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Birreci D, Angelini L, Paparella G, Costa D, Cannavacciuolo A, Passaretti M, De Riggi M, Aloisio S, Colella D, Guerra A, Bologna M. Pathophysiological Role of Primary Motor Cortex in Essential Tremor. Mov Disord 2025. [PMID: 40243615 DOI: 10.1002/mds.30197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Revised: 03/11/2025] [Accepted: 03/24/2025] [Indexed: 04/18/2025] Open
Abstract
BACKGROUND Essential tremor (ET) is one of the most prevalent movement disorders. However, the complete understanding of ET pathophysiology remains elusive. OBJECTIVE To explore the pathophysiological role of primary motor cortex (M1) in ET, specifically exploring its neurophysiological changes and their correlation with voluntary motor abnormalities. METHODS We recruited 30 ET patients and 18 healthy controls (HC). Evaluations were conducted on patients using clinical scales. Transcranial magnetic stimulation (TMS) was used to assess M1 excitability, including motor thresholds and motor evoked potentials (MEPs) input/output curve, together with intracortical excitability measures. Long-term potentiation (LTP)-like plasticity of M1 was tested using intermittent theta-burst stimulation (iTBS). Objective assessments of tremor and voluntary movement execution during finger-tapping were conducted through kinematic analysis. Finally, we explored the potential relationship between TMS, clinical, and kinematic data. RESULTS Compared with HC, ET patients had lower excitability, intracortical inhibition, and lower LTP-like plasticity of M1. ET patients also exhibited slower finger-tapping performance compared with HC. Among ET patients, the degree of movement slowing during finger-tapping correlated with alterations in corticospinal excitability. Specifically, reduced M1 excitability was associated with lower finger-tapping velocity. No other correlations were found. CONCLUSIONS The study findings reveal neurophysiological alterations of M1 in ET and demonstrate correlations between excitability measures and voluntary motor performance. These results provide novel insight into the pathophysiology of ET, emphasizing the role of M1 changes in this condition. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | | | | | - Massimiliano Passaretti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martina De Riggi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Simone Aloisio
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Guerra
- Parkinson and Movement Disorder Unit, Study Center on Neurodegeneration (CESNE) Department of Neuroscience, University of Padua, Padua, Italy
- Padova Neuroscience Center, University of Padua, Padua, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
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Li Y, He R, Li M, Liu L, Sun Q. Higher Prevalence of Common Neurological Soft Signs in Essential Tremor With Midline Distribution: A Multicenter Cohort Study. J Clin Neurol 2025; 21:95-104. [PMID: 40065450 PMCID: PMC11896743 DOI: 10.3988/jcn.2024.0427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 12/03/2024] [Accepted: 12/28/2024] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND AND PURPOSE Essential tremor with a midline distribution (Mid-ET) may represent a distinct subtype of essential tremor (ET) that primarily affects midline structures, often indicating advanced disease stage and increased severity. Recent studies have highlighted the complexity of Mid-ET, but research on neurological soft signs (NSS) in Mid-ET remains insufficient. METHODS The patients with ET included in this cross-sectional study were divided into two subgroups based on whether or not the ET had a midline distribution: Mid-ET and No-Mid-ET. Comparative analyses were performed to assess clinical features and NSS prevalence in these subgroups. RESULTS Among 1,160 patients, 567 (48.9%) were Mid-ET and 593 (51.1%) were No-Mid-ET. The prevalence rates of head, face (including the jaw), and voice tremors were 31.9%, 23.0%, and 25.8%, respectively. In Mid-ET, tremor often affects multiple midline structures simultaneously. In the entire cohort, 24.7%, 16.6%, and 7.6% of patients exhibited tremors in one, two, and three midline structures, respectively. The prevalence of common NSS, including mild cognitive impairment, impaired tandem gait, and questionable dystonic posturing, was significantly higher in the Mid-ET than the No-Mid-ET subgroup (all p<0.001). Furthermore, we found that female sex (p<0.001), olfactory dysfunction (p=0.003), and questionable dystonic posturing (p=0.004) were associated with Mid-ET. CONCLUSIONS Mid-ET and No-Mid-ET presented significant clinical differences. The presence of questionable dystonic posturing may contribute to the distinct characteristics of Mid-ET, suggesting the presence of pathophysiological differences between the subgroups. Further investigations are warranted to determine the potential pathophysiological link between NSS and Mid-ET.
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Affiliation(s)
- Yanting Li
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Runcheng He
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mingqiang Li
- Department of Neurology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China
| | - Lanqing Liu
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiying Sun
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Paparella G, Angelini L, Cannizzo V, Aloisio S, Martini A, Birreci D, Costa D, De Riggi M, Cannavacciuolo A, Bologna M. Subtle bradykinesia features are easier to identify and more prevalent than questionable dystonia in essential tremor. J Neural Transm (Vienna) 2025; 132:443-454. [PMID: 39570420 DOI: 10.1007/s00702-024-02861-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 11/02/2024] [Indexed: 11/22/2024]
Abstract
Essential tremor (ET) is characterized by upper limbs action tremor, sometimes extending to other body parts. However, ET can present with additional neurological features known as "soft signs." These signs of uncertain clinical significance are not sufficient to suggest an alternative neurological diagnosis, and include, among others, questionable dystonia and subtle voluntary movement alterations, i.e., bradykinesia and related features. This study aimed to explore the prevalence and relationship between questionable dystonia and subtle bradykinesia features in ET. Forty ET patients were video-recorded during clinical examination. Five movement disorder experts reviewed the videos to identify soft motor signs, i.e., dystonia and movement alterations during finger-tapping namely, (i) bradykinesia (reduced velocity), (ii) dysrhythmia, and (iii) sequence effect. Inter-rater agreement was quantified using the Fleiss' Kappa index. Data analysis was performed using nonparametric tests. We found a fair inter-rater agreement for upper limb dystonia (Fleiss' K = 0.27). Inter-rater agreement was higher (moderate) for head dystonia (Fleiss' K = 0.49) and finger-tapping assessment (Fleiss' K = 0.45). Upper limb dystonia was identified in 70% of patients, head dystonia in 35%, and finger-tapping alterations (in variable combinations) were observed in 95% of individuals (P < 0.001 by Fisher's exact test), including subtle bradykinesia and related features. No significant concordance or correlation was found between the soft signs. Subtle bradykinesia and related features are the most easily identifiable and frequent soft signs in ET, appearing in a higher percentage of patients than subtle dystonia. These findings provide insights into the clinical and pathophysiological understanding of ET.
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Affiliation(s)
- Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - Valentina Cannizzo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Simone Aloisio
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Adriana Martini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | | | - Martina De Riggi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | | | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
- IRCCS Neuromed, Pozzilli, IS, Italy.
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Butler RD, Brinda AK, Blumenfeld M, Bryants MN, Grund PM, Pandey SR, Cornish CK, Sullivan D, Krieg J, Umoh M, Vitek JL, Almeida L, Orcutt T, Cooper SE, Johnson MD. Differentiating Postural and Kinetic Tremor Responses to Deep Brain Stimulation in Essential Tremor. Mov Disord Clin Pract 2025; 12:166-176. [PMID: 39508598 PMCID: PMC11802662 DOI: 10.1002/mdc3.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 10/12/2024] [Accepted: 10/18/2024] [Indexed: 11/15/2024] Open
Abstract
BACKGROUND While deep brain stimulation (DBS) targeting the ventral intermediate nucleus (VIM) of thalamus or posterior subthalamic area (PSA) can suppress forms of action tremor in people with Essential Tremor, previous studies have suggested postural tremor may respond more robustly than kinetic tremor to DBS. OBJECTIVES In this study, we aimed to more precisely quantify the (1) onset/offset dynamics and (2) steady-state effects of VIM/PSA-DBS on postural and kinetic tremor. METHODS Tremor data from wireless inertial measurement units were collected from 11 participants with ET (20 unilaterally assessed DBS leads). Three postural hold tasks and one kinetic task were performed with stimulation turned off, in 2-min intervals after enabling unilateral DBS at the clinician-optimized DBS setting (15 min), and in 2-min intervals following cessation of DBS (5 min). RESULTS At baseline, kinetic tremor had significantly higher amplitudes, standard deviation, and frequency than postural tremor (P < 0.001). DBS had a more robust acute effect on postural tremors (54% decrease, P < 0.001), with near immediate tremor suppression in amplitude and standard deviation, but had non-significant improvement of kinetic tremor on the population-level across the wash-in period (34% decrease). Tremor response was not equivalent between wash-in and wash-out timepoints and involved substantial individual variability including task-specific rebound or long wash-out effects. CONCLUSIONS Programming strategies for VIM/PSA-DBS should consider the individual temporal and effect size variability in postural versus kinetic tremor improvement. Improved targeting and programming strategies around VIM and PSA may be necessary to equivalently suppress both postural and kinetic tremors.
