Neurophysiological investigations in patients with head tremor (original) (raw)

Early Head Tremor in Essential Tremor: A Case Series and Commentary

Tremor and other hyperkinetic movements (New York, N.Y.), 2017

Classically, the onset of head tremor in essential tremor (ET) patients follows that of hand tremor, such that there is a somatotopic spread of involved areas. Here we present a series of seven self-reportedly "unaffected" relatives of ET cases. These seven were clinically asymptomatic and had normal levels of arm tremor on examination, yet each evidenced a transient head wobble on examination. We estimate the prevalence of this phenotype within the two studies from which cases were ascertained. ET cases and their self-reportedly affected and unaffected relatives, enrolled in two family studies, underwent a medical history and videotaped neurological examination. In seven self-reportedly "unaffected" relatives, a transient and subtle head wobble was seen, always during sustained phonation, speech, or reading aloud. Total tremor score (a measure of arm tremor) ranged from 5 to 12 (i.e., mild tremor within the range of normal). The prevalence of this phenotype of e...

Are Patients with Limb and Head Tremor a Clinically Distinct Subtype of Essential Tremor?

Background: Essential tremor (ET) is the most common tremor disorder in adults. In addition to upper limbs, the tremor in ET may also involve head, jaw, voice, tongue, and trunk. Though head tremor (HT) is commonly present in patients with ET, large comparative studies of ET patients with HT (HT+) and without HT (HT−) are few. Methods: To determine whether ET with HT is a distinct clinical subtype by comparing ET patients with and without HT, a chart review of 234 consecutive patients with ET attending the neurology clinics of the National Institute of Mental Health and Neurosciences, India, was done. A movement disorder specialist confirmed the diagnosis of ET in all patients using the National Institutes of Health collaborative genetic criteria. Results: HT was present in 44.4% of the patients. Comparison between HT+ and HT− showed that the HT+ group patients: (1) were older, (2) had later onset of tremor, (3) had unimodal distribution of age at onset with a single peak in the fifth decade, (4) had more frequent voice tremor, and (5) were more likely to have mild cervical dystonia. HT was part of presenting symptoms in nearly two thirds of the ET patients and in the rest it was detected during clinical examination. Conclusions: Several demographic and clinical variables suggest that ET patients with HT have a distinct clinical phenotype.

Head tremor in patients with cervical dystonia: different outcome?

2008

Objective: The association of cervical dystonia (CD) with other movement disorders have been already described, but data on clinical outcome regarding these patients are scant. The aim of this paper was to investigate whether patients with CD and head tremor (HT) would have a different outcome regarding to botulinum toxin type-A (BTX-A) treatment response and clinical and demographic parameters. Method: We retrospectively evaluated 118 medical charts of patients with CD and divided them into two groups: with (HT+) and without (HT-) head tremor. We compared the following clinical and demographic parameters: age at onset, disease duration, progression of symptoms, etiology, familial history, presence of hand tremor. We also analyzed the response to BTX-A according to Tsui score in both groups. Results: The occurrence of head tremor in our sample was of 38.2%. The occurrence of postural hand tremor in the patients from the HT+ group was higher than in the HT-one (p=0.015) and if we compare BTX-A response in each group, we observe that patients with HT present a better outcome in a setting of longer follow-up. In HT+ group, Tsui score pre treatment was 10 (6-12.5) and after follow-up was 8 (5.5-10.5); p<0.001. In HT-group there was no significant difference 9 (7-12) in pre treatment and after follow-up; p=0.07. Conclusion: According to our data it seems that head tremor may influence the clinical outcome or treatment response with BTX-A in patients with CD.

Isolated head tremor: A DAT-SPECT and somatosensory temporal discrimination study

Parkinsonism & Related Disorders, 2020

To better understand the pathophysiology of isolated head tremor, we investigated somatosensory temporal discrimination threshold (STDT) and dopaminergic neurotransmission with 123 I-FP-CIT (DAT-SPECT) in patients with isolated head tremor, as well as potential correlations with their clinical features. Methods: We enrolled 14 patients with isolated head tremor who underwent clinical examination, STDT testing, and DAT-SPECT. Results: We found normal radiotracer uptake in both striata as assessed with DAT-SPECT examination, but higher STDT values in patients as compared to healthy subjects. No significant correlations emerged between STDT values, specific binding ratios of radiotracer uptake, and demographic or clinical features. Conclusion: Our study found normal radiotracer uptake with DAT-SPECT examination, suggesting dopaminergic neurotransmission integrity in patients with isolated head tremor. Patients with isolated head tremor exhibited an abnormally elevated STDT. Both results support the hypothesis that isolated head tremor should be considered a form of dystonia.

