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PubMedDate not supplied

[Study of presynaptic nigrostriatal pathway by 123-I-FD-CIT-SPECT (DatSCAN SPECT) in primary orthostatic tremor].

INTRODUCTION: Primary orthostatic tremor (OT) is defined as a clinical syndrome with high frequency (13-18 Hz) tremor when standing predominantly involving legs and trunk. OT is thought to be driven by an unique supraspinal tremor generator. Previous studies suggest that the nigrostriatal dopaminergic transmission is impaired in patients with OT. CLINICAL CASE: All three patients at an age of 56, 45 and 72 years fulfilled the diagnosis criteria of primary OT. The duration of illness amounted to 4, 3 and 1 year, respectively. The three patients had single-photon emission computed tomography (SPECT) using 123-I-FP-CIT as dopamine transporter tracer (DatSCAN). RESULTS: DatSCAN was normal in every patient. CONCLUSIONS: OT is considered to be caused by a central oscillator because high-frequency tremor bursts are time locked in arm, leg, trunk, and even facial muscles and peripheral stimulation does not reset the tremor. Some reports suggest that the central generator may be located in the posterior fossa. In our patients presynaptic nigrostriatal pathway was normal.

Aged↗
PubMedDate not supplied

[Unilateral thalamotomy for the treatment of tremor dominant Parkinson's disease].

BACKGROUND AND PURPOSE: To assess the effectiveness of unilateral thalamotomy for the treatment of parkinsonian tremor and other motor signs of Parkinson's disease (PD). MATERIAL AND METHODS: Between 1999 and 2004, 41 patients with idiopathic tremor dominant PD were treated surgically in the Neurosurgical Department of Postgraduate Medical Center in Warsaw. Stereotactic thalamotomy was performed with Leksell stereotactic frame (model G) using intraoperative macrostimulation. The patients were assessed according to the Unified Parkinson's Disease Rating Scale version 3. (UPDRS) before and after thalamotomy in the off state. The progression of PD was also evaluated according to the Hoehn and Yahr scale in the off state and also Schwab and England was used to assess the disability of the patients. The patients were evaluated before thalamotomy in the off state, and 3, 12, 24 and 36 months after surgery, according to the above mentioned clinical rating scales. RESULTS: The authors report their results among 41 patients who underwent stereotactic thalamotomy 3 years postoperatively. At 3 years follow-up (in the group of 19 patients) the contralateral tremor from the presurgical value of 11.2 (items 20 - 21 UPDRS) decreased to 2.6. The rigidity in contralateral limbs at 3 years follow-up was 1.7 (item 22 UPDRS) when compared to 2.8 (item 22 UPDRS) preoperative value. Thalamotomy had no effect on bradykinesia or other manifestations of PD such as balance or gait disturbance. There were 13 transient and 6 permanent complications. CONCLUSIONS: Thalamotomy using intraoperative macrostimulation in carefully selected patients is a beneficial operation for the control of medically refractory parkinsonian resting and postural tremor. The effect of unilateral thalamotomy on tremor is long lasting.

Adult↗
PubMedDate not supplied

[Tremor and epidural anesthesia].

To evaluate the influence of temperature of the injected anesthetic solution on the development of tremor during epidural anesthesia, 66 patients divided in three homogeneous groups were evaluated: group I (n = 22; bupivacaine 4 degrees C), group II (n = 24; bupivacaine 20 degrees C), and group III (n = 24; bupivacaine 37 degrees C). The incidence of tremor was 20% (4 patients) in group I, 9% (2 patients) in group II and 12.5% (3 patients) in group III. No significant differences were found between the groups. The overall incidence was 13.6%. The epidural injection of 5 ml of saline at 37 degrees C achieved the attenuation and/or disappearance of tremor in three (3/4) group I patients (4 degrees C) and in one (1/3) group III patient (37 degrees C), whereas it was ineffective in one patient from group I and one from group III. In the two patients from group II (20 degrees C) and in one from group III (37 degrees C), tremor was self-limited. We conclude that the incidence of tremor during epidural anesthesia is not correlated with the temperature of anesthetic solutions, and that the epidural injection of saline at 37 degrees C may give some therapeutic benefit.