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Affiliation(s)
- Rebecca D. Butler
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Annemarie K. Brinda
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Madeline Blumenfeld
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Marina N. Bryants
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Peter M. Grund
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Shivansh R. Pandey
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Chelsea K.S. Cornish
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Disa Sullivan
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jordan Krieg
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Matthew Umoh
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jerrold L. Vitek
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Leonardo Almeida
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Tseganesh Orcutt
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Scott E. Cooper
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Matthew D. Johnson
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisMinnesotaUSA
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Costa D, Grandolfo S, Birreci D, Angelini L, Passaretti M, Cannavacciuolo A, Martini A, De Riggi M, Paparella G, Fasano A, Bologna M. Impact of SARS-CoV-2 Infection on Essential Tremor: A Retrospective Clinical and Kinematic Analysis. CEREBELLUM (LONDON, ENGLAND) 2024; 23:2477-2486. [PMID: 39382809 PMCID: PMC11585502 DOI: 10.1007/s12311-024-01751-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2024] [Indexed: 10/10/2024]
Abstract
In the past few years, SARS-CoV-2 infection has substantially impacted public health. Alongside respiratory symptoms, some individuals have reported new neurological manifestations or a worsening of pre-existing neurological conditions. We previously documented two cases of essential tremor (ET) who experienced a deterioration in tremor following SARS-CoV-2 infection. However, the effects of SARS-CoV-2 on ET remain largely unexplored. This study aims to evaluate the impact of SARS-CoV-2 infection on a relatively broad sample of ET patients by retrospectively comparing their clinical and kinematic data collected before and after the exposure to SARS-CoV-2. We surveyed to evaluate the impact of SARS-CoV-2 infection on tremor features in ET. Subsequently, we retrospectively analysed clinical and kinematic data, including accelerometric recordings of postural and kinetic tremor. We included 36 ET patients (14 females with a mean age of 71.1 ± 10.6 years). Among the 25 patients who reported SARS-CoV-2 infection, 11 (44%) noted a subjective worsening of tremor. All patients reporting subjective tremor worsening also exhibited symptoms of long COVID, whereas the prevalence of these symptoms was lower (50%) in those without subjective exacerbation. The retrospective analysis of clinical data revealed a tremor deterioration in infected patients, which was not observed in non-infected patients. Finally, kinematic analysis revealed substantial stability of tremor features in both groups. The study highlighted a potential correlation between the SARS-CoV-2 infection and clinical worsening of ET. Long COVID contributes to a greater impact of tremor on the daily life of ET patients.
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Affiliation(s)
| | - Sofia Grandolfo
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Massimiliano Passaretti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | | | - Adriana Martini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Martina De Riggi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Paparella
- IRCCS Neuromed, Pozzilli (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Alfonso Fasano
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli (IS), Italy.
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
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Paparella G, Angelini L, Margiotta R, Passaretti M, Birreci D, Costa D, Cannavacciuolo A, De Riggi M, Alunni Fegatelli D, Bologna M. Insight into the Relationship Between Motor and Cognitive Symptoms in Essential Tremor. CEREBELLUM (LONDON, ENGLAND) 2024; 23:2050-2059. [PMID: 38748348 PMCID: PMC11489240 DOI: 10.1007/s12311-024-01704-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 10/20/2024]
Abstract
Essential tremor (ET) is a heterogeneous disorder characterized by bilateral upper limbs action tremor and, possibly, neurological signs of uncertain significance, including voluntary movement abnormalities and cognitive disturbances, i.e., the so-called 'soft' signs configuring the ET-plus definition. While motor and cognitive disturbances often coexist in ET, their interrelationship remains largely unexplored. Here we aim to further investigate the relationship between motor symptoms, objectively assessed through kinematic analysis, and cognitive dysfunctions in ET. Seventy ET patients underwent clinical examination, as well as kinematic recordings of tremor and finger tapping and a thorough cognitive assessment. We then tested clinic-demographic and kinematic differences between patients with and without cognitive abnormalities, i.e., with mild cognitive impairment (MCI). Correlation analysis served to explore potential associations between kinematic and cognitive data. Forty-three ET patients (61.42%) had MCI. ET-MCI patients exhibited reduced movement velocity during finger tapping compared to those with normal cognition (p < 0.001). Lower movement velocity during finger tapping was associated with poorer cognitive performance. Namely, we observed a correlation between movement velocity and performance on the Babcock Story Immediate and Delayed Recall Test (r = 0.52 and r = 0.45, both p < 0.001), as well as the interference memory task at 10 and 30 s (r = 0.3, p = 0.008 and r = 0.2, p = 0.03). In this study, we have provided data for a better pathophysiological interpretation of motor and cognitive signs in ET, including the role played by the cerebellum or extra-cerebellar areas, which possibly underpin both signs.
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Affiliation(s)
- Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - Roberta Margiotta
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Martina De Riggi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
- IRCCS Neuromed, Pozzilli, IS, Italy.
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Angelini L, Paparella G, Cannavacciuolo A, Costa D, Birreci D, De Riggi M, Passaretti M, Colella D, Guerra A, Berardelli A, Bologna M. Clinical and kinematic characterization of parkinsonian soft signs in essential tremor. J Neural Transm (Vienna) 2024; 131:941-952. [PMID: 38744708 PMCID: PMC11343963 DOI: 10.1007/s00702-024-02784-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Subtle parkinsonian signs, i.e., rest tremor and bradykinesia, are considered soft signs for defining essential tremor (ET) plus. OBJECTIVES Our study aimed to further characterize subtle parkinsonian signs in a relatively large sample of ET patients from a clinical and neurophysiological perspective. METHODS We employed clinical scales and kinematic techniques to assess a sample of 82 ET patients. Eighty healthy controls matched for gender and age were also included. The primary focus of our study was to conduct a comparative analysis of ET patients (without any soft signs) and ET-plus patients with rest tremor and/or bradykinesia. Additionally, we investigated the asymmetry and side concordance of these soft signs. RESULTS In ET-plus patients with parkinsonian soft signs (56.10% of the sample), rest tremor was clinically observed in 41.30% of cases, bradykinesia in 30.43%, and rest tremor plus bradykinesia in 28.26%. Patients with rest tremor had more severe and widespread action tremor than other patients. Furthermore, we observed a positive correlation between the amplitude of action and rest tremor. Most ET-plus patients had an asymmetry of rest tremor and bradykinesia. There was no side concordance between these soft signs, as confirmed through both clinical examination and kinematic evaluation. CONCLUSIONS Rest tremor and bradykinesia are frequently observed in ET and are often asymmetric but not concordant. Our findings provide a better insight into the phenomenology of ET and suggest that the parkinsonian soft signs (rest tremor and bradykinesia) in ET-plus may originate from distinct pathophysiological mechanisms.
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Affiliation(s)
- Luca Angelini
- IRCCS Neuromed, Via Atinense, 18, Pozzilli (IS), 86077, Italy
| | - Giulia Paparella
- IRCCS Neuromed, Via Atinense, 18, Pozzilli (IS), 86077, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy
| | | | - Davide Costa
- IRCCS Neuromed, Via Atinense, 18, Pozzilli (IS), 86077, Italy
| | - Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy
| | - Martina De Riggi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy
| | - Massimiliano Passaretti
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy
| | - Andrea Guerra
- Parkinson and Movement Disorders Unit, Study Center on Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
- Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Via Atinense, 18, Pozzilli (IS), 86077, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Via Atinense, 18, Pozzilli (IS), 86077, Italy.
