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Puig I, Gea M, Núñez F, Ispierto L, Grau-López L, Roure S, Lozano M, Lucente G, Vilas D. Dystonic head tremor secondary to neurocysticercosis. Neurologia 2023; 38:226-227. [PMID: 37059575 DOI: 10.1016/j.nrleng.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/20/2022] [Indexed: 04/16/2023] Open
Affiliation(s)
- I Puig
- Neurology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M Gea
- Neurology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - F Núñez
- Radiology Service, Institut Diagnòstic per la Imatge (IDI), Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - L Ispierto
- Neurology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - L Grau-López
- Neurology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - S Roure
- Infectious Diseases Department, Fight Against AIDS Foundation (FLS), Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M Lozano
- Neurology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - G Lucente
- Neurology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - D Vilas
- Neurology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
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Dystonic head tremor secondary to neurocysticercosis. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lang EJ, Handforth A. Is the inferior olive central to essential tremor? Yes. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:133-165. [PMID: 35750361 DOI: 10.1016/bs.irn.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We consider the question whether the inferior olive (IO) is required for essential tremor (ET). Much evidence shows that the olivocerebellar system is the main system capable of generating the widespread synchronous oscillatory Purkinje cell (PC) complex spike (CS) activity across the cerebellar cortex that would be capable of generating the type of bursting cerebellar output from the deep cerebellar nuclei (DCN) that could underlie tremor. Normally, synchronous CS activity primarily reflects the effective electrical coupling of IO neurons by gap junctions, and traditionally, ET research has focused on the hypothesis of increased coupling of IO neurons as the cause of hypersynchronous CS activity underlying tremor. However, recent pathology studies of brains from humans with ET and evidence from mutant mice, particularly the hotfoot17 mouse, that largely replicate the pathology of ET, suggest that the abnormal innervation of multiple Purkinje cells (PCs) by climbing fibers (Cfs) is related to tremor. In addition, ET brains show partial PC loss and axon terminal sprouting by surviving PCs. This may provide another mechanism for tremor. It is proposed that in ET, these three mechanisms may promote tremor. They all involve hypersynchronous DCN activity and an intact IO, but the level at which excessive synchronization occurs may be at the IO level (from abnormal afferent activity to this nucleus), the PC level (via aberrant Cfs), or the DCN level (via terminal PC collateral innervation).
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Lora-Millan JS, Delgado-Oleas G, Benito-León J, Rocon E. A Review on Wearable Technologies for Tremor Suppression. Front Neurol 2021; 12:700600. [PMID: 34434161 PMCID: PMC8380769 DOI: 10.3389/fneur.2021.700600] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/28/2021] [Indexed: 12/29/2022] Open
Abstract
Tremor is defined as a rhythmic, involuntary oscillatory movement of a body part. Although everyone exhibits a certain degree of tremor, some pathologies lead to very disabling tremors. These pathological tremors constitute the most prevalent movement disorder, and they imply severe difficulties in performing activities of daily living. Although tremors are currently managed through pharmacotherapy or surgery, these treatments present significant associated drawbacks: drugs often induce side effects and show decreased effectiveness over years of use, while surgery is a hazardous procedure for a very low percentage of eligible patients. In this context, recent research demonstrated the feasibility of managing upper limb tremors through wearable technologies that suppress tremors by modifying limb biomechanics or applying counteracting forces. Furthermore, recent experiments with transcutaneous afferent stimulation showed significant tremor attenuation. In this regard, this article reviews the devices developed following these tremor management paradigms, such as robotic exoskeletons, soft robotic exoskeletons, and transcutaneous neurostimulators. These works are presented, and their effectiveness is discussed. The article also evaluates the different metrics used for the validation of these devices and the lack of a standard validation procedure that allows the comparison among them.
