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Correlation between the dischanges of two simultaneously recorded motor units and physiological tremor.

Simultaneous recording was performed from pairs of motor units either in a small intrinsic hand muscle (first dorsal interosseus, 6 subjects, 37 records) or in two synergistic calf muscles (gastrocnemius and soleus, 6 subjects, 50 records). The two motor units were recorded by means of two electrodes inserted into the muscle during stationary isometric contractions of different strengths. Cross-correlograms were calculated in two ways: (1) between spike trains of two motor units; (2) between either spike train and the peaks of the tremor record. The cross-correlation between pairs of motor units showed a consistent tendency to synchronization in the hand as well as in the calf muscles. This synchronization was higher than could be expected from the random activity of asynchronously firing motor units. The amount of synchronization was correlated with the amplitude of physiological tremor: the stronger the tremor, the higher the synchronization coefficient. The cross-correlation between a spike train and the peaks of the tremor records showed a higher probability of unit firing 30-60 msec prior to the tremor beats. It is concluded that the tremor force produced by one muscle or a pair of synergistic muscles is the result of the synchronized activity of motor units. This hypothesis is supported by some characteristic changes in the amplitudes and rates of tremor in Parkinson's disease and myopathies. In these diseases the pathological changes in tremor rates simply reflect underlying changes of the motoneuronal firing rates.

Action Potentials↗

Interaction of central serotonin and dopamine in the regulation of carbaryl-induced tremor.

Carbaryl (50-200 mg/kg, p.o.) produced dose-dependent tremors and inhibition of striatal AChE activity. A dose-dependent elevation of striatal 5-HT and 5-HIAA levels was also observed with carbaryl but at the higher doses (100-200 mg/kg p.o.). L-Trp or 5-HTP or haloperidol potentiated the carbaryl-induced tremors. Further, 5-HTP or haloperidol, when administered (i) alone, reduced the ED50 value and increased the duration of carbaryl-induced tremors without affecting the maximum tremorogenic response of rats and (ii) together, did not change any of these measures significantly. Atropine (acetylcholine antagonist) completely blocked the tremors produced by carbaryl in the absence or presence of 5-HTP or haloperidol. Methysergide (5-HT antagonist) and bromocriptine (DA agonist) antagonised the potentiating effect of 5-HTP and haloperidol, respectively, on the carbaryl-induced tremors. Furthermore, bromocriptine antagonised the potentiating effect of 5-HTP on the carbaryl-induced tremor but, methysergide failed to achieve this antagonism in presence of haloperidol. These results indicate that carbaryl-induced tremors primarily involve the activation of central cholinoceptors and that the serotonergic potentiation of carbaryl-induced tremors is possibly mediated through the dopaminergic disinhibition of cholinergic neurons.

5-Hydroxytryptophan↗

Effect of lesioning dopamine, noradrenaline and 5-hydroxytryptamine pathways on tremorine-induced tremor and rigidity.

The effects of lesioning monoamine pathways in the rat brain on tremorine-induced hind-limb tremor and rigidity were studied. Nigro-striatal and mesolimbic dopamine (DA) neurones were lesioned unilaterally by injecting 6-hydroxydopamine (6-OHDA) into the median forebrain bundle. Tremor was reduced in the contralateral leg and rigidity was prevented in the ipsilateral leg. Injection of 6-OHDA into the nucleus accumbens affected tremor but not rigidity. In general, nigral DA neurones may influence rigidity whilst mesolimbic DA neurones affect tremor. A unilateral locus coeruleus electrolesion which destroys noradrenaline (NA) fibres reduced both tremor and rigidity. A median raphe electrolytic lesion affecting 5-hydroxytryptamine (5-HT) neurones had no effect on tremor and rigidity, whereas lesioning the dorsal raphe electrolytically or by injecting 5,6-dihydroxytryptamine prevented rigidity without affecting tremor. Electrical stimulation of the dorsal raphe increased transiently the hindlimb tone of normal rats. The findings demonstrate that the monoamines, especially 5-HT, are differently involved in the mechanisms of tremor and rigidity produced by tremorine.

Animals↗

Evaluation of tremor and efficacy of oral procaterol in adult patients with asthma.

