changes

Self-injurious behaviours (SIBs) are defined as deliberate, repetitive and persistent behaviours that are directed towards the body and lead to physical injury and are not associated with sexual arousal and without suicidal intent. In movement disorders, SIBs are typically associated with tic disorders, most commonly Tourette syndrome, and neurometabolic conditions, such as classic Lesch-Nyhan syndrome. However, beyond these well-known aetiologies, a range of other movement disorder syndromes may also present with SIBs, even though this clinical association remains less well-known. Given the scarcity of comprehensive works on this topic, here we performed a systematic review of the literature to delineate the spectrum of movement disorder aetiologies associated with SIBs. We report distinct aetiologies, which are clustered in five different categorical domains, namely, neurodevelopmental, neurometabolic and neurodegenerative disorders, as well as disorders with characteristic structural brain changes and heterogeneous aetiologies (eg, autoimmune and drug-induced). We also provide insights in the pathophysiology of SIBs in these patients and discuss neurobiological key risk factors, which may facilitate their manifestation. Finally, we provide a list of treatments, including practical measures, such as protective devices, as well as behavioural interventions and pharmacological and neurosurgical therapies.

Download Full-text