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Affiliation(s)
- Julio S. Lora-Millan
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
| | - Gabriel Delgado-Oleas
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
- Ingeniería Electrónica, Universidad del Azuay, Cuenca, Ecuador
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
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5
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Spinal astroglial cannabinoid receptors control pathological tremor. Nat Neurosci 2021; 24:658-666. [PMID: 33737752 PMCID: PMC7610740 DOI: 10.1038/s41593-021-00818-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/17/2021] [Indexed: 12/21/2022]
Abstract
Cannabinoids reduce tremor associated with motor disorders induced by injuries and neurodegenerative disease. Here we show that this effect is mediated by cannabinoid receptors on astrocytes in the ventral horn of the spinal cord, where alternating limb movements are initiated. We first demonstrate that tremor is reduced in a mouse model of essential tremor after intrathecal injection of the cannabinoid analog WIN55,212-2. We investigate the underlying mechanism using electrophysiological recordings in spinal cord slices and show that endocannabinoids released from depolarized interneurons activate astrocytic cannabinoid receptors, causing an increase in intracellular Ca2+, subsequent release of purines and inhibition of excitatory neurotransmission. Finally, we show that the anti-tremor action of WIN55,212-2 in the spinal cords of mice is suppressed after knocking out CB1 receptors in astrocytes. Our data suggest that cannabinoids reduce tremor via their action on spinal astrocytes.
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6
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Raina GB, Cersosimo MG, Folgar SS, Giugni JC, Calandra C, Paviolo JP, Tkachuk VA, Zuñiga Ramirez C, Tschopp AL, Calvo DS, Pellene LA, Uribe Roca MC, Velez M, Giannaula RJ, Fernandez Pardal MM, Micheli FE. Holmes tremor: Clinical description, lesion localization, and treatment in a series of 29 cases. Neurology 2016; 86:931-8. [PMID: 26865524 PMCID: PMC4782118 DOI: 10.1212/wnl.0000000000002440] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 11/16/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the clinical features, etiology, findings from neuroimaging, and treatment results in a series of 29 patients with Holmes tremor (HT). METHODS A retrospective study was performed based on review of medical records and videos of patients with HT diagnosis. RESULTS A total of 16 women and 13 men were included. The mean age at the moment of CNS insult was 33.9 ± 20.1 years (range 8-76 years). The most common causes were vascular (48.3%), ischemic, or hemorrhagic. Traumatic brain injury only represented 17.24%; other causes represented 34.5%. The median latency from lesion to tremor onset was 2 months (range 7 days-228 months). The most common symptoms/signs associated with HT were hemiparesis (62%), ataxia (51.7%), hypoesthesia (27.58%), dystonia (24.1%), cranial nerve involvement (24.1%), and dysarthria (24.1%). Other symptoms/signs were vertical gaze disorders (6.8%), bradykinesia/rigidity (6.8%), myoclonus (3.4%), and seizures (3.4%). Most of the patients had lesions involving more than one area. MRI showed lesions in thalamus or midbrain or cerebellum in 82.7% of the patients. Levodopa treatment was effective in 13 out of 24 treated patients (54.16%) and in 3 patients unilateral thalamotomy provided excellent results. CONCLUSIONS The most common causes of HT in our series were vascular lesions. The most common lesion topography was mesencephalic, thalamic, or both. Treatment with levodopa and thalamic stereotactic lesional surgery seems to be effective.
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Affiliation(s)
- Gabriela B Raina
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Maria G Cersosimo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Silvia S Folgar
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Juan C Giugni
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Cristian Calandra
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Juan P Paviolo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Veronica A Tkachuk
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Carlos Zuñiga Ramirez
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Andrea L Tschopp
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Daniela S Calvo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Luis A Pellene
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Marcela C Uribe Roca
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Miriam Velez
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Rolando J Giannaula
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Manuel M Fernandez Pardal
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Federico E Micheli
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
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7
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Raina GB, Cersosimo MG, Folgar SS, Giugni JC, Calandra C, Paviolo JP, Tkachuk VA, Zuñiga Ramirez C, Tschopp AL, Calvo DS, Pellene LA, Uribe Roca MC, Velez M, Giannaula RJ, Fernandez Pardal MM, Micheli FE. Holmes tremor: Clinical description, lesion localization, and treatment in a series of 29 cases. Neurology 2016. [PMID: 26865524 DOI: 10.1212/wnl.0000000000002440.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the clinical features, etiology, findings from neuroimaging, and treatment results in a series of 29 patients with Holmes tremor (HT). METHODS A retrospective study was performed based on review of medical records and videos of patients with HT diagnosis. RESULTS A total of 16 women and 13 men were included. The mean age at the moment of CNS insult was 33.9 ± 20.1 years (range 8-76 years). The most common causes were vascular (48.3%), ischemic, or hemorrhagic. Traumatic brain injury only represented 17.24%; other causes represented 34.5%. The median latency from lesion to tremor onset was 2 months (range 7 days-228 months). The most common symptoms/signs associated with HT were hemiparesis (62%), ataxia (51.7%), hypoesthesia (27.58%), dystonia (24.1%), cranial nerve involvement (24.1%), and dysarthria (24.1%). Other symptoms/signs were vertical gaze disorders (6.8%), bradykinesia/rigidity (6.8%), myoclonus (3.4%), and seizures (3.4%). Most of the patients had lesions involving more than one area. MRI showed lesions in thalamus or midbrain or cerebellum in 82.7% of the patients. Levodopa treatment was effective in 13 out of 24 treated patients (54.16%) and in 3 patients unilateral thalamotomy provided excellent results. CONCLUSIONS The most common causes of HT in our series were vascular lesions. The most common lesion topography was mesencephalic, thalamic, or both. Treatment with levodopa and thalamic stereotactic lesional surgery seems to be effective.