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy.
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Angelini L, Paparella G, Bologna M. Distinguishing essential tremor from Parkinson's disease: clinical and experimental tools. Expert Rev Neurother 2024; 24:799-814. [PMID: 39016323 DOI: 10.1080/14737175.2024.2372339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/20/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Essential tremor (ET) and Parkinson's disease (PD) are the most common causes of tremor and the most prevalent movement disorders, with overlapping clinical features that can lead to diagnostic challenges, especially in the early stages. AREAS COVERED In the present paper, the authors review the clinical and experimental studies and emphasized the major aspects to differentiate between ET and PD, with particular attention to cardinal phenomenological features of these two conditions. Ancillary and experimental techniques, including neurophysiology, neuroimaging, fluid biomarker evaluation, and innovative methods, are also discussed for their role in differential diagnosis between ET and PD. Special attention is given to investigations and tools applicable in the early stages of the diseases, when the differential diagnosis between the two conditions is more challenging. Furthermore, the authors discuss knowledge gaps and unsolved issues in the field. EXPERT OPINION Distinguishing ET and PD is crucial for prognostic purposes and appropriate treatment. Additionally, accurate diagnosis is critical for optimizing clinical and experimental research on pathophysiology and innovative therapies. In a few years, integrated technologies could enable accurate, reliable diagnosis from early disease stages or prodromal stages in at-risk populations, but further research combining different techniques is needed.
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Affiliation(s)
| | - Giulia Paparella
- IRCCS Neuromed, Pozzilli, (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Berry DS, Ghanem A, McGurn MM, Huey ED, Cosentino S, Louis ED. Baseline Depressive Symptoms as a Predictor of Incident Dementia in a Prospectively Followed Cohort of Elders with Essential Tremor. NEURODEGENER DIS 2024; 24:80-90. [PMID: 38981446 PMCID: PMC11460651 DOI: 10.1159/000540027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/20/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Essential tremor (ET) patients may exhibit a variety of non-motor features, including cognitive decline and depressive symptoms. Studies of several neurodegenerative diseases link depression to cognitive decline, suggesting depression is an early marker of dementia. We examined whether baseline depressive symptoms predict incident dementia in elders with ET. METHODS Hundred and forty-one ET cases aged 70 years or older at baseline, enrolled in a prospective study of cognitive performance, took part in evaluations at baseline and at 18, 36, 54, and 72 months. Participants completed the Geriatric Depression Scale (GDS), a 30-item self-report measure of depressive symptoms, and a battery of neuropsychological tests and functional assessments, from which we derived cognitive diagnoses at each evaluation. Cox proportional hazards regression equations determined incident dementia risk based on participants' baseline depression scores. RESULTS Mean baseline age was 81.5 ± 6.7 years. Higher baseline GDS scores were associated with increased risk of dementia in an unadjusted model (hazards ratio [HR] = 1.11, 95% confidence interval [CI] = 1.02-1.20, p = 0.01) and after controlling for baseline age, education, number of medications, and tremor onset age (HR = 1.13, 95% CI = 1.02-1.25, p = 0.02). CONCLUSION Baseline depression scores predicted incident dementia in elders with ET. With each one-point increase in baseline depression score, there was a 13% increase in incident dementia risk. Given the published data that reported depression may be twice as high in elders with ET compared to controls, this association is particularly worrisome in the ET population.
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Affiliation(s)
- Diane S. Berry
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ali Ghanem
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Margaret M. McGurn
- Medical School, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Edward D. Huey
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Stephanie Cosentino
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Elan D. Louis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O’Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Erro R, Lazzeri G, Terranova C, Paparella G, Gigante AF, De Micco R, Magistrelli L, Di Biasio F, Valentino F, Moschella V, Pilotto A, Esposito M, Olivola E, Malaguti MC, Ceravolo R, Dallocchio C, Spagnolo F, Nicoletti A, De Rosa A, Di Giacopo R, Sorrentino C, Padovani A, Altavista MC, Pacchetti C, Marchese R, Contaldi E, Tessitore A, Misceo S, Bologna M, Rizzo V, Franco G, Barone P. Comparing Essential Tremor with and without Soft Dystonic Signs and Tremor Combined with Dystonia: The TITAN Study. Mov Disord Clin Pract 2024; 11:645-654. [PMID: 38594807 PMCID: PMC11145151 DOI: 10.1002/mdc3.14026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Tremor disorders remain as clinical diagnoses and the rate of misdiagnosis between the commonest non-parkinsonian tremors is relatively high. OBJECTIVES To compare the clinical features of Essential Tremor without other features (pure ET), ET plus soft dystonic signs (ET + DS), and tremor combined with dystonia (TwD). METHODS We compared the clinical features of patients with pure ET, ET + DS, and TwD enrolled in The ITAlian tremor Network (TITAN). Linear regression models were performed to determine factors associated with health status and quality of life. RESULTS Three-hundred-eighty-three patients were included. Sex distribution was significantly different between the groups with males being more represented in pure ET and females in TwD. The initial site of tremor was different between the groups with about 40% of TwD having head tremor and ET + DS unilateral upper limb tremor at onset. This pattern mirrored the distribution of overt dystonia and soft dystonic signs at examination. Sensory trick, task-specificity, and position-dependence were more common, but not exclusive, to TwD. Pure ET patients showed the lowest degree of alcohol responsiveness and ET + DS the highest. Midline tremor was more commonly encountered and more severe in TwD than in the other groups. Regression analyses demonstrated that tremor severity, sex, age, and to a lesser degree the variable "group", independently predicted health status and quality of life, suggesting the existence of other determinants beyond tremor. CONCLUSIONS Pure ET and TwD manifest with a phenotypic overlap, which calls for the identification of diagnostic biomarkers. ET + DS shared features with both syndromes, suggesting intra-group heterogeneity.
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Affiliation(s)
- Roberto Erro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Neuroscience SectionUniversity of SalernoBaronissiItaly
| | - Giulia Lazzeri
- Neurology Unit, Department of Neuroscience, Dino Ferrari CenterFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Carmen Terranova
- Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - Giulia Paparella
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
- Neuromed Institute IRCCSPozzilliItaly
| | | | - Rosa De Micco
- Department of Advanced Medical and Surgical SciencesUniversità della Campania “Luigi Vanvitelli”NapoliItaly
| | - Luca Magistrelli
- Department of Translational Medicine, Section of NeurologyUniversity of Piemonte OrientaleNovaraItaly
- “Maggiore della Carità” University HospitalNovaraItaly
| | | | - Francesca Valentino
- Parkinson's Disease and Movement Disorders UnitIRCCS Mondino FoundationPaviaItaly
| | | | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | | | | | - Maria Chiara Malaguti
- Clinical Unit of Neurology, Department of EmergencySanta Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS)TrentoItaly
| | - Roberto Ceravolo
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Carlo Dallocchio
- Neurology Unit, Department of Medical Specialist Area, ASST PaviaVogheraItaly
| | | | - Alessandra Nicoletti
- Department “G.F. Ingrassia”, Section of NeurosciencesUniversity of CataniaCataniaItaly
| | - Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological SciencesFederico II UniversityNaplesItaly
| | | | - Cristiano Sorrentino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Neuroscience SectionUniversity of SalernoBaronissiItaly
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | | | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders UnitIRCCS Mondino FoundationPaviaItaly
| | | | - Elena Contaldi
- Department of Translational Medicine, Section of NeurologyUniversity of Piemonte OrientaleNovaraItaly
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical SciencesUniversità della Campania “Luigi Vanvitelli”NapoliItaly
| | - Salvatore Misceo
- Neurosensory Department, Neurology UnitSan Paolo Hospital, ASL BariBariItaly
| | - Matteo Bologna
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
- Neuromed Institute IRCCSPozzilliItaly
| | - Vincenzo Rizzo
- Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - Giulia Franco
- Neurology Unit, Department of Neuroscience, Dino Ferrari CenterFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Neuroscience SectionUniversity of SalernoBaronissiItaly
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11
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Franthal S, Khalil M, Kern D, Gattermeyer L, Buchmann A, Katschnig‐Winter P, Kögl M, Demjaha R, Tafrali C, Hofer E, Schmidt R, Schwingenschuh P. Elevated serum neurofilament light chain protein in patients with essential tremor. Eur J Neurol 2024; 31:e16143. [PMID: 37975778 PMCID: PMC11235714 DOI: 10.1111/ene.16143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND PURPOSE Quantification of neurofilament light chain protein in serum (sNfL) enables the neuro-axonal damage in peripheral blood to be reliably assessed and monitored. There is a long-standing debate whether essential tremor represents a 'benign' tremor syndrome or whether it is linked to neurodegeneration. This study aims to investigate sNfL concentrations in essential tremor compared to healthy controls (cross-sectionally and longitudinally) and to assess whether sNfL is associated with motor and nonmotor markers of disease progression. METHODS Data of patients with essential tremor from our prospective registry on movement disorders (PROMOVE) were retrospectively analysed. Age-, sex- and body-mass-index-matched healthy controls were recruited from an ongoing community-dwelling aging cohort. sNfL was quantified by an ultra-sensitive single molecule array (Simoa). All participants underwent detailed clinical examination at baseline and after approximately 5 years of follow-up. RESULTS Thirty-seven patients with clinically diagnosed essential tremor were included and 37 controls. The essential tremor group showed significantly higher sNfL levels compared to healthy controls at baseline and follow-up. sNfL levels increased over time in both groups, and the slope of sNfL increase was similar in the essential tremor and healthy control groups. Comparing patients with a disease duration under 5 years to those with a longer disease duration, the former group had a significantly greater increase of sNfL over time, which strongly correlated to worsening of tremor and cognition. CONCLUSION Our findings indicate that neurodegeneration, possibly happening at an early disease stage, might play a role in the pathophysiology of essential tremor.
