Therapeutic Neurogenic Tremors for Treating Neurogenic Pathologies (original) (raw)
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Diagnosis and Treatment of Common Forms of Tremor
Seminars in Neurology, 2011
Tremor is the most common movement disorder presenting to an outpatient neurology practice and is defined as a rhythmical, involuntary oscillatory movement of a body part. The authors review the clinical examination, classification, and diagnosis of tremor. The pathophysiology of the more common forms of tremor is outlined, and treatment options are discussed. Essential tremor is characterized primarily by postural and action tremors, may be a neurodegenerative disorder with pathologic changes in the cerebellum, and can be treated with a wide range of pharmacologic and nonpharmacologic methods. Tremor at rest is typical for Parkinson's disease, but may arise independently of a dopaminergic deficit. Enhanced physiologic tremor, intention tremor, and dystonic tremor are discussed. Further differential diagnoses described in this review include drug-or toxin-induced tremor, neuropathic tremor, psychogenic tremor, orthostatic tremor, palatal tremor, tremor in Wilson's disease, and tremor secondary to cerebral lesions, such as Holmes' tremor (midbrain tremor). An individualized approach to treatment of tremor patients is important, taking into account the degree of disability, including social embarrassment, which the tremor causes in the patient's life.
Psychogenic tremor: long-term outcome
CNS spectrums, 2006
Psychogenic disorders, also referred to as somatoform, conversion, somatization, hysteria, and medically unexplained symptoms, are among the most challenging disorders to diagnose and treat. Psychogenic movement disorders are increasingly encountered in specialized clinics, and represent approximately 15% of all patients evaluated in the Baylor College of Medicine Movement Disorders Clinic. To characterize psychogenic tremor and provide data on prognosis and long-term outcome in a large group of patients with psychogenic tremor followed in a movement disorders clinic. Patients evaluated at the Baylor College of Medicine Movement Disorders Clinic in Houston, Texas, between 1990 and 2003 with the diagnosis of psychogenic movement disorder (PMD), who consented to be interviewed, were administered a structured questionnaire designed to assess current motor and psychological function. psychogenic tremor is the most common PMD, accounting for 4.1% of all patients evaluated in our clinic. ...
The differential diagnosis and treatment of tremor
Deutsches Ärzteblatt international, 2014
Essential tremor is the most common type of tremor, with a prevalence of 0.4% in the overall population and 4-7% in persons over age 65. In general, tremor is so common that patients with tremor are frequently treated not only by neurologists, but also by physicians from other specialties. This review is based on publications retrieved by a selective PubMed search and on guidelines from Germany and abroad. Particular tremor syndromes are usually diagnosed on the basis of their typical clinical presentation and whatever accompanying manifestations may be present. Ancillary tests are usually unnecessary. Unilateral rest tremor accompanied by rigidity and bradykinesia is typical of Parkinson's disease. Essential tremor is a bilateral postural tremor. The most common cause of intention tremor is multiple sclerosis. Mild tremor syndromes can often be treated satisfactorily with drugs. In case of severe tremor, which is rarer, a stereotactic operation can be considered. The usual outc...
Tremor retrainment as therapeutic strategy in psychogenic (functional) tremor
2014
Background: Entrainment, the change or elimination of tremor as patients perform a voluntary rhythmical movement by the unaffected limb, is a key diagnostic hallmark of psychogenic tremor. Objective: To evaluate the feasibility of using entrainment as a bedside therapeutic strategy ('retrainment') in patients with psychogenic tremor. Methods: Ten patients with psychogenic tremor (5 women, mean age, 53.6 AE 12.8 years; mean disease duration 4.3 AE 2.7 years) were asked to participate in a pilot proof-of-concept study aimed at "retraining" their tremor frequency. Retrainment was facilitated by tactile and auditory external cueing and real-time visual feedback on a computer screen. The primary outcome measure was the Tremor subscale of the Rating Scale for Psychogenic Movement Disorders. Results: Tremor improved from 22.2 AE 13.39 to 4.3 AE 5.51 (p ¼ 0.0019) at the end of retrainment. The benefits were maintained for at least 1 week and up to 6 months in 6 patients, with relapses occurring in 4 patients between 2 weeks and 6 months. Three subjects achieved tremor freedom. Conclusions: Tremor retrainment may be an effective short-term treatment strategy in psychogenic tremor. Although blinded evaluations are not feasible, future studies should examine the long-term benefits of tremor retrainment as adjunctive to psychotherapy or specialized physical therapy.
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
Neurology, 2005
Background: Essential tremor (ET) is one of the most common tremor disorders in adults and is characterized by kinetic and postural tremor. To develop this practice parameter, the authors reviewed available evidence regarding initiation of pharmacologic and surgical therapies, duration of their effect, their relative benefits and risks, and the strength of evidence supporting their use. Methods: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 1966 and August 2004. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence. Results and Conclusions: Propranolol and primidone reduce limb tremor (Level A). Alprazolam, atenolol, gabapentin (monotherapy), sotalol, and topiramate are probably effective in reducing limb tremor (Level B). Limited studies suggest that propranolol reduces head tremor (Level B). Clonazepam, clozapine, nadolol, and nimodipine possibly reduce limb tremor (Level C). Botulinum toxin A may reduce hand tremor but is associated with dose-dependent hand weakness (Level C). Botulinum toxin A may reduce head tremor (Level C) and voice tremor (Level C), but breathiness, hoarseness, and swallowing difficulties may occur in the treatment of voice tremor. Chronic deep brain stimulation (DBS) (Level C) and thalamotomy (Level C) are highly efficacious in reducing tremor. Each procedure carries a small risk of major complications. Some adverse events from DBS may resolve with time or with adjustment of stimulator settings. There is insufficient evidence regarding the surgical treatment of head and voice tremor and the use of gamma knife thalamotomy (Level U). Additional prospective, double-blind, placebo-controlled trials are needed to better determine the efficacy and side effects of pharmacologic and surgical treatments of ET. netic tremor of the hands in the absence of other neurologic signs. Many clinicians accept isolated tremor of the head if there is no evidence of dystonia. Propranolol and primidone are commonly used to treat ET, although propranolol is the only medication that is approved by the Food and Drug Administration (FDA) for this purpose. It is estimated that at least 30% of patients with ET will not respond to propranolol or primidone. 7 Alcohol reduces tremor amplitude in 50 to 90% of cases, 8-10 but tremor may temporarily worsen after the effect of alcohol has worn off. 11 Invasive therapies including surgical procedures may provide clinical benefit in cases of refractory tremor.
Pathophysiology of nonparkinsonian tremors
Movement Disorders, 2002
Patients with nonparkinsonian tremors are the second largest group treated with functional neurosurgery. We summarize the present pathophysiological knowledge of these conditions. Essential tremor (ET) may be due to oscillations within the olivocerebellar circuit. There is experimental evidence from animal models for such a mechanism, and clinical data indicate an abnormal function of the cerebellum in ET. Cerebellar tremor may be closely related to the tremor seen in advanced ET. The malfunction of the cerebellum causes a pathological feed-forward control. Additionally an oscillator within the cerebellum or its input/output pathways may cause cerebellar tremor. Almost nothing is known about the patho-physiology of dystonic tremor. Holmes tremor is based on a nigral and a cerebellar malfunction and presents clinically as the combination of tremor in Parkinson's disease and cerebellar tremor. Neuropathic tremor can be extremely disabling and is thought to be due to an abnormal interaction of the disturbances within the periphery and abnormal cerebellar feedback. Unlike the case of Parkinson's disease, functional neurosurgery of nonparkinsonian tremors is not yet based on a solid pathophysiological background.
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...