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Affiliation(s)
- Gabriela B Raina
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Maria G Cersosimo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Silvia S Folgar
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Juan C Giugni
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Cristian Calandra
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Juan P Paviolo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Veronica A Tkachuk
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Carlos Zuñiga Ramirez
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Andrea L Tschopp
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Daniela S Calvo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Luis A Pellene
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Marcela C Uribe Roca
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Miriam Velez
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Rolando J Giannaula
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Manuel M Fernandez Pardal
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Federico E Micheli
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
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8
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Abstract
Over the past few decades it has been recognized that traumatic brain injury may result in various movement disorders. In survivors of severe head injury, post-traumatic movement disorders were reported in about 20%, and they persisted in about 10% of patients. The most frequent persisting movement disorder in this population is kinetic cerebellar outflow tremor in about 9%, followed by dystonia in about 4%. While tremor is associated most frequently with cerebellar or mesencephalic lesions, patients with dystonia frequently have basal ganglia or thalamic lesions. Moderate or mild traumatic brain injury only rarely causes persistent post-traumatic movement disorders. It appears that the frequency of post-traumatic movement disorders overall has been declining which most likely is secondary to improved treatment of brain injury. In patients with disabling post-traumatic movement disorders which are refractory to medical treatment, stereotactic neurosurgery can provide long-lasting benefit. While in the past the primary option for severe kinetic tremor was thalamotomy and for dystonia thalamotomy or pallidotomy, today deep brain stimulation has become the preferred treatment. Parkinsonism is a rare consequence of single head injury, but repeated head injury such as seen in boxing can result in chronic encephalopathy with parkinsonian features. While there is still controversy whether or not head injury is a risk factor for the development of Parkinson's disease, recent studies indicate that genetic susceptibility might be relevant.
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Affiliation(s)
- Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany.
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9
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Schiefer TK, Matsumoto JY, Lee KH. Moving forward: advances in the treatment of movement disorders with deep brain stimulation. Front Integr Neurosci 2011; 5:69. [PMID: 22084629 PMCID: PMC3211039 DOI: 10.3389/fnint.2011.00069] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 10/07/2011] [Indexed: 11/13/2022] Open
Abstract
The modern era of stereotactic and functional neurosurgery has ushered in state of the art technologies for the treatment of movement disorders, particularly Parkinson's disease (PD), tremor, and dystonia. After years of experience with various surgical therapies, the eventual shortcomings of both medical and surgical treatments, and several serendipitous discoveries, deep brain stimulation (DBS) has risen to the forefront as a highly effective, safe, and reversible treatment for these conditions. Idiopathic advanced PD can be treated with thalamic, globus pallidus internus (GPi), or subthalamic nucleus (STN) DBS. Thalamic DBS primarily relieves tremor while GPi and STN DBS alleviate a wide range of Parkinsonian symptoms. Thalamic DBS is also used in the treatment of other types of tremor, particularly essential tremor, with excellent results. Both primary and various types of secondary dystonia can be treated very effectively with GPi DBS. The variety of anatomical targets for these movement disorders is indicative of the network-level dysfunction mediating these movement disturbances. Despite an increasing understanding of the clinical benefits of DBS, little is known about how DBS can create such wide sweeping neuromodulatory effects. The key to improving this therapeutic modality and discovering new ways to treat these and other neurologic conditions lies in better understanding the intricacies of DBS. Here we review the history and pertinent clinical data for DBS treatment of PD, tremor, and dystonia. While multiple regions of the brain have been targeted for DBS in the treatment of these movement disorders, this review article focuses on those that are most commonly used in current clinical practice. Our search criteria for PubMed included combinations of the following terms: DBS, neuromodulation, movement disorders, PD, tremor, dystonia, and history. Dates were not restricted.