Adolescent↗
PubMed1977

Resting tremor in alcoholic brain disease.

Two patients with signs of alcoholic brain disease of the Wernicke-Korsakoff type were found to have an unusual movement disorder manifested basically as a resting tremor. Electrographic recording showed that the tremor wave comprised multiple elements, though the rate of the basic tremor was stable. Though the tremor was qualitatively similar to documented rubral tremor, a mesencephalic lesion could be defined in only 1 patient.

Alcohol Amnestic Disorder↗
PubMed1983

Differential sensitivity of ethanol withdrawal signs in the rat to gamma-aminobutyric acid (GABA)mimetics: blockade of audiogenic seizures but not forelimb tremors.

Intraperitoneal injection of ethanol (1-2 g/kg) and chlordiazepoxide (2-16 mg/kg) suppressed susceptibility to audiogenically induced, clonic-tonic seizures and antagonized forelimb tremor in rats undergoing ethanol withdrawal, 30 min after treatment. However, a smaller dose of ethanol (0.5 g/kg) actually increased clonic seizure frequency, suggesting that ethanol exerts a biphasic proconvulsant/anticonvulsant action. Direct activation of gamma-aminobutyric acid (GABA) receptors by intracisternal administration of GABA (100-1000 micrograms), muscimol (0.3-1.0 micrograms) or 4,5,6,7-tetrahydroisoxazolo[5,4-c]pyridin-3-ol (THIP) (0.3-3.0 micrograms) 5 to 10 min before testing also reduced susceptibility to audiogenic clonic-tonic seizures. In sharp contrast to these anticonvulsant actions, GABA, muscimol and THIP had no effect on withdrawal-induced forelimb tremors. Blockade of GABA uptake with 1-2,4-diaminobutyric acid (300 and 600 mg/kg i.p.) and inhibition of GABA transaminase with aminooxyacetic acid (12.5 and 25.0 mg/kg i.p.) both reduced susceptibility to seizures. However, anticonvulsant doses of these two drugs, unlike GABA, muscimol and THIP, also reduced forelimb tremor. Three other GABA transaminase inhibitors, gamma-vinyl GABA (450 and 900 mg/kg i.p.), gamma-acetylenic GABA (50-150 mg/kg i.p.) and ethanolamine-O-sulfate (250-750 mg/kg i.p.), were inactive against ethanol withdrawal audiogenic seizures and forelimb tremors. These results indicate that direct GABA receptor activation can selectively suppress one type of ethanol withdrawal response (i.e., audiogenic seizure susceptibility) while failing to influence another (forelimb tremors).

4-Aminobutyrate Transaminase↗
PubMed1983

[Epidemiological study on tremor in the aged].

203 hospitalized old-aged patients were examined for the presence of tremor. This physical sign was found in 58.6% of cases. By far the largest diagnostic category resulted that of essential tremor: 46.7% of all patients investigated and 77.8% of all cases of tremor. The frequency of this type of tremor was found to increase proportionally to age. The conclusion is drawn that also tremor, as well as other neurological signs frequently demonstrable in "normal" old people (for example, the so-called primitive reflexes), should be inscribed in the group of the phenomena due to the ageing process itself.

Aged↗
PubMed1983

Development of a quantitative test for hand tremor measurement. Study of factors influencing the response in a control population.