Tremor, the most common side effect of ordinary doses of beta 2-agonists, was evaluated in a quantitative manner and compared to improvement in pulmonary function in respect to time of onset, duration, peak effect, and tachyphylaxis with procaterol in adults. Forty-five adult patients with reversible obstructive airway disease were studied during administration of three different dosages of procaterol, 25 micrograms escalating to 100 micrograms, and 100 micrograms twice daily. Tremor was quantitatively evaluated with a Grass model accelerometer. The patients were evaluated during 8 hours approximately every 2 weeks for 8 weeks. Daily diaries of symptoms and side effects were also maintained. The study demonstrated no direct relationship between tremor and pulmonary function as far as time of onset, peak effect, or duration. Although tachyphylaxis was demonstrated, much of the tolerance developed to the tremor was explained by an increase in baseline tremor. Procaterol was demonstrated to be an effective bronchodilator, and tolerance to tremor was demonstrated to develop with time but is highly variable. There was not a direct relationship between tremor and pulmonary function, indicating possible differences between lung and peripheral muscle beta 2-receptors. It appeared that the best way to minimize the problem of tremor is to begin with a lower dose and increase the dose gradually during a period of weeks.

Administration, Oral↗

Effect of stereotactic thalamic lesion on essential tremor.

The cause of essential (low-frequency) tremor is unknown and its relation to physiological (high-frequency) tremor is unclear. We assessed essential tremor in one patient before and after a stereotactic thalamic lesion. The procedure changed the size of the tremor in the right hand but not in the left. Persistence of a low-frequency component suggested that essential tremor was an additional feature superimposed on physiological tremor in this patient. The focus of essential tremor seems to be an autonomous central generator that is independent of physiological tremor mechanisms.

Adult↗

Mechanical implications of paired motor unit discharges in pathological and voluntary tremor.

Paired motor unit discharges (PDs), i.e., two discharges of the same motor unit (MU) with short interval, and their relation to tremor amplitude were studied in the first dorsal interosseous muscle (FDI) of patients with parkinsonian or essential tremor and in normal subjects mimicking tremor. In both pathological and voluntary tremor, interdischarge intervals of PDs were inversely correlated with the amplitude of the subsequent tremor beat, i.e., PDs with shorter intervals were followed by higher tremor beats. To further assess their mechanical impact, PDs were simulated by applying paired stimuli to MUs of the FDI in normal subjects using intramuscular microstimulation. Following paired stimuli, summation of twitch responses was more than linear. This was also the case with the paired stimuli applied at a tremor-like repetition rate (5 Hz). These findings stress the importance of PDs for tremor expression.

Adult↗

Evidence for the involvement of central serotonergic mechanisms in cholinergic tremor induced by tacrine in Balb/c mice.

Tacrine is a potent and reversible inhibitor of acetylcholinesterase (AChE) in the brain. It produces tremor in animals, which is believed to be due to an increase in the brain acetylcholine level following AChE inhibition. The present study was undertaken to investigate the involvement, if any, of biogenic amines in the genesis of this motor dysfunction. Administration of tacrine (10-20 mg/kg, i.p.) produced dose- and time-dependent tremor in Balb/c mice. While in vivo inhibition of striatal AChE activity was observed only for the highest dose of tacrine, a dose-dependent increase in striatal choline acetyltransferase activity was obtained. Serotonin (5-HT) levels, as assayed following a sensitive HPLC-electrochemical procedure, were significantly increased in nucleus caudatus putamen, nucleus accumbens, substantia nigra, nucleus raphe dorsalis, olivary nucleus and the cerebellum. However, dopamine or norepinephrine levels remained unaltered in these areas of the brain. In animals treated with p-chlorophenylalanine, a specific tryptophan hydroxylase inhibitor and 5-HT depletor, tacrine failed to elevate the levels of 5-HT in the brain regions, and significantly attenuated tremor response to the drug. Tacrine-induced tremor was also significantly (83%) attenuated by 5-HT(2A/2C) receptor antagonist mianserin (5 mg/kg, i.p.), but methysergide (5 mg/kg, i.v.) could block tacrine-induced tremor only by 20%. Atropine (5 mg/kg, i.p.) antagonized tacrine-induced tremor by about 53%, but a combination of atropine and mianserin completely blocked the tremor response. These results indicate that the cholinergic tremor produced by tacrine in Balb/c mice is mediated via central serotonergic mechanisms, and stimulation of 5-HT(2A/2C) receptors plays a pivotal role in this motor dysfunction.

Acetylcholine↗

Rest and postural tremors in patients with Parkinson's disease.