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Affiliation(s)
| | | | - Kendall H. Lee
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
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10
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Abstract
The use of pharmacological agents as rehabilitative tools following brain injury remains to some degree both a science and an art. Recent work in the area of the neural sciences has shed new light on the workings of basic CNS neurochemical systems and the use of pharmacologic agents in altering central neurophysiologic processes. The major central neurochemical systems are reviewed both anatomically and physiologically. An overview is provided of basic neuropharmacologic agents by class. Lastly, some of the newer neuropharmacological options for treatment of post-acute brain injury deficits are examined.
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Affiliation(s)
- N D Zasler
- Department of Rehabilitation Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298
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11
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Igarashi T, Potts MB, Noble-Haeusslein LJ. Injury severity determines Purkinje cell loss and microglial activation in the cerebellum after cortical contusion injury. Exp Neurol 2006; 203:258-68. [PMID: 17045589 DOI: 10.1016/j.expneurol.2006.08.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 08/05/2006] [Accepted: 08/10/2006] [Indexed: 10/24/2022]
Abstract
Clinical evidence suggests that the cerebellum is damaged after traumatic brain injury (TBI) and experimental studies have validated these observations. We have previously shown cerebellar vulnerability, as demonstrated by Purkinje cell loss and microglial activation, after fluid percussion brain injury. In this study, we examine the effect of graded controlled cortical impact (CCI) injury on the cerebellum in the context of physiologic and anatomical parameters that have been shown by others to be sensitive to injury severity. Adult male rats received mild, moderate, or severe CCI and were euthanized 7 days later. We first validated the severity of the initial injury using physiologic criteria, including apnea and blood pressure, during the immediate postinjury period. Increasing injury severity was associated with an increased incidence of apnea and higher mortality. Severe injury also induced transient hypertension followed by hypotension, while lower grade injuries produced an immediate and sustained hypotension. We next evaluated the pattern of subcortical neuronal loss in response to graded injuries. There was significant neuronal loss in the ipsilateral cortex, hippocampal CA2/CA3, and laterodorsal thalamus that was injury severity-dependent and that paralleled microglial activation. Similarly, there was a distinctive pattern of Purkinje cell loss and microglial activation in the cerebellar vermis that varied with injury severity. Together, these findings emphasize the vulnerability of the cerebellum to TBI. That a selective pattern of Purkinje cell loss occurs regardless of the type of injury suggests a generalized response that is a likely determinant of recovery and a target for therapeutic intervention.
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Affiliation(s)
- Takuji Igarashi
- Department of Neurological Surgery, University of California, San Francisco, 521 Parnassus Avenue, Room C-224, San Francisco, CA 94143-0520, USA
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12
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Umemura A, Samadani U, Jaggi JL, Hurtig HI, Baltuch GH. Thalamic deep brain stimulation for posttraumatic action tremor. Clin Neurol Neurosurg 2004; 106:280-3. [PMID: 15297000 DOI: 10.1016/j.clineuro.2003.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2003] [Revised: 12/08/2003] [Accepted: 12/17/2003] [Indexed: 11/25/2022]
Abstract
We report a case of thalamic deep brain stimulation (DBS) for treatment of posttraumatic tremor. An 18-year-old right-handed man developed a disabling and medically refractory action tremor in the right upper extremity 9 months after sustaining diffuse axonal injury in a motor vehicle collision. DBS of the left ventral intermediate nucleus of the thalamus (Vim) suppressed the tremor without complication and should be considered as an option for the management of intractable posttraumatic tremor.