The frequency spectrum of hand tremor amplitude was investigated in a group of 15 control subjects under four different conditions (rest position, wrist loading with 2 kg, pointer directed to a target, and wrist loading with 2 kg, pointer directed to a target, and wrist loading plus pointer). The series of four tremor recordings was repeated on three different days. The hand tremor pattern was recorded using an accelerometer connected to a tape recorder through a precision sound level meter. The tremor signals were subsequently analyzed with a real time spectrum analyzer. Different parameters (peak frequencies, acceleration amplitudes, moments, displacements, and velocities) have been determined and their variability has been characterized. The method described for hand tremor recording is suitable for field application.

Adult↗
PubMed1981

[Metrifonate-induced congenital tremor in piglets].

Congenital tremor was experimentally induced in pigs. Eight sows of the Comborough breed that had farrowed for the first time were used, having a good body condition and a liveweight of 115 to 120 kg. Other 96 sows of the same breed and body weight were used as controls. The test animals were given metrifonate orally in the prescribed therapeutic and prophylactic doses (50 mg/kg) four times during pregnancy. Both test and control sows were fed a standard mixture No 16 during pregnancy, and were vaccinated against swine fever, leptospirosis, Aujeszky's disease, and erysipelas. Congenital tremor was manifested in 42 out of 78 offsprings. The following conclusions were drawn: 1. The induced congenital tremor was manifested morphologically by varying hypoplasia of the cerebellum. 2. The use of organic phospohrous compounds for therapeutic and prophylactic purposes should be reduced during pregnancy. 3. The induced congenital tremor in pigs clinically and morphologically similar to the spontaneous congenital tremor in these animals described previously by the same authors.

Animals↗
PubMed1994

Metoprolol for action tremor following intracerebral hemorrhage.

Tremor has been rarely described as a manifestation of stroke. A 21-year-old left-handed man developed severe action tremor of his distal left upper extremity and hand following a right parieto-occipital intracerebral hemorrhage. Strength of the left upper extremity improved gradually during a 3-month period but a severe action tremor developed. The patient was treated with the cardioselective beta-blocking agent, metoprolol, initially for elevated blood pressure and tachycardia at 25 mg twice daily for approximately 2 months. Metoprolol was then increased at weekly intervals by 25mg twice daily to a total of 100mg twice daily. Tremor intensity decreased clinically and graphically as monitored by a trace test by having the patient attempt to trace a horizontal and vertical axis and scoring the errors. The scores declined weekly from the first week (4,347), second week (3,786), third week (1,088), to the fourth week (484). No adverse cognitive or cardiopulmonary effects were noted. Action tremor should be considered as one of the movement disorders caused by hemorrhagic cerebral infarction. This case responded well to treatment with metoprolol.

Activities of Daily Living↗
PubMed1993

Arm tremor, tardive dyskinesia, and mental retardation.

The arm tremor of adults diagnosed as having mental retardation and/or tardive dyskinesia was examined through an analysis of the acceleration properties of several arm postures. The degree of arm acceleration was increased in all groups compared to a control group without mental retardation. The tardive dyskinesia and/or mentally retarded groups also showed a shift to a lower modal frequency of physiological tremor. Results showed that both time domain and frequency properties of the tremor acceleration signal are necessary to distinguish between groups. The neuroleptic medication appears to engender a dual and opposing influence on performance in the arm tremor task for the mentally retarded group. The medication reduces behavioral variability as indexed by analyses of arm acceleration over time (time domain) but lowers the modal frequency of physiological tremor.

Adult↗
PubMed1997

Quantification of rigidity and tremor activity in rats by using a new device and its validation by different classes of drugs.

Subjective techniques employed for measuring skeletal muscle tone and tremor, leading symptoms of several diseases, have certain limitations. Objective methods are usually more sensitive and accurate. The equipment developed by the authors allows the objective and rapid measurement of experimentally induced rigidity and tremor in the same small laboratory animal (rat). The present method considerably reduces the number of animals needed to investigate the activity of drugs, especially when compounds should be screened. Due to the greater sensitivity of the equipment, doses of reserpine and oxotremorine which do not cause any postural, autonomic or parasympathetic symptoms can be used to induce muscular rigidity and tremor. Therefore, not only the number of animals but also their stress can be reduced. It was possible to differentiate the oxotremorine-induced tremor from the spontaneous motor activity and to determine qualitative differences in tremor caused by antitremor agents. A number of clinically effective muscle relaxants and antiparkinsonian drugs were examined in this model in order to determine its utility.