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Affiliation(s)
| | - Michael Khalil
- Department of NeurologyMedical University of GrazGrazAustria
| | - Daniela Kern
- Department of NeurologyMedical University of GrazGrazAustria
| | | | | | | | - Mariella Kögl
- Department of NeurologyMedical University of GrazGrazAustria
| | - Rina Demjaha
- Department of NeurologyMedical University of GrazGrazAustria
| | - Cansu Tafrali
- Department of NeurologyMedical University of GrazGrazAustria
| | - Edith Hofer
- Department of NeurologyMedical University of GrazGrazAustria
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12
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Angelini L, Terranova R, Lazzeri G, van den Berg KRE, Dirkx MF, Paparella G. The role of laboratory investigations in the classification of tremors. Neurol Sci 2023; 44:4183-4192. [PMID: 37814130 PMCID: PMC10641063 DOI: 10.1007/s10072-023-07108-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Tremor is the most common movement disorder. Although clinical examination plays a significant role in evaluating patients with tremor, laboratory tests are useful to classify tremors according to the recent two-axis approach proposed by the International Parkinson and Movement Disorders Society. METHODS In the present review, we will discuss the usefulness and applicability of the various diagnostic methods in classifying and diagnosing tremors. We will evaluate a number of techniques, including laboratory and genetic tests, neurophysiology, and neuroimaging. The role of newly introduced innovative tremor assessment methods will also be discussed. RESULTS Neurophysiology plays a crucial role in tremor definition and classification, and it can be useful for the identification of specific tremor syndromes. Laboratory and genetic tests and neuroimaging may be of paramount importance in identifying specific etiologies. Highly promising innovative technologies are being developed for both clinical and research purposes. CONCLUSIONS Overall, laboratory investigations may support clinicians in the diagnostic process of tremor. Also, combining data from different techniques can help improve understanding of the pathophysiological bases underlying tremors and guide therapeutic management.
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Affiliation(s)
- Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy.
| | - Roberta Terranova
- Department of Medical, Surgical Sciences and Advanced Technologies "GF Ingrassia," University of Catania, Catania, Italy
| | - Giulia Lazzeri
- IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Kevin R E van den Berg
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Michiel F Dirkx
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
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13
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Colella D, Passaretti M, Frantellizzi V, Silvia De Feo M, Cannavacciuolo A, Angelini L, Birreci D, Costa D, Paparella G, Guerra A, De Vincentis G, Berardelli A, Bologna M. Subtle changes in central dopaminergic tone underlie bradykinesia in essential tremor. Neuroimage Clin 2023; 40:103526. [PMID: 37847966 PMCID: PMC10587600 DOI: 10.1016/j.nicl.2023.103526] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION In this research, our primary objective was to explore the correlation between basal ganglia dopaminergic neurotransmission, assessed using 123I-FP-CIT (DAT-SPECT), and finger movements abnormalities in patients with essential tremor (ET) and Parkinson's disease (PD). METHODS We enrolled 16 patients with ET, 17 with PD, and 18 healthy controls (HC). Each participant underwent comprehensive clinical evaluations, kinematic assessments of finger tapping. ET and PD patients underwent DAT-SPECT imaging. The DAT-SPECT scans were subjected to both visual and semi-quantitative analysis using DaTQUANT®. We then investigated the correlations between the clinical, kinematic, and DAT-SPECT data, in patients. RESULTS Our findings confirm that individuals with ET exhibited slower finger tapping than HC. Visual evaluation of radiotracer uptake in both striata demonstrated normal levels within the ET patient cohort, while PD patients displayed reduced uptake. However, there was notable heterogeneity in the quantification of uptake within the striata among ET patients. Additionally, we found a correlation between the amount of radiotracer uptake in the striatum and movement velocity during finger tapping in patients. Specifically, lower radioligand uptake corresponded to decreased movement velocity (ET: coef. = 0.53, p-adj = 0.03; PD: coef. = 0.59, p-adj = 0.01). CONCLUSION The study's findings suggest a potential link between subtle changes in central dopaminergic tone and altered voluntary movement execution, in ET. These results provide further insights into the pathophysiology of ET. However, longitudinal studies are essential to determine whether the slight reduction in dopaminergic tone observed in ET patients represents a distinct subtype of the disease or could serve as a predictor for the clinical progression into PD.
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Affiliation(s)
- Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Massimiliano Passaretti
- Department of Human Neurosciences, Sapienza University of Rome, Italy; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Viviana Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Italy
| | - Maria Silvia De Feo
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Italy
| | | | - Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Davide Costa
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed Pozzilli (IS), Italy
| | - Andrea Guerra
- Parkinson and Movement Disorder Unit, Study Center on Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed Pozzilli (IS), Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed Pozzilli (IS), Italy.
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14
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Erro R, Lazzeri G, Gigante AF, Pilotto A, Magistrelli L, Bologna M, Terranova C, Olivola E, Dallocchio C, Moschella V, Valentino F, Di Biasio F, Nicoletti A, De Micco R, Brusa L, Sorrentino C, Matinella A, Bertino S, Paparella G, Modugno N, Contaldi E, Padovani A, Di Fonzo A, Restaino M, Barone P. Clinical correlates of "pure" essential tremor: the TITAN study. Front Neurol 2023; 14:1233524. [PMID: 37681007 PMCID: PMC10481166 DOI: 10.3389/fneur.2023.1233524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/24/2023] [Indexed: 09/09/2023] Open
Abstract
Background To date, there are no large studies delineating the clinical correlates of "pure" essential tremor (ET) according to its new definition. Methods From the ITAlian tremor Network (TITAN) database, we extracted data from patients with a diagnosis of "pure" ET and excluded those with other tremor classifications, including ET-plus, focal, and task-specific tremor, which were formerly considered parts of the ET spectrum. Results Out of 653 subjects recruited in the TITAN study by January 2022, the data of 208 (31.8%) "pure" ET patients (86M/122F) were analyzed. The distribution of age at onset was found to be bimodal. The proportion of familial cases by the age-at-onset class of 20 years showed significant differences, with sporadic cases representing the large majority of the class with an age at onset above 60 years. Patients with a positive family history of tremor had a younger onset and were more likely to have leg involvement than sporadic patients despite a similar disease duration. Early-onset and late-onset cases were different in terms of tremor distribution at onset and tremor severity, likely as a function of longer disease duration, yet without differences in terms of quality of life, which suggests a relatively benign progression. Treatment patterns and outcomes revealed that up to 40% of the sample was unsatisfied with the current pharmacological options. Discussion The findings reported in the study provide new insights, especially with regard to a possible inversed sex distribution, and to the genetic backgrounds of "pure" ET, given that familial cases were evenly distributed across age-at-onset classes of 20 years. Deep clinical profiling of "pure" ET, for instance, according to age at onset, might increase the clinical value of this syndrome in identifying pathogenetic hypotheses and therapeutic strategies.