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Affiliation(s)
- Atsushi Umemura
- Department of Neurosurgery, Penn Neurological Institute at Pennsylvania Hospital, University of Pennsylvania, 330 South, 9th Street, Philadelphia, PA 19107, USA
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13
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Piette T, Mescola P, Henriet M, Cornil C, Jacquy J, Vanderkelen B. Approche chirurgicale d’un tremblement de Holmes associé à un tremblement synchrone de haute fréquence. Rev Neurol (Paris) 2004; 160:707-11. [PMID: 15247862 DOI: 10.1016/s0035-3787(04)71023-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The effectiveness of thalamic stimulation is now clearly demonstrated for essential tremor, but remains to be demonstrated for other types of tremor. OBSERVATION A young woman presented Holmes' tremor resulting from a pontine tegmental hemorrhage related to an arteriovenous malformation. A surgical approach was considered when major functional impairment persisted at 2-year follow-up despite drug therapy. The patient underwent unilateral thalamic deep brain stimulation (Vim); major improvement persisted at eighteen months follow-up. CONCLUSION This observation is in line with previous reports suggesting that thalamic surgery can be one of the best options for treating medically intractable Holmes' tremor. The mechanism underlying the tremor, implying dentate-rubro-thalamic pathways is discussed. Moreover, the patient exhibited short periods of 16Hz tremor when her arms were maintained outstretched. Thalamic stimulation also appears to be effective for these high-frequency synchronous cerebellar bursts.
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Affiliation(s)
- T Piette
- Service de Neurologie, ISPPC, Charleroi, Belgique.
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14
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Mark MH. TREMOR DISORDERS. Continuum (Minneap Minn) 2004. [DOI: 10.1212/01.con.0000293571.02458.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Evans RW. The postconcussion syndrome and whiplash injuries: a question-and-answer review for primary care physicians. Prim Care 2004; 31:1-17. [PMID: 15110155 DOI: 10.1016/s0095-4543(03)00112-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Randolph W Evans
- Department of Neurology, University of Texas at Houston Medical School, USA.
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16
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Abstract
A 14-year-old girl presented with Complex Regional Pain Syndrome, Type I (CRPS-1) of the left ankle after a remote history of sprain. Allodynia, pain, temperature and color changes, and swelling were successfully treated with physical therapy, transcutaneous electrical nerve stimulation (TENS), gabapentin, amitriptyline, and tramadol. Five weeks later, she presented with a continuous, involuntary, intermittent coarse tremor of the left foot causing increased pain. The electromyogram showed rhythmic discharges of 3 Hz frequency lasting 20-80 milliseconds in the left tibialis, peroneus and gastrocnemius, suggestive of either basal ganglia or spinal origin. Tremor and pain were controlled with epidural bupivacaine, but the tremor reappeared after discontinuing epidural blockade. Carbidopa/levodopa 25/100 (Sinemet) was started and the tremor disappeared after two days. With continued physical therapy, pain and swelling resolved within two months and carbidopa/levodopa was discontinued after five weeks with no recurrence of the tremor. Our success in the treatment of CRPS-associated tremor in this young girl with carbidopa/levodopa suggests that this patient may have had underlying movement disorder which was unmasked by the peripheral injury.
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Affiliation(s)
- Annu Navani
- Department of Anesthesiology, Children's Hospital and Medical College of Wisconsin, Milwaukee, WI, USA
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17
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18
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Krauss JK, Jankovic J. Head injury and posttraumatic movement disorders. Neurosurgery 2002; 50:927-39; discussion 939-40. [PMID: 11950395 DOI: 10.1097/00006123-200205000-00003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2001] [Accepted: 10/17/2001] [Indexed: 11/26/2022] Open
Abstract
WE REVIEW THE phenomenology, pathophysiology, pathological anatomy, and therapy of posttraumatic movement disorders with special emphasis on neurosurgical treatment options. We also explore possible links between craniocerebral trauma and parkinsonism. The cause-effect relationship between head injury and subsequent movement disorder is not fully appreciated. This may be related partially to the delayed appearance of the movement disorder. Movement disorders after severe head injury have been reported in 13 to 66% of patients. Although movement disorders after mild or moderate head injury are frequently transient and, in general, do not result in additional disability, kinetic tremors and dystonia may be a source of marked disability in survivors of severe head injury. Functional stereotactic surgery provides long-term symptomatic and functional benefits in the majority of patients. Thalamic radiofrequency lesioning, although beneficial in some patients, frequently is associated with side effects such as increased dysarthria or gait disturbance, particularly in patients with kinetic tremor secondary to diffuse axonal injury. Deep brain stimulation is used increasingly as an option in such patients. It remains unclear whether pallidal or thalamic targets are more beneficial for treatment of posttraumatic dystonia. Trauma to the central nervous system is an important causative factor in a variety of movement disorders. The mediation of the effects of trauma and the pathophysiology of the development of posttraumatic movement disorders require further study. Functional stereotactic surgery should be considered in patients with disabling movement disorders refractory to medical treatment.