Diagnosis and management of essential tremor and dystonic tremor

Therapeutic advances in neurological disorders, 2009

Essential tremor (ET) is the most common adult movement disorder. Traditionally considered as a benign disease, it can cause an important physical and psychosocial disability. Drug treatment for ET remains poor and often unsatisfactory. Current therapeutic strategies for ET are reviewed according to the level of discomfort caused by tremor. For mild tremor, nonpharmacological strategies consist of alcohol and acute pharmacological therapy; for moderate tremor, pharmacological therapies (propranolol, gabapentin, primidone, topiramate, alprazolam and other drugs); and for severe tremor, the role of functional surgery is emphasised (thalamic deep brain stimulation, thalamotomy). The more specific treatment of head tremor with the use of botulinum toxin is also discussed. Several points are discussed to guide the immediate research into this disease in the near future. Dystonic tremor is a common symptom in dystonia. Diagnostic criteria for dystonic tremor and differential diagnosis wit...

Diagnostic and pathophysiological aspects of psychogenic tremors

Movement Disorders, 1998

Twenty-five patients from our movement disorder clinic with the clinical diagnosis of psychogenic tremor were included. According to a modified version of Fahn's criteria for psychogenic dystonia,I3 the diagnosis of psychogenic tremor was accepted if

Subdivision of essential tremor patients according to physiologic characteristics

Acta Neurologica Scandinavica, 2004

Essential tremor (ET) is a common condition manifesting as limb or head postural tremor without other neurologic signs and symptoms. ET is considered to be generated by neural oscillators, that are located in the central nervous system (1). The olivocerebellar network is one such oscillatory circuit thought to be involved in ET production (2). Many ET patients report an increase in tremor severity while bringing a full cup or spoon closer to their mouth. This clinical observation led us to quantify and characterize the changes that take place in ET amplitude and frequency with varying posture of the upper limb while attempting to drink. Tremor that arises from central structures is characterized by a stable frequency even if the mechanical condition of the limb changes (3). Hence, a change in ET frequency with postural variation is not trivial. The clinical observation of tremor enhancement in the drinking posture led us to suspect that tremor characteristics other than amplitude might also be influenced by posture. Putative position-related changes in tremor characteristics could be theoretically induced by alterations in the mechanical properties of the upper limb. Alternatively, they might stem from a change in the neural oscillator output. It is well known that the clinical expression of ET may be variable (4). There are differences between cases in their age of onset, anatomic distribution of tremor and the rate of disease progression (5). Some ET patients have a family history of tremor while others do not (6). Additionally, ET patients may respond differently to pharmacologic treatment with propranolol or primidone (7). This clinical heterogeneity hints that ET may have various underlying electrophysiologic mechanisms. In this work we addressed the hypothesis that subgroups of ET could be classified based on differential physiologic properties.

Non-motor features of essential tremor, Updated review of evolving aspects

Sohag Medical Journal, 2021

Essential tremor (ET) is defined as an action tremor syndrome with a duration of more than three years in both upper limbs with or without tremor in other areas and with no other neurological signs. ET's non-motor characteristics add to the evidence of clinical variability in ET, a disease with a wide range of pathological and etiological characteristics. Problems in frontal-executive function, comparable to Parkinson's disease (PD), were one of the most common patterns of cognitive affection in ET. ET individuals who started tremor after the age of 65 were 64 to 70% more likely than control subjects to develop dementia, but ET cases who started tremor before the age of 65 have an equal chance to develop dementia as controls. Depression rates were considerably higher in ET than controls and more severe depression is found. A strong evidence linking anxiety and ET. Many studies have documented sleep disturbances in ET.