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Affiliation(s)
- Roberto Erro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Neuroscience Section, University of Salerno, Baronissi, SA, Italy
| | - Giulia Lazzeri
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Angelo Fabio Gigante
- Department of Medical Sciences and Public Health, Section of Neurology, San Paolo Hospital, Bari, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luca Magistrelli
- Department of Translational Medicine, Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale, Novara, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Neuromed Institute IRCCS, Pozzilli, IS, Italy
| | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Carlo Dallocchio
- Neurology Unit, Department of Medical Area, ASST Pavia, Voghera, PV, Italy
| | | | - Francesca Valentino
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Alessandra Nicoletti
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Catania, Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences, Università della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Livia Brusa
- Neurology Department, S.Eugenio Hospital, Rome, Italy
| | - Cristiano Sorrentino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Neuroscience Section, University of Salerno, Baronissi, SA, Italy
| | - Angela Matinella
- Neurology Unit, Department of Medical Area, ASST Pavia, Voghera, PV, Italy
| | - Salvatore Bertino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Elena Contaldi
- Department of Translational Medicine, Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale, Novara, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessio Di Fonzo
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Marialuisa Restaino
- Department of Economics and Statistics, University of Salerno, Fisciano, SA, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Neuroscience Section, University of Salerno, Baronissi, SA, Italy
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15
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Destrebecq V, Naeije G. Cognitive impairment in essential tremor assessed by the cerebellar cognitive affective syndrome scale. Front Neurol 2023; 14:1224478. [PMID: 37662041 PMCID: PMC10473101 DOI: 10.3389/fneur.2023.1224478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/17/2023] [Indexed: 09/05/2023] Open
Abstract
Background Essential tremor (ET) is a movement disorder characterized by cerebellar neurodegenerative changes. ET is also associated with non-motor symptoms including cognitive impairment. The neuropsychologic profile of a patient with ET could relate to cerebellar cognitive affective syndrome (CCAS). Objective This study aimed to assess the prevalence of cognitive impairment in patients with ET and identify whether the cognitive impairment in ET corresponds to a CCAS. Methods Cognitive functions were evaluated with the CCAS-Scale (CCAS-S) in 20 patients with ET and 20 controls matched for age, sex, and level of education. The results of the CCAS-S were compared between patients and controls. The underlying determinant of CCAS inpatients with ET was identified through the correlation between the results of the CCAS-S and age at onset of symptoms, disease duration, and the Essential Tremor Rating Assessment Scale (TETRAS). Results On a group level, ET patients performed significantly worse than matched controls. In total, 13 individuals with ET had a definite CCAS (CCAS-S failed items ≥ 3). ASO and TETRAS scores significantly correlated with CCAS-S performances in ET patients. Conclusion CCAS is highly prevalent in patients with ET which supports the cerebellar pathophysiology of associated cognitive impairment and supports a more systematic use of the CCAS-S to cognitively assessed patients with ET.
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Affiliation(s)
- Virginie Destrebecq
- Clinique Universitaire de Bruxelles (CUB) Hôpital Erasme, Department of Neurology, Université Libre de Bruxelles, Brussels, Belgium
- Laboratoire de Neuroanatomie et Neuroimagerie translationnelles, UNI-ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Gilles Naeije
- Clinique Universitaire de Bruxelles (CUB) Hôpital Erasme, Department of Neurology, Université Libre de Bruxelles, Brussels, Belgium
- Laboratoire de Neuroanatomie et Neuroimagerie translationnelles, UNI-ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
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16
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Angelini L, Paparella G, De Biase A, Maraone A, Panfili M, Berardelli I, Cannavacciuolo A, Di Vita A, Margiotta R, Fabbrini G, Berardelli A, Bologna M. Longitudinal study of clinical and neurophysiological features in essential tremor. Eur J Neurol 2023; 30:631-640. [PMID: 36437695 PMCID: PMC10107502 DOI: 10.1111/ene.15650] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Essential tremor (ET) is a common and heterogeneous disorder characterized by postural/kinetic tremor of the upper limbs and other body segments and by non-motor symptoms, including cognitive and psychiatric abnormalities. Only a limited number of longitudinal studies have comprehensively and simultaneously investigated motor and non-motor symptom progression in ET. Possible soft signs that configure the ET-plus diagnosis are also under-investigated in follow-up studies. We aimed to longitudinally investigate the progression of ET manifestations by means of clinical and neurophysiological evaluation. METHODS Thirty-seven ET patients underwent evaluation at baseline (T0) and at follow-up (T1; mean interval ± SD = 39.89 ± 9.83 months). The assessment included the clinical and kinematic evaluation of tremor and voluntary movement execution, as well as the investigation of cognitive and psychiatric disorders. RESULTS A higher percentage of patients showed tremor in multiple body segments and rest tremor at T1 as compared to T0 (all p-values < 0.01). At T1, the kinematic analysis revealed reduced finger-tapping movement amplitude and velocity as compared to T0 (both p-values < 0.001). The prevalence of cognitive and psychiatric disorders did not change between T0 and T1. Female sex, absence of family history, and rest tremor at baseline were identified as predictive factors of worse disease progression. CONCLUSIONS ET progression is characterized by the spread of tremor in multiple body segments and by the emergence of soft signs. We also identified possible predictors of disease worsening. The results contribute to a better understanding of ET classification and pathophysiology.
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Affiliation(s)
- Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Annalisa Maraone
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Panfili
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health, and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Antonella Di Vita
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Roberta Margiotta
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
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17
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Rekik A, Nasri A, Mrabet S, Gharbi A, Souissi A, Gargouri A, Kacem I, Gouider R. Non-motor features of essential tremor with midline distribution. Neurol Sci 2022; 43:5917-5925. [DOI: 10.1007/s10072-022-06262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
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18
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De Biase A, Paparella G, Angelini L, Cannavacciuolo A, Colella D, Cerulli Irelli E, Giallonardo AT, Di Bonaventura C, Berardelli A, Bologna M. TREMOR AND MOVEMENT SLOWNESS ARE TWO UNRELATED SIDE EFFECTS INDUCED BY VALPROATE INTAKE. Mov Disord Clin Pract 2022; 9:1062-1073. [DOI: 10.1002/mdc3.13560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/29/2022] [Accepted: 08/13/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | - Luca Angelini
- Department of Human Neurosciences Sapienza University of Rome Italy
| | | | - Donato Colella
- Department of Human Neurosciences Sapienza University of Rome Italy
| | | | | | | | - Alfredo Berardelli
- Department of Human Neurosciences Sapienza University of Rome Italy
- IRCCS Neuromed Pozzilli (IS) Italy
| | - Matteo Bologna
- Department of Human Neurosciences Sapienza University of Rome Italy
- IRCCS Neuromed Pozzilli (IS) Italy
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19
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Gerbasi ME, Nambiar S, Reed S, Hennegan K, Hadker N, Eldar-Lissai A, Cosentino S. Essential tremor patients experience significant burden beyond tremor: A systematic literature review. Front Neurol 2022; 13:891446. [PMID: 35937052 PMCID: PMC9354397 DOI: 10.3389/fneur.2022.891446] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Essential tremor (ET) is among the most common movement disorders in adults. While ET is diagnosed and primarily characterized by the presence of tremor, it also can impact cognition, sleep, mood, and motor functioning more broadly. The manifestations of ET can have various consequences, including difficulty with activities of daily living (ADL), embarrassment, and overall decline in health-related quality of life, which have not been fully explored in prior studies. Objective We performed a systematic literature review to comprehensively characterize the burden experienced by patients with ET from the clinical and humanistic perspectives, focusing on outcomes beyond tremor. Methods This systematic literature review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches in PubMed, Embase, and Cochrane Library identified original, observational studies of the clinical and humanistic burden in adult patients with ET published in English between 2010 and 2020. Studies assessing epidemiology, treatment patterns, or disease management were excluded. Search results were screened according to pre-determined eligibility criteria. Data from included studies were collected, independently verified, and qualitatively synthesized. Results Following the screening of 2,303 records and 145 full-text articles, 39 studies were identified. There was significant heterogeneity in study designs, statistical approaches, and patient cohorts across the included studies. Patients with ET in these studies exhibited more severe disabilities and reduced independence compared to healthy individuals, and they often struggled to perform ADL and relied on caregivers for physical and emotional support. Patients also experienced various issues with movement and balance, increased risk of falls, depression, anxiety, poor sleep quality, and psychosocial consequences including embarrassment, apathy, and enfeeblement. Conclusion A systematic literature review of non-tremor manifestations and/or consequences of ET identified far-reaching negative impacts on patients' ability to function independently and revealed accompanying psychosocial effects, including social fear and embarrassment. The reduced function and psychosocial deficits observed in patients with ET result in significant clinical and humanistic burdens, decreasing quality of life. Future studies should evaluate this condition beyond the tremor itself to provide an improved understanding of the multi-dimensional burden of the disease, thereby highlighting the need to diagnose and appropriately manage patients with ET.