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Affiliation(s)
- Joachim K Krauss
- Departments of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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19
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Abstract
Tremor is classified according to anatomic distribution among body parts, and by frequency and amplitude during rest, postural maintenance, movement, intention, and the performance of specific tasks. Key historical features include age at onset, progression over time, family history, exacerbating and remitting factors and behaviors, response to alcohol and medications, and additional neurological signs and symptoms. Accurate diagnosis is a critical factor in predicting the natural history and response to treatment.
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Affiliation(s)
- T A Zesiewicz
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Department of Pharmacology and Experimental Therapeutics, University of South Florida, Tampa, Florida, USA
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20
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Vanhatalo S, Paetau R, Mustonen K, Hernesniemi J, Riikonen R. Posttraumatic tremor and Arnold Chiari malformation: no sign of compression, but cure after surgical decompression. Mov Disord 2000; 15:581-3. [PMID: 10830428 DOI: 10.1002/1531-8257(200005)15:3<581::aid-mds1025>3.0.co;2-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- S Vanhatalo
- Department of Child Neurology, Children's Hospital, University of Kuopio, Finland
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21
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Cassim F, Derambure P, Defebvrè L, Bourriez JL, Destée A, Guieu JD. [Neurophysiologic study of tremor]. Neurophysiol Clin 2000; 30:81-96. [PMID: 10812577 DOI: 10.1016/s0987-7053(00)00060-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tremor is frequently encountered in neurologic practice. Clinical examination supplies information regarding its approximative frequency, regularity, amplitude, topography and activation conditions. The neurophysiological study helps in confirming the tremor, in differentiating it from other movement disorders like myoclonus, and may provide distinctive features which are important for the aetiological diagnosis. The neurophysiological investigation includes accelerometry, which analyses the mechanics of the movement. Spectral analysis with FFT allows the determination of frequency and amplitude. Accelerometry is always associated with surface EMG of at least two antagonistic muscles. It may show rhythmic bursts, their frequency, duration and activation pattern (alternating or synchronous). This neurophysiological approach to tremor has multiple interests. It may help in differentiating a true rest tremor from a postural tremor seemingly persisting at rest. Brief interruptions or rhythm breaks during distraction manoeuvers are seen in psychogenic tremors. Surface EMG may also demonstrate positive myoclonic bursts, or brief silent periods corresponding to negative myoclonus, sometimes pseudorhythmic, thus appearing clinically like a tremor, but investigations, aetiologies and treatment are different. Several features, especially slow frequency, may suggest a midbrain tremor, thus requiring brain imagery centered around the posterior fossa. Finally, the neurophysiological examination is the only way to demonstrate a primary writing tremor, or a primary orthostatic tremor, the frequency of which is pathognomonic while clinical symptoms are rather misleading.