The mild tremor of twenty-four patients with Parkinson's disease (PD) was quantified in four conditions: finger-rest, finger-postural, hand-rest and hand-postural. Tremor characteristics such as amplitude, median power frequency, power dispersion, and power percentage within the 4-7 Hz band were correlated across conditions. Results show that all tremor characteristics were well correlated across conditions (Spearman's Rank), signifying that presence of PD rest tremor was accompanied with a postural tremor having similar characteristics to that of rest tremor. The present results suggest that neural mechanisms involved in PD rest tremor do remain active in the postural condition, even in patients with mild tremor.

Aged↗

Tremor analysis in two normal cohorts.

OBJECTIVE: Quantitative tremor analyses using almost identical methods were compared between two independent large normal cohorts, to separate robust measures that may readily be used diagnostically from more critical ones needing lab-specific normalization. METHODS: Hand accelerometry and surface EMG from forearm flexors and extensors were recorded with (500 and 1000 g) and without weight loading under postural conditions in 117 and 67 normal volunteers in two different specialty centers for movement disorders in Germany. RESULTS: Tremor amplitude (total power) and frequency fell within a similar range but differed significantly. A significant reduction of tremor frequency under 1000 g weight load (>1 Hz), and a lack of rhythmic EMG activity at the tremor frequency in around 85-90% of the recordings were robust findings in both centers. CONCLUSIONS: The differences in frequency and total power indicate that these measures critically depend on the details of the recording conditions being slightly different between the two centers. Thus each lab needs to establish its own normative data. We estimate that at least 25 normal subjects have to be recorded to obtain normal values. The reduction of tremor frequency under load and lacking tremor-related EMG activity were well reproducible allowing a differentiation of physiological from low amplitude pathological tremor. SIGNIFICANCE: This study provides a framework for more standardized tremor analyses in clinical neurophysiology.

Adult↗

Physiological and harmonic components in neural and muscular coherence in Parkinsonian tremor.

OBJECTIVE: To differentiate physiological from harmonic components in coherence analysis of the tremor-related neural and muscular signals by comparing power, cross-power and coherence spectra. METHODS: Influences of waveform, burst-width and additional noise on generating harmonic peaks in the power, cross-power and coherence spectra were studied using simulated signals. The local field potentials (LFPs) of the subthalamic nucleus (STN) and the EMGs of the contralateral forearm muscles in PD patients with rest tremor were analysed. RESULTS: (1) Waveform had significant effect on generating harmonics; (2) noise significantly decreased the coherence values in a frequency-dependent fashion; and (3) cross-spectrum showed high resistance to harmonics. Among six examples of paired LFP-EMG signals, significant coherence appeared at the tremor frequency only, both the tremor and double tremor frequencies and the double-tremor frequency only. CONCLUSIONS: In coherence analysis of neural and muscular signals, distortion in waveform generates significant harmonic peaks in the coherence spectra and the coherence values of both physiological and harmonic components are modulated by extra noise or non-tremor related activity. SIGNIFICANCE: The physiological or harmonic nature of a coherence peak at the double tremor frequency may be differentiated when the coherence spectra are compared with the power and in particular the cross-power spectra.

Electric Stimulation↗

Thalamotomy versus thalamic stimulation for multiple sclerosis tremor.

Disabling intractable tremor occurs frequently in patients with multiple sclerosis (MS). There is currently no effective medical treatment available, and the results of surgical intervention have been variable. Thalamotomy has been the mainstay of neurosurgical therapy for intractable MS tremor, however the popularisation of deep brain stimulation (DBS) has led to the adoption of chronic thalamic stimulation in an attempt to ameliorate this condition. With the goal of examining the relative efficacy and adverse effects of these two surgical strategies, we studied twenty carefully selected patients with intractable MS tremor. Thalamotomy was performed in 10 patients, with chronic DBS administered to the remaining 10. Both thalamotomy and thalamic stimulation produced improvements in postural and intention tremor. The mean improvement in postural tremor at 16.2 months following surgery was 78%, compared with a 64% improvement after thalamic stimulation (14.6 month follow-up) (P > 0.05). Intention tremor improved by 72% in the group undergoing thalamotomy, a significantly larger gain than the 36% tremor reduction following DBS (P < 0.05). Early postoperative complications were common in both groups. Permanent complications related to surgery occurred in four patients overall. Following thalamotomy, long-term adverse effects were observed in three patients (30%), and comprised hemiparesis and seizures. Only one patient in the thalamic stimulation group experienced a permanent deficit (monoparesis). We conclude that thalamotomy is a more efficacious surgical treatment for intractable MS tremor, however the higher incidence of persistent neurological deficits in patients receiving lesional surgery may support the use of DBS as the preferred surgical strategy.