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Affiliation(s)
| | | | - Spencer Reed
- Trinity Life Sciences, Waltham, MA, United States
| | | | | | | | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Department of Neurology, Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States
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Riboldi GM, Frucht SJ. Is essential tremor a family of diseases or a syndrome? A family of diseases. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:7-29. [PMID: 35750371 DOI: 10.1016/bs.irn.2022.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Giulietta M Riboldi
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University Langone Health, New York, NY, United States
| | - Steven J Frucht
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University Langone Health, New York, NY, United States.
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21
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Reclassification of patients with tremor syndrome and comparisons of essential tremor and essential tremor-plus patients. J Neurol 2022; 269:3653-3662. [DOI: 10.1007/s00415-022-10985-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 12/20/2022]
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22
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Lenka A, Pandey S. Essential Tremor: Five New Things. Neurol Clin Pract 2021; 12:183-186. [PMID: 35747894 PMCID: PMC9208407 DOI: 10.1212/cpj.0000000000001145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/19/2021] [Indexed: 11/15/2022]
Abstract
ABSTRACTPurpose of the review:To highlight five new things in the research and clinical aspects of essential tremor (ET).Recent findings:The introduction of a new definition of ET and a new category “ET plus” were the major themes of the recent consensus statement. This new change demands a change in the approach to the clinical diagnosis of ET and related diseases. From the pathogenesis standpoint, the cerebellar neurodegenerative model seems to have numerous evidence in its favor compared to the olivary model which has largely fallen out of favor. From the standpoint of therapeutics, magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy has enriched the therapeutic armamentarium.Summary:There has been considerable progress in the field of ET. We discuss five new things in this article which include- (i) new definition (ii) ET plus (iii) approach to the diagnosis of ET, (iv) cerebellar degeneration, and (v) MRgFUS thalamotomy.
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Affiliation(s)
- Abhishek Lenka
- MedStar Georgetown University Hospital (AL), Washington, DC; and G.B. Pant Institute of Postgraduate Medical Education and Research (SP), New Delhi, India
| | - Sanjay Pandey
- MedStar Georgetown University Hospital (AL), Washington, DC; and G.B. Pant Institute of Postgraduate Medical Education and Research (SP), New Delhi, India
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23
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van den Berg KRE, Helmich RC. The Role of the Cerebellum in Tremor - Evidence from Neuroimaging. Tremor Other Hyperkinet Mov (N Y) 2021; 11:49. [PMID: 34820148 PMCID: PMC8603856 DOI: 10.5334/tohm.660] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/28/2021] [Indexed: 01/04/2023] Open
Abstract
Background Neuroimaging research has played a key role in identifying which cerebral changes are associated with tremor. Here we will focus on the cerebellum, which may drive tremor oscillations, process tremor-related afferents, modulate activity in remote brain regions, or a combination. Methods On the 6th of October 2021, we conducted a PubMed search to select articles providing neuroimaging evidence for cerebellar involvement in essential tremor (ET), Parkinson's disease (PD) tremor, and dystonic tremor (DT). Results In ET, tremor-related activity is found in motor areas of the bilateral cerebellum, and altered functional connectivity within and outside the cerebellum correlates with tremor severity. Furthermore, ET is associated with cerebellar atrophy, but also with compensatory structural changes outside the cerebellum (e.g. supplementary motor area). In PD, tremor-related cerebellar activity and increased cerebello-thalamic coupling has been found. Emerging evidence suggests that the cerebellum plays a key role in dopamine-resistant rest tremor and in postural tremor. Cerebellar structural alterations have been identified in PD, but only some relate to tremor. DT is associated with more widespread cerebral networks than other tremor types. Discussion In ET, the cerebellum likely acts as an oscillator, potentially due to loss of inhibitory mechanisms. In contrast, in PD the cerebellum may be a modulator, which contributes to tremor oscillations by influencing the thalamo-cortical system. The precise role of the cerebellum in DT remains unclear. We recommend that future research measures tremor-related activity directly by combining electrophysiology with neuroimaging, while brain stimulation techniques may be used to establish causality. Highlights This review of neuroimaging studies has provided convincing evidence that the cerebellum plays a key role in the pathophysiology of ET, PD tremor, and dystonic tremor syndromes. This contribution may consist of driving tremor oscillations, processing tremor-related afferents, modulating activity in remote brain regions, or all the above.
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Affiliation(s)
- Kevin R. E. van den Berg
- Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rick C. Helmich
- Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
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Abstract
Essential tremor (ET) is one of the most common movement disorders, with a reported >60 million affected individuals worldwide. The definition and underlying pathophysiology of ET are contentious. Patients present primarily with motor features such as postural and action tremors, but may also have other non-motor features, including cognitive impairment and neuropsychiatric symptoms. Genetics account for most of the ET risk but environmental factors may also be involved. However, the variable penetrance and challenges in validating data make gene-environment analysis difficult. Structural changes in cerebellar Purkinje cells and neighbouring neuronal populations have been observed in post-mortem studies, and other studies have found GABAergic dysfunction and dysregulation of the cerebellar-thalamic-cortical circuitry. Commonly prescribed medications include propranolol and primidone. Deep brain stimulation and ultrasound thalamotomy are surgical options in patients with medically intractable ET. Further research in post-mortem studies, and animal and cell-based models may help identify new pathophysiological clues and therapeutic targets and, together with advances in omics and machine learning, may facilitate the development of precision medicine for patients with ET.
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25
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Pietracupa S, Bologna M, Tommasin S, Berardelli A, Pantano P. The Contribution of Neuroimaging to the Understanding of Essential Tremor Pathophysiology: a Systematic Review. THE CEREBELLUM 2021; 21:1029-1051. [PMID: 34657271 DOI: 10.1007/s12311-021-01335-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 12/14/2022]
Abstract
Essential tremor (ET) is one of the most common movement disorders. Over the last 10 years, magnetic resonance imaging (MRI) has shed light on the structural and functional abnormalities possibly involved in ET pathophysiology. In this systematic review, we aimed to identify the cortical and subcortical structures involved and the role that different brain areas play in the pathophysiology of motor and non-motor ET features. We found that structural (grey and white matter) cerebellar damage and connectivity alterations between the cerebellum and various cortical areas play a role in both motor and non-motor symptoms of ET. In particular, many studies found an association between MRI findings and non-motor symptoms.