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Affiliation(s)
- F Cassim
- Service de neurophysiologie clinique, hôpital Roger Salengro, CHU Lille, France
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22
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Miyagi Y, Shima F, Ishido K, Moriguchi M, Kamikaseda K. Posteroventral pallidotomy for midbrain tremor after a pontine hemorrhage. Case report. J Neurosurg 1999; 91:885-8. [PMID: 10541252 DOI: 10.3171/jns.1999.91.5.0885] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This 49-year-old man gradually developed a disabling action tremor in the proximal right upper extremity 8 months after suffering a pontine tegmental hemorrhage. The intraoperative microrecording in the nucleus ventralis intermedius (VIM) of the left thalamus revealed tremor-synchronous grouped discharges with a vigorous (2.7 Hz) action tremor predominantly in the shoulder and upper arm. High frequency electrical stimulation in the VIM did not affect the tremor. A posteroventral pallidotomy (PVP) was performed and resulted in the successful alleviation of all tremor activity. Posteroventral pallidotomy is known to alleviate parkinsonian tremors, especially those occurring in the contralateral lower extremity, trunk, and proximal segment of the contralateral upper extremity. The authors consider the pallidoreticular pathway to be an important tremor-mediating pathway for the proximal segment of the upper extremities and believe it can be controlled more effectively by PVP than by VIM thalamotomy, as demonstrated by the PVP-induced resolution of the midbrain tremor observed in this case.
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Affiliation(s)
- Y Miyagi
- Department of Neurosurgery, Kaizuka Hospital, Fukuoka, Japan.
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23
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Abstract
Three patients who presented with parkinsonian signs resulting from a focal midbrain lesion are reported. In all patients parkinsonian features occurred acutely and improved following acute challenge with apomorphine but not with levodopa. Remission of parkinsonian signs occurred spontaneously to a different degree. Inconsistent clinical response following administration of levodopa has been well documented in patients with focal midbrain lesions associated with parkinsonian signs; however, the efficacy of apomorphine has not been tested before. Anatomic or etiologic features do not allow us to predict in which cases parkinsonian signs secondary to a midbrain lesion would respond to levodopa or to dopamine agonists. A trial with apomorphine is warranted in all such cases.
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Affiliation(s)
- E Moro
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
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24
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Affiliation(s)
- G K Leung
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, People's Republic of China
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25
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Abstract
Tremor is a common neurologic symptom that can also be incapacitating to the patient, so effective therapy is needed. The causes of tremor are heterogeneous. Essential tremor (ET) and the tremor associated with Parkinson's disease (PD) are the most common encountered in clinical practice. Beta-adrenergic blockers and primidone remain the mainstay of treatment for ET, whereas carbidopa/levodopa and anticholinergics are most beneficial in PD. However, the efficacy of various other medications has been studied in ET and PD, and also in patients with tremor resulting from other conditions, with varying results.
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Affiliation(s)
- P G Wasielewski
- Department of Neurology, University of Kansas Medical Center, Kansas City 66160-7314, USA
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26
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Abstract
Symptomatic tremors are labeled in the literature under different names including rubral tremor, midbrain tremor, thalamic tremor, myorhythmia, Holmes' tremor, cerebellar tremor, and goal-directed tremor. The most common tremor is a delayed-onset postural and action tremor with a low frequency of 3 Hz and a proximal distribution. Resting irregular tremor is sometimes present. Mild cerebellar dysmetria is often detected. The lesions are mainly located in the thalamus, the brain stem, and the cerebellum, with secondary interruption and degeneration of various pathways and olivary hypertrophy. The more consistent lesions are found in the cerebello-thalamo-cortical and dentato-rubro-olivary pathways. The role of superimposed dysfunction of the nigrostriatal system may account for the rest component. The role of the basal ganglia in the emergence and control of tremor is poorly understood.
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Affiliation(s)
- M Vidailhet
- INSERM U289, Hôpital de la Salpêtrière, Paris, France
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27
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Krauss JK, Tränkle R, Kopp KH. Posttraumatic movement disorders after moderate or mild head injury. Mov Disord 1997; 12:428-31. [PMID: 9159742 DOI: 10.1002/mds.870120326] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We examined the occurrence of posttraumatic movement disorders after moderate or mild head injury with a three-level follow-up study including questionnaires, telephone interviews, and personal examinations 4-6 years after the trauma (mean 5.2 years). Sixteen of 158 patients (10.1%) for whom a detailed follow-up was available had developed movement disorders most probably related to craniocerebral trauma. The most frequent finding was a low-amplitude postural/intention tremor that appeared to resemble enhanced physiological or essential tremor. Twelve patients reported transient tremor, two patients had persistent tremor, one patient had transient tremor and persistent hyperekplexia, and another patient had mild persistent cervical myoclonic twitches. Overall, the movement disorder was transient in 12 patients (7.6%) and persisted in only 4 patients (2.6%). These movement disorders were not disabling and did not require medical therapy. Taking into account possible bias by selection of the sample group, the frequency of movement disorders secondary to moderate or mild head trauma might be lower than 10.1%. Posttraumatic movement disorders occurred significantly more often in the group of patients with Glasgow Coma Scores between 9 and 14 than in those with a score of 15. Severe movement disorders such as low-frequency kinetic tremor or hemidystonia were not identified in this survey.