Analgesics, Opioid↗
PubMed1998

Tremor: how to determine if the patient has Parkinson's disease.

Tremor is commonly the first neurologic sign of Parkinson's disease (PD) that leads patients to see a physician. Knowing how to differentiate the resting tremor of PD from essential tremor is an important diagnostic skill. Unlike patients with essential tremor, those with PD have other neurologic findings. A diagnosis of PD is likely if the patient has two of three major clinical features: resting tremor, bradykinesia, and rigidity. Minor signs may also be seen, including cognitive slowing, speech abnormalities, depression, dysautonomia, and sleep disturbances. The history and physical exam can determine if the patient has parkinsonism and whether the cause is Parkinson's disease.

Diagnosis, Differential↗
PubMed1998

[Comparative clinical study of patients with Parkinson disease and essential tremor].

INTRODUCTION AND OBJECTIVE: Some studies have shown that essential tremor (ET) occurs more frequently in Parkinson disease (PD) patients and opposite, suggesting these disorders are pathogenically related. To evaluate this relationship, we have compared some clinical features between patients with ET and with PD. PATIENTS AND METHODS: PD patients (N = 134) and patients with ET (N = 46), were collected from Bajo Aragon district. A diagnosis of PD was taken according to the United Kingdom Parkinson's Disease Society Brain Bank criteria. A diagnosis of ET was confirmed on the basis of Rajput et al criteria. RESULTS: A statistically significant higher number of females with ET were founded (p < 0.05). An earlier mean age at tremor onset was observed in ET patients (p < 0.0001). More than half ET patients had a positive had a positive family history of ET (p < 0.0001). Interval period between tremor onset and first medical consulting was higher in ET patients (p < 0.01). Depression was more common in PD patients (p < 0.05). CONCLUSIONS: A statistically significant differences about mean age at tremor onset, duration of illness, positive family history of ET, one side or bilateral tremor onset and frequency of depression were observed between these two disorders. The differences found in clinical features and others described previously about necropsy findings and TEP with 18F-Dopa studies, don't support the possibility that PD and ET are pathogenically related.

Aged↗
PubMed2006

Wilson's disease tremor is associated with magnetic resonance imaging lesions in basal ganglia structures.

Wilson's disease (WD) is an inherited disorder of copper metabolism yielding marked motor deficits, including a severely disabling tremor. As a structural correlate of the disease, a variety of cerebral abnormalities has been revealed. However, the relationship between motor deficits and cerebral lesions has remained largely unknown. Here, we investigated correlation between WD tremor and cerebral magnetic resonance imaging (MRI) findings. Cerebral MRI abnormalities in 6 symptomatic WD patients were compared to findings in 6 asymptomatic WD patients and 10 healthy controls. All patients were treated with long-term copper chelating therapy. Motor symptoms including tremor were determined by Unified Parkinson's Disease Rating Scale Part III (UPDRS-III). MRI findings in symptomatic WD patients revealed significant symmetric T2*-weighted hypointense signal alterations of globus pallidus, head of the caudate nucleus, and substantia nigra. In contrast, MRI of asymptomatic WD patients did not differ from healthy controls. Correlation analysis revealed a significant positive correlation between MRI basal ganglia lesions and UPDRS action tremor score. Our results demonstrate for the first time that Wilson's disease tremor is associated with lesions of the globus pallidus, the head of the caudate nucleus, and the substantia nigra.

Adult↗
PubMed1998

The role of the thalamus and basal ganglia in parkinsonian tremor.

