RESUMEN

Background: Task specific tremor (TST) is a poorly understood entity without any standard treatments, that may subsequently develop tremor during additional tasks, later develop postural/kinetic tremor (essential tremor criteria), and later develop Parkinson's disease. The pathophysiology is not understood as it has features of tremor, dystonia, and parkinsonism. Objectives: To assess response of TST to apomorphine and thus infer pathophysiology. Methods: We administered sublingual apomorphine to 8 patients diagnosed with Parkinson's disease based on clinical criteria and dopamine imaging, who all initially presented with TST and later presented other parkinsonian signs and dopamine imaging deficits. Results: Apomorphine improved TST, which was refractory to oral levodopa and other tremor therapies, in 6/8 subjects. Discussion: These results offer a treatment option for TST, which is usually refractory to other pharmacologic treatments, in patients with other parkinsonian features, and infers a dopaminergic pathophysiology of TST.

Asunto(s)

Enfermedad de Parkinson , Humanos , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/tratamiento farmacológico , Apomorfina/uso terapéutico , Apomorfina/farmacología , Temblor/tratamiento farmacológico , Temblor/etiología , Dopamina/uso terapéutico , Levodopa/uso terapéutico

RESUMEN

It is now well-established that essential tremor (ET) can manifest with different clinical presentations and progressions (i.e., upper limb tremor, head tremor, voice tremor, lower limb tremor, task- or position-specific tremor, or a combination of those). Common traits and overlaps are identifiable across these different subtypes of ET, including a slow rate of progression, a response to alcohol and a positive family history. At the same time, each of these manifestations are associated with specific demographic, clinical and treatment-response characteristics suggesting a family of diseases rather than a spectrum of a syndrome. Here we summarize the most important clinical, demographic, neuropathological and imagingfeatures of ET and of its subtypes to support ET as a family of identifiable conditions. This classification has relevance for counseling of patients with regard to disease progression and treatment response, as well as for the design of therapeutic clinical trials.

Asunto(s)

Temblor Esencial , Temblor Esencial/diagnóstico , Temblor Esencial/terapia , Humanos , Síndrome , Temblor

RESUMEN

The various forms of tremor are now classified in two axes: clinical characteristics (axis 1) and etiology (axis 2). Electrophysiology is an extension of the clinical exam. Electrophysiologic tests are diagnostic of physiologic tremor, primary orthostatic tremor, and functional tremor, but they are valuable in the clinical characterization of all forms of tremor. Electrophysiology will likely play an increasing role in axis 1 tremor classification because many features of tremor are not reliably assessed by clinical examination alone. In particular, electrophysiology may be needed to distinguish tremor from tremor mimics, assess tremor frequency, assess tremor rhythmicity or regularity, distinguish mechanical-reflex oscillation from central neurogenic oscillation, determine if tremors in different body parts, muscles, or brain regions are strongly correlated, document tremor suppression or entrainment by voluntary movements of contralateral body parts, and document the effects of voluntary movement on rest tremor. In addition, electrophysiologic brain mapping has been crucial in our understanding of tremor pathophysiology. The electrophysiologic methods of tremor analysis are reviewed in the context of physiologic tremor and pathologic tremors, with a focus on clinical characterization and pathophysiology. Electrophysiology is instrumental in elucidating tremor mechanisms, and the pathophysiology of the different forms of tremor is summarized in this review.

Asunto(s)

Temblor Esencial , Temblor , Encéfalo , Mapeo Encefálico/efectos adversos , Temblor Esencial/diagnóstico , Humanos

RESUMEN

A 79-year-old woman presented 3 years' history of hand shaking while drinking a cup of tea. The tremor was seen bilaterally, more predominantly on the left, and it also appeared when reading a book or writing. It was also induced by flexing the elbow to about 90 degrees or more without any specific task. Although there was no family history, the tremor in the present case was clinically diagnosed as essential tremor, because there were no other movement abnormalities, and other causes of tremor were excluded by laboratory tests. The tremor was dependent on the position of the involved extremity regardless of the kind of tasks. Position-specific tremor is discussed in relation to postural tremor.

Asunto(s)

Trastornos del Movimiento , Temblor , Anciano , Extremidades , Femenino , Humanos , Temblor/diagnóstico , Temblor/etiología

RESUMEN

BACKGROUND: Parkinson's Disease (PD) can present with dystonia or essential tremor but task specific tremor (TST) preceding PD has been only rarely reported. The relationship between TST and PD is unclear. We report a series of 12 patients with TST who later developed PD. CASES: Patients with TST and PD were identified from our database. Records and imaging were reviewed and descriptive statistics presented. Twelve patients were identified. All 11 patients who had TST of arm developed rest tremor ipsilateral to the TST arm. DaTscan showed reduced dopaminergic uptake in all 11 patients who were scanned. The TST improved with STN and VIM DBS (3/12) and partially to dopaminergic medications (N = 3) and trihexyphenidyl (N = 2). CONCLUSION: Rest tremor consistently occurring ipsilateral to TST, positive DaTscan, and partial response to dopaminergic medications but not to ET medications suggests TST is a precursor to PD in this population rather than chance occurrence.

RESUMEN

Task-specific tremor in musicians is an involuntary oscillating muscular activity mostly of the hand or the embouchure, which predominantly occurs while playing the instrument. In contrast to arm or hand tremors, which have been examined and objectified based on movement kinematics and muscular activity, embouchure tremor has not yet been investigated. To quantify and describe embouchure tremor we analysed sound production and investigated the fluctuation of the time-varying fundamental frequency of sustained notes. A comparison between patients with embouchure tremor and healthy controls showed a significantly higher fluctuation of the fundamental frequency for the patients in the high pitch with a tremor frequency range between 3 and 8 Hz. The present findings firstly provide further information about a scarcely described movement disorder and secondly further evaluate a new quantification method for embouchure tremor, which has recently been established for embouchure dystonia.

Asunto(s)

Trastornos Distónicos/diagnóstico , Trastornos Distónicos/etiología , Temblor/complicaciones , Estimulación Acústica , Adulto , Análisis de Varianza , Femenino , Humanos , Masculino , Persona de Mediana Edad , Música , Desempeño Psicomotor , Adulto Joven

RESUMEN

This letter was written in response to: Zesiewicz T, Vu T, Carranza MA, et al. Unusual wrist tremor: unilateral isometric tremor? Tremor Other Hyperkinet Mov. 2014; 4: http://tremorjournal.org/article/view/194.