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Affiliation(s)
| | - Matteo Bologna
- IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, Italy.,Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Silvia Tommasin
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, Italy.,Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pantano
- IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, Italy.,Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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26
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Mild cognitive impairment, dementia and risk of mortality in essential tremor: A longitudinal prospective study of elders. J Neurol Sci 2021; 428:117563. [PMID: 34274879 DOI: 10.1016/j.jns.2021.117563] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/09/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is evidence that the risk of mortality is increased in patients with essential tremor (ET), however, there are few longitudinal, prospective data on the predictors of mortality in ET. There is also evidence that ET is associated with cognitive impairment; yet, it is unknown whether this is associated with elevated risk of mortality. METHODS In a longitudinal, prospective study of 194 elders with ET, an extensive neuropsychological test battery was performed at three time points: baseline, 18 months, and 36 months, and cognitive diagnoses (normal, mild cognitive impairment [MCI], and dementia) were assigned during consensus conferences. We used Cox proportional hazards models to estimate hazard ratios (HR) for death. RESULTS The mean baseline age was 79.1 ± 9.7 years. During follow-up, 52 (26.8%) died. In initial univariate models, a variety of baseline factors were associated with increased risk of mortality, including demographic variables (i.e., older age), cognitive variables and gait and balance variables. In the final multivariate Cox model, baseline dementia (HR = 2.66, p = 0.006), older baseline age (HR = 1.18, p < 0.001), and more reported falls at baseline (HR = 1.10, p < 0.001) were independently associated with increased risk of mortality. Amnestic MCI was marginally associated with increased risk of mortality (HR = 1.93, p = 0.08) in primary analyses and significantly (p < 0.05) in several sensitivity analyses. CONCLUSIONS In this longitudinal, prospective study, baseline dementia resulted in a 2- to 3-times increase in risk of mortality in ET, further highlighting the clinical significance of cognitive impairment, specifically dementia, in this population.
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27
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Paparella G, Angelini L, De Biase A, Cannavacciuolo A, Colella D, Di Bonaventura C, Giallonardo AT, Berardelli A, Bologna M. Clinical and Kinematic Features of Valproate-Induced Tremor and Differences with Essential Tremor. CEREBELLUM (LONDON, ENGLAND) 2021; 20:374-383. [PMID: 33200286 PMCID: PMC8213593 DOI: 10.1007/s12311-020-01216-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
Tremor is a common movement disorder that can be induced by medications, including valproate, which is used for the treatment of epilepsy. However, the clinical and neurophysiological features of valproate-induced tremor are still under-investigated. We performed a clinical and kinematic assessment of valproate-induced tremor by considering tremor body distribution and activation conditions. We investigated possible correlations between demographic and clinical data and kinematic features. Valproate-induced tremor results were also compared with those collected in a large sample of patients with essential tremor. Sixteen valproate-induced tremor patients and 93 essential tremor patients were enrolled. All participants underwent a standardised neurological examination and video recording. Patients also underwent an objective assessment of postural, kinetic and rest tremor of the upper limbs and head tremor through kinematic analysis. Nonparametric tests were used for statistical comparisons between the two groups. Clinical evaluation showed a higher occurrence of rest tremor as well as head or voice, and lower limb involvement in patients with valproate-induced tremor. Kinematic analysis showed a substantial variability in the tremor features of patients with valproate-induced tremor. Compared to essential tremor, we found a higher occurrence of rest tremor of the upper limbs and the involvement of more body segments in valproate-induced tremor patients. Valproate-induced tremor has distinctive clinical and kinematic features, which may suggest that valproate interferes with the cerebellar functions.
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Affiliation(s)
| | - Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Alessandro De Biase
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Antonio Cannavacciuolo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Anna Teresa Giallonardo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli (IS), Italy.
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
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28
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Louis ED. The Essential Tremors: Evolving Concepts of a Family of Diseases. Front Neurol 2021; 12:650601. [PMID: 33841316 PMCID: PMC8032967 DOI: 10.3389/fneur.2021.650601] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/12/2021] [Indexed: 12/31/2022] Open
Abstract
The past 10 years has seen a remarkable advance in our understanding of the disease traditionally referred to as “essential tremor” (ET). First, the clinical phenotype of ET has been expanded from that of a bland, unidimensional, and monosymptomatic entity to one with a host of heterogeneous features. These features include a broader and more nuanced collection of tremors, non-tremor motor features (e.g., gait abnormalities) and a range of non-motor features, including cognitive, psychiatric, sleep, and other abnormalities. The natural history of these features, as well as their relationships with one another and with disease duration and severity, are better appreciated than they were previously. Studies of disease etiology have identified a number of candidate genes as well as explored several environmental determinants of disease. In addition, the decade has seen the beginnings and expansion of rigorous postmortem studies that have identified and described the postmortem changes in the brains of patients with ET. This emerging science has given rise to a new notion that the disease, in many cases, is one of cerebellar system degeneration. Across all of these studies (clinical, etiological, and pathophysiological) is the observation that there is heterogeneity across patients and that “essential tremor” is likely not a single disease but, rather, a family of diseases. The time has come to use the more appropriate terminology, “the essential tremors,” to fully describe and encapsulate what is now apparent. In this paper, the author will review the clinical, etiological, and pathophysiological findings, referred to above, and make the argument that the terminology should evolve to reflect advances in science and that “the essential tremors” is a more scientifically appropriate term.
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Affiliation(s)
- Elan D Louis
- Department of Neurology, University of Texas Southwestern, Dallas, TX, United States
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29
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Sedov A, Usova S, Semenova U, Gamaleya A, Tomskiy A, Beylergil SB, Jinnah HA, Shaikh AG. Pallidal Activity in Cervical Dystonia with and Without Head Tremor. THE CEREBELLUM 2021; 19:409-418. [PMID: 32095996 DOI: 10.1007/s12311-020-01119-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The relationship between two common movement disorders, dystonia and tremor, is controversial. Both deficits have correlates in the network that includes connections between the cerebellum and the basal ganglia. In order to assess the physiological relationship between tremor and dystonia, we measured the activity of 727 pallidal single-neurons during deep brain stimulation surgery in patients with cervical dystonia without head oscillations, cervical dystonia plus jerky oscillations, and cervical dystonia with sinusoidal oscillations. Cluster analyses of spike-train recordings allowed classification of the pallidal activity into burst, pause, and tonic. Burst neurons were more common, and number of spikes within spike and inter-burst intervals was shorter in pure dystonia and jerky oscillation groups compared to the sinusoidal oscillation group. Pause neurons were more common and irregular in pure tremor group compared to pure dystonia and jerky oscillation groups. There was bihemispheric asymmetry in spontaneous firing discharge in pure dystonia and jerky oscillation groups, but not in sinusoidal oscillation group. These results demonstrate that the physiology of pallidal neurons in patients with pure cervical dystonia is similar to those who have cervical dystonia combined with jerky oscillations, but different from those who have cervical dystonia combined with sinusoidal oscillations. These results imply distinct mechanistic underpinnings for different types of head oscillations in cervical dystonia.
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Affiliation(s)
- Alexey Sedov
- Semenov Institute of chemical physics, Russian Academy of Sciences, Moscow, Russia.,Moscow Institute of physics and technology, Moscow, Dolgoprudny, Russia
| | - Svetlana Usova
- Semenov Institute of chemical physics, Russian Academy of Sciences, Moscow, Russia
| | - Ulia Semenova
- Semenov Institute of chemical physics, Russian Academy of Sciences, Moscow, Russia
| | - Anna Gamaleya
- N .N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Alexey Tomskiy
- N .N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Sinem B Beylergil
- Departments of Neurology and Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - H A Jinnah
- Department of Neurology, Pediatrics, and Genetics, Emory University, Atlanta, GA, USA
| | - Aasef G Shaikh
- Departments of Neurology and Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA. .,Neurological Institute, University Hospitals, Cleveland, OH, USA. .,Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA. .,Department of Neurology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
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30
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Huang H, Zhao Q, Ning P, Shen Q, Wang H, Xie D, Lu H, Tian S, Yang X, Xu Y. Non-motor symptoms are associated with midline tremor in essential tremor. Acta Neurol Scand 2020; 142:501-510. [PMID: 32476139 DOI: 10.1111/ane.13290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/19/2020] [Accepted: 05/24/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Essential tremor (ET) patients presenting tremor in the midline structures may be a distinct subtype of the syndrome. Therefore, we sought to explore the clinical manifestations, especially non-motor symptoms (NMS) of Chinese ET patients with midline tremor (MT). METHODS In the cross-sectional study, we grouped 290 definite or probable ET patients based on their MT conditions. The NMS in ET patients were evaluated using the NMS scale (NMSS). NMS and other clinical correlates were then compared among subgroups with, and without MT. RESULTS We revealed that 39.0%, 27.6%, and 6.9% of the patients respectively had neck, voice, and facial tremors. With the accumulation of tremor in midline structures, NMS became more severe and prevalent. Logistic regression analyses revealed that factors such as: female gender (OR = 2.164, 95% CI: 1.307-3.583), having least or highest action arm tremor (OR = 2.512, 95% CI: 1.520-4.151), having higher score of sleep/fatigue domain (OR = 1.692, 95% CI: 1.004-2.850) and mood/apathy (OR = 1.926, 95% CI: 1.143-3.246) domain, to be independently associated with MT manifestation. CONCLUSIONS Our study demonstrates the heterogeneity of symptoms in ET patients with MT, especially in prominent NMS. In addition, the discrepancy of NMS between patients with, and without MT provides novel insight into the underlying pathophysiology and therapeutic of ET.