The mechanism of parkinsonian tremor may involve a central oscillator, peripheral feedback to the central nervous system (CNS), or both. The thalamus or the globus pallidus is the most likely site for a central oscillator and would be predicted to generate thalamic tremor-related activity characterized, respectively, by calcium spike-associated bursts and by maximal tremor-related activity in the pallidal relay nucleus of thalamus. Thalamic spike trains demonstrate neither of these characteristics. However, cross-correlation, latency, and transfer function analysis indicate that sensory feedback is a critical element in the relationship between thalamic activity and parkinsonian tremor. Therefore, thalamic spike train activity is most consistent with parkinsonian tremor being mediated by peripheral inputs involved in either an unstable reflex loop or sensory modulation of a central oscillator.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗
PubMed1986

Relationship between amplitude of tremor and reflex responses of the human jaw-closing system.

Jaw-closing force was transduced while subjects maintained a biting force of 9.8 N. To estimate the amplitude of tremor in each subject's force record, the average spectrum of the force was computed, and the definite integral of the averaged spectrum in the frequency range from 3.5 to 10 Hz was calculated. For the same subjects, the amplitude of reflex responses to innocuous mechanical stimuli delivered to intraoral and perioral sites was measured as the peak-to-peak change in jaw-closing force following application of the stimulus. Force responses produced by stimulation at each site were used to compute an average reflex response measure for each subject. Large intersubject variability was observed in the amplitudes of jaw tremor and reflex responses. A correlation coefficient computed between the tremor and reflex measures revealed that subjects with large amplitude tremor tended also to have large reflex force responses. This correlation is consistent with the suggestion that activity in cutaneous reflex pathways contributes to tremor of the human mandible.

Electromyography↗
PubMed2001

Rubral tremor after thalamic infarction in childhood.

The occurrence of tremor after thalamic lesions is well known. Delayed rubral tremor secondary to bilateral thalamic infarction is a rare finding and has not been reported previously in childhood. We present two children with a combined resting-postural-kinetic tremor caused by bithalamic infarction. The first child was a male 14 months of age, and the second was a male 9 years of age. These children come from unrelated families. On hospital admission of the first patient, generalized seizures and routine electroencephalogram (EEG) findings with diffuse spike-wave discharges predominantly over the left frontal area were clinically observed, leading to the initial diagnosis of epilepsia partialis continua. However, clinical observation and video-EEG monitoring of the movements revealed nonepileptiform accompaniments, favoring the diagnosis of rubral tremor. In the second patient, EEG revealed no paroxysmal activity and was within normal limits for age. In both patients, cranial magnetic resonance imaging revealed ischemic lesions in thalami bilaterally but failed to reveal any mesencephalic lesion. These patients demonstrate that thalamic infarction can cause rubral tremor in childhood.

Ataxia↗
PubMed2001

Dynamics of Parkinsonian tremor during deep brain stimulation.

The mechanism by which chronic, high frequency, electrical deep brain stimulation (HF-DBS) suppresses tremor in Parkinson's disease is unknown. Rest tremor in subjects with Parkinson's disease receiving HF-DBS was recorded continuously throughout switching the deep brain stimulator on (at an effective frequency) and off. These data suggest that the stimulation induces a qualitative change in the dynamics, called a Hopf bifurcation, so that the stable oscillations are destabilized. We hypothesize that the periodic stimulation modifies a parameter affecting the oscillation in a time dependent way and thereby induces a Hopf bifurcation. We explore this hypothesis using a schematic network model of an oscillator interacting with periodic stimulation. The mechanism of time-dependent change of a control parameter in the model captures two aspects of the dynamics observed in the data: (1) a gradual increase in tremor amplitude when the stimulation is switched off and a gradual decrease in tremor amplitude when the stimulation is switched on and (2) a time delay in the onset and offset of the oscillations. This mechanism is consistent with these rest tremor transition data and with the idea that HF-DBS acts via the gradual change of a network property. (c) 2001 American Institute of Physics.

Journal Article↗