Adult↗

The effect of changed visual feedback on intention tremor in multiple sclerosis.

In patients with multiple sclerosis (MS), intention tremor amplitude is enhanced during the visually guided compared to the memory guided motor tasks. In the present study, the effect of visual feedback on intention tremor was investigated during visually guided wrist step-tracking tasks. Specifically, visual feedback of the hand was provided either instantly or averaged over different time windows. Thirteen MS patients with intention tremor and 14 healthy controls performed the wrist step-tracking task, while the visual representation of the actual hand position was displayed instantly or averaged over time windows of 150, 250 and 350 ms. It has been found in the patient group that, in association with a decreased initial error and decreased tremor amplitude on the screen, the amplitude of the actual performed tremor also decreased when visual feedback was changed. The tremor reduction was not different between conditions with manipulated feedback, although delays in presenting visual feedback of the hand position increased when the time window was larger. The reduction in overall tremor amplitude was unlikely related to other factors, such as eye fixation deficits or the speed of the primary hand movement. These results suggest that hand tremor severity is dependent on the visual feedback of position and movement errors.

Adult↗

Hand tremor related to smoking habits and the consumption of caffeine in male industrial workers.

Tremor was measured in 49 smokers/snuffers and in 49 non-smokers/non-snuffers in a cross-sectional study. The Kløve-Matthews static steadiness test and TREMOR 7.0 from the CATSYS test system were used to assess the hand tremor. The creatinine (cr) corrected arithmetic mean concentrations of cotinine in urine were 11 microg/g cr (range 0.1-430) in the non-smokers/non-snuffers compared to 1,417 microg/g cr (range 45-3,780) in the smokers/snuffers. The geometric mean urinary caffeine concentrations were 797 microg/g cr (range 0.5-13,330) in the non-smokers/non-snuffers versus 654 microg/g cr (range 0.9-7,470) in the smokers/snuffers. Increased tremor was found in the group of smokers/snuffers compared to the non-smokers/non-snuffers for several parameters on the tremor measurements, e.g. geometric mean tremor intensity of 0.14 m/s(2) (range 0.09-0.40) in the smokers/snuffers versus 0.11 m/s(2) (range 0.07-0.22) in the non-smokers/non-snuffers for the dominant hand were quantified. Also the mean scores on the static steadiness test were inferior in the smokers/snuffers, in particular for the number of touches. The results further indicate that the frequency dispersion is smaller in the smokers/snuffers compared to the non-smokers/non-snuffers. No systematic association was observed between the biomarkers of nicotine and caffeine exposure and the tremor measurements. However, older age appeared to be an important predictor for the magnitude of tremor in the smokers/snuffers, but not in the non-smokers/non-snuffers.

Adult↗

Quantitative tremor assessment in workers with current low exposure to mercury vapor.

Measurement of tremor has been used in several occupational studies of workers with long-term exposure to mercury vapor (Hg(0)). Recent studies indicate an adverse effect even at relatively low exposure levels. In the present study, we used sensitive quantitative methods to assess tremor in chloralkali workers with current low exposure to Hg(0). Neurological examinations and recordings of tremor using both an accelerometer and a laser-based system were conducted in 43 mercury-exposed workers and 22 age-matched referents. The median urinary mercury concentration in exposed workers was 5.9 (1.3-25) microg/g creatinine (microg/gC), while it was 0.7 (0.2-4.1) microg/gC in referents. The mean exposure time was 15 years, and the median cumulative mercury index was 161 years x microg/gC in exposed workers. There were no differences between the exposed workers and the referents in the clinical evaluation of tremor. In the quantitative tremor tests, no associations were found with current or cumulative mercury exposure for the majority of tremor measures. There were indications that exposure to Hg(0) was associated with a lowering of tremor frequency in the non-dominant hand, and a possible interaction with smoking. The differences were small, however, and overall, this study indicates no significant adverse effects on tremor at these exposure levels.

Adult↗

Exacerbation of harmaline-induced tremor by imipramine.