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Affiliation(s)
- Hong‐yan Huang
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Quan‐zhen Zhao
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Ping‐ping Ning
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Qiu‐yan Shen
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Hui Wang
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Dan Xie
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Hai‐tao Lu
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Si‐jia Tian
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Xing‐long Yang
- Department of Geriatric Neurology First Affiliated Hospital of Kunming Medical University Kunming China
| | - Yan‐ming Xu
- Department of Neurology West China Hospital Sichuan University Chengdu China
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31
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Schirinzi T, Canevelli M, Suppa A, Bologna M, Marsili L. The continuum between neurodegeneration, brain plasticity, and movement: a critical appraisal. Rev Neurosci 2020; 31:723-742. [DOI: 10.1515/revneuro-2020-0011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/08/2020] [Indexed: 01/09/2023]
Abstract
Abstract
While the “physiological” aging process is associated with declines in motor and cognitive features, these changes do not significantly impair functions and activities of daily living. Differently, motor and cognitive impairment constitute the most common phenotypic expressions of neurodegeneration. Both manifestations frequently coexist in the same disease, thus making difficult to detect “pure” motor or cognitive conditions. Movement disorders are often characterized by cognitive disturbances, and neurodegenerative dementias often exhibit the occurrence of movement disorders. Such a phenotypic overlap suggests approaching these conditions by highlighting the commonalities of entities traditionally considered distinct. In the present review, we critically reappraised the common clinical and pathophysiological aspects of neurodegeneration in both animal models and patients, looking at motricity as a trait d’union over the spectrum of neurodegeneration and focusing on synaptopathy and oscillopathy as the common pathogenic background. Finally, we discussed the possible role of movement as neuroprotective intervention in neurodegenerative conditions, regardless of the etiology. The identification of commonalities is critical to drive future research and develop novel possible disease-modifying interventions.
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Affiliation(s)
- Tommaso Schirinzi
- Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Marco Canevelli
- Department of Human Neurosciences , Sapienza University of Rome , Rome , Italy
- National Center for Disease Prevention and Health Promotion, National Institute of Health , Rome , Italy
| | - Antonio Suppa
- Department of Human Neurosciences , Sapienza University of Rome , Rome , Italy
- IRCCS Neuromed , Pozzilli , IS , Italy
| | - Matteo Bologna
- Department of Human Neurosciences , Sapienza University of Rome , Rome , Italy
- IRCCS Neuromed , Pozzilli , IS , Italy
| | - Luca Marsili
- Department of Neurology, Gardner Family Center for Parkinson’s Disease and Movement Disorders , University of Cincinnati , 260 Stetson Street , Cincinnati , 45219, OH , USA
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32
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Peng J, Wang L, Li N, Li J, Duan L, Peng R. Distinct non-motor features of essential tremor with head tremor patients. Acta Neurol Scand 2020; 142:74-82. [PMID: 32176316 DOI: 10.1111/ane.13242] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/20/2020] [Accepted: 03/10/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND There have been few comprehensive scale studies on the non-motor symptoms (NMS) of patients with essential tremor (ET) with head tremor (ETh) and those with ET without head tremor (ETol). We aimed to explore the motor symptoms and NMS of these two subgroups. METHODS We enrolled 199 patients with ET (125, ETol; 74 ETh) and 132 healthy controls. We evaluated motor symptoms using the Fahn-Tolosa-Marin Tremor Rating Scale (TRS) and NMS using the Non-Motor Symptom Scale (NMSS). We compared NMSS scores and the prevalence of each NMS between the patient subgroups. Finally, we conducted a logistic regression analysis of the correlation between head tremor and NMS severity, as well as other determinants. RESULTS There were no significant between-subgroup differences in demographic characteristics. Further, they presented similar tremor clinical manifestation; however, the ETh subgroup showed a higher prevalence of rest tremor, feeling of sadness, forgetting things or events, and swallowing difficulty, as well as TRS scores, compared with the ETol subgroup. Both patient subgroups showed high scores and prevalence (>50%) in difficulty falling asleep. Logistic regression analysis indicated age as a tremor severity determinant; further, head tremor and tremor severity were NMS determinants. CONCLUSION Both patient subgroups presented various NMS including sleep disturbances, cognitive deficits, and affective disorders. The ETh subgroup showed a high prevalence of certain NMS aspects including memory and affective disorder; further, they had aggravated NMS. ET with both upper limb tremor and head tremor may be regarded as a more severe clinical subtype.
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Affiliation(s)
- Jiaxin Peng
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Ling Wang
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Nannan Li
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Junying Li
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Liren Duan
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Rong Peng
- Department of Neurology West China Hospital Sichuan University Chengdu China
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33
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Bologna M, Paparella G, Colella D, Cannavacciuolo A, Angelini L, Alunni‐Fegatelli D, Guerra A, Berardelli A. Is there evidence of bradykinesia in essential tremor? Eur J Neurol 2020; 27:1501-1509. [DOI: 10.1111/ene.14312] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022]
Affiliation(s)
- M. Bologna
- Department of Human Neurosciences Sapienza University of Rome RomeItaly
- IRCCS Neuromed Pozzilli (IS)Italy
| | | | - D. Colella
- Department of Human Neurosciences Sapienza University of Rome RomeItaly
| | - A. Cannavacciuolo
- Department of Human Neurosciences Sapienza University of Rome RomeItaly
| | - L. Angelini
- Department of Human Neurosciences Sapienza University of Rome RomeItaly
| | - D. Alunni‐Fegatelli
- Department of Public Health and Infectious Disease Sapienza University of Rome Rome Italy
| | | | - A. Berardelli
- Department of Human Neurosciences Sapienza University of Rome RomeItaly
- IRCCS Neuromed Pozzilli (IS)Italy
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34
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Gill JS, Sillitoe RV. Functional Outcomes of Cerebellar Malformations. Front Cell Neurosci 2019; 13:441. [PMID: 31636540 PMCID: PMC6787289 DOI: 10.3389/fncel.2019.00441] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022] Open
Abstract
The cerebellum is well-established as a primary center for controlling sensorimotor functions. However, recent experiments have demonstrated additional roles for the cerebellum in higher-order cognitive functions such as language, emotion, reward, social behavior, and working memory. Based on the diversity of behaviors that it can influence, it is therefore not surprising that cerebellar dysfunction is linked to motor diseases such as ataxia, dystonia, tremor, and Parkinson's disease as well to non-motor disorders including autism spectrum disorders (ASD), schizophrenia, depression, and anxiety. Regardless of the condition, there is a growing consensus that developmental disturbances of the cerebellum may be a central culprit in triggering a number of distinct pathophysiological processes. Here, we consider how cerebellar malformations and neuronal circuit wiring impact brain function and behavior during development. We use the cerebellum as a model to discuss the expanding view that local integrated brain circuits function within the context of distributed global networks to communicate the computations that drive complex behavior. We highlight growing concerns that neurological and neuropsychiatric diseases with severe behavioral outcomes originate from developmental insults to the cerebellum.
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Affiliation(s)
- Jason S. Gill
- Section of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, TX, United States
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, United States
- Jan and Dan Duncan Neurological Research Institute of Texas Children’s Hospital, Houston, TX, United States
| | - Roy V. Sillitoe
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, United States
- Jan and Dan Duncan Neurological Research Institute of Texas Children’s Hospital, Houston, TX, United States
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
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