Imipramine is a well-established tricyclic antidepressant which was first approved for the treatment of depression in the late fifties. Antidepressant effect of imipramine is attributed to inhibition of serotonin (5HT) and noradrenaline (NA) reuptake in brain. These monoamines have been implicated in a variety of neurological disorders including tremor. In the present investigation attempt was made to study the effect of imipramine on harmaline-induced tremor in rats. Male Sprague Dawley rats weighing 115+/-2.5 g were given harmaline (10 mg/kg, i.p.) alone or along with imipramine (30 min before harmaline) in doses of 60 and 90 mg/kg respectively. The latency of onset, intensity and duration of tremor and EMG were recorded. To substantiate the role of 5HT in aetiopathology of tremor the above experiment was repeated in the rats pretreated with P-chlorophenylalanine (PCPA), a potent 5HT depleter. The levels of 5HT and 5-hydroxyindole acetic acid (5HIAA) in the brain stem were measured using high performance liquid chromatography. Imipramine dose-dependently exacerbated the duration, intensity and amplitude of EMG following harmaline-induced tremor. Imipramine treatment further decreased harmaline-induced 5HT turnover in the brain stem. However, this was statistically insignificant. Depletion of 5HT produced a significant reduction in the intensity and duration of harmaline-induced tremor. In conclusion, this study suggests that imipramine exacerbates harmaline-induced tremor. Clinical use of imipramine for the treatment of depression in patients who also suffer from tremors may require a close monitoring.

Animals↗

Physiological tremor in human jaw-muscle system.

Small, quasi-rhythmical tremor of the jaw occurs at rest and during voluntary movements. In peripheral limbs, tremor consists of a component due to mechanical resonance properties of the system, and a neurogenic component mediated by a central pacemaker or neural loops. The present study attempted to determine if these components were present in jaw tremor measured with a position transducer held lightly between the incisors. When weights were suspended from the mandible, the tremor frequency was unaltered; sharp taps delivered to the jaw did not elicit any kind of damped oscillations of the system. These findings indicated the absence of mechanical resonance in the system. No correlation of the tremor signal with the electrocardiogram was found. However, a strong correlation was found between the rectified electromyographic signals recorded over the masseter muscles and the tremor signal, where the electromyographic signal preceded jaw movement by 20-30 msec. Frequency-domain analysis also showed positive peaks in a majority of coherence functions between electromyographic and tremor signals. These results suggested a strong neurogenic component of the tremor.

Adult↗

Effect of lidocaine on harmaline-induced tremors in the rat.

The present study was undertaken to investigate the effect of lidocaine on harmaline-induced tremors in the rat. Four groups of Wistar rats weighing 45-50 g were injected with harmaline (50 mg/kg i.p.) for inducing experimental tremors. The rats in group 1 served as control, whereas the animals in groups 2, 3, and 4 were also given lidocaine i.p. at doses of 12.5, 25, and 50 mg/kg, respectively, 10 min after the onset of tremors (therapeutic study). In a separate four groups of animals intraperitoneal lidocaine injection was given 10 min before harmaline (prophylactic study) in the same dose regimen as mentioned above. The latency of onset, intensity, and duration of tremor and electromyographic responses were recorded. Lidocaine dose dependently attenuated harmaline-induced tremors in rats. The latency period was increased, and duration and intensity of harmaline-induced tremors was reduced by lidocaine. Our electromyography (EMG) study also revealed a decrease in the amplitude of harmaline-induced tremors in lidocaine-treated rats. In conclusion, the results of this study clearly suggest beneficial effects of lidocaine in harmaline-induced tremors.

Animals↗

[Primary orthostatic tremor].

INTRODUCTION: Tremor is frequent in neurologic practice but primary orthostatic tremor was first described in 1984. Its prevalence accounts for around 4% for tremors explored in neurophysiology; in contrast, essential and parkinsonian tremors represent respectively 28 and 22% of these cases. EXEGESIS: Orthostatic tremor is characterized by its appearance while standing. Walking, sitting, and lying down are unaffected. Clinical examination is normal except for unsteadiness disappearing when walking. Surface electromyography in the standing position is necessary for the diagnosis and shows a regular rapid tremor (frequency around 14 to 18 Hz). Its pathophysiology is unknown. CONCLUSION: Clonazepam is the first-line treatment for orthostatic tremor. In cases of resistance or side effects of this drug orthostatic tremor may be improved by primidone or, as in our case, gabapentin.

Female↗