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Affiliation(s)
- J K Krauss
- Department of Neurosurgery, Albert-Ludwigs-Universität, Freiburg, Germany
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28
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Borrás JM, Salazar FG, Grandas F. Oculomotor palsy and contralateral tremor (Benedikt's syndrome) following a stereotactic procedure. J Neurol 1997; 244:272-4. [PMID: 9112599 DOI: 10.1007/s004150050085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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29
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McIntosh GC. Medical Management of Noncognitive Sequelae of Minor Traumatic Brain Injury. ACTA ACUST UNITED AC 1997; 4:62-8. [PMID: 16318497 DOI: 10.1207/s15324826an0401_8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Mild traumatic brain injury (TBI) encompasses the postconcussion syndrome characterized by symptoms that include a variety of physical symptoms as well as cognitive and behavioral impairments. The focus of this discussion is on the medical management of posttraumatic headaches, posttraumatic seizures, dizziness, auditory impairments, anosmia, tremor, paraspinal pain, and visual symptoms. Adjustment disorders with disturbances of affect and emotion lability also may accompany mild TBI. All of these conditions may be approached with medications or a variety of therapy techniques or both. The approach to concussion in sports-related injuries is also reviewed.
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Affiliation(s)
- G C McIntosh
- Rehabilitation Department and Life Skills Rehabilitation Center, Poudre Valley Hospital, Fort Collins, CO, USA
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Abstract
Until there is a greater understanding of basic tremorgenic mechanisms in the central nervous system, current classifications of tremors rely heavily on the behavioural characteristics, putative sites of origin, and/or the underlying disease process. Careful clinical evaluation remains the centrum of tremor classification. Few tremors do show specific neurophysiological features that will clinch diagnosis, e.g., primary orthostatic tremor and dystonic tremor. With the exception of dopaminergic drugs in Parkinson's disease, drug effects in tremors are unpredictable and nonspecific. Drug side effects should be considered in the differential diagnosis of any unexplained tremor.
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Affiliation(s)
- L J Findley
- Essex Neurosciences Unit, Oldchurch Hospital, England
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Defer GL, Remy P, Malapert D, Ricolfi F, Samson Y, Degos JD. Rest tremor and extrapyramidal symptoms after midbrain haemorrhage: clinical and 18F-dopa PET evaluation. J Neurol Neurosurg Psychiatry 1994; 57:987-9. [PMID: 8057126 PMCID: PMC1073089 DOI: 10.1136/jnnp.57.8.987] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A 25 year old man had an acute subarachnoid haemorrhage due to the rupture of a right peduncular subthalamic arteriovenous malformation. Seven months later he developed a left rest tremor associated with mild bilateral extrapyramidal symptoms and responsive to levodopa treatment. Surface EMG recording showed synchronous activity of agonist and antagonist muscles in the left limbs. A PET 18F-dopa study showed a large decrease of the Ki value in the right striatum. One year after the stroke a persistent postural component developed in the tremor.
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Affiliation(s)
- G L Defer
- Départment de Neurosciences, Hôpital Henri Mondor, Créteil, France
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32
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Abstract
Orthostatic tremor is a 14 to 16Hz (range 7 to 36Hz) tremor of uncertain etiology elicited within seconds of an isometric contraction. It is described as a shaking, cramping of the lower extremities upon standing and is relieved with movement or sitting. Typically patients are unable to stand in place for long periods of time secondary to instability and fatigue. A 73-year-old woman with orthostatic tremor following a history of head trauma is presented. Recognition of the characteristic history and electromyographic findings may lead to appropriate treatment for this annoying and sometimes incapacitating disorder.
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Harmon RL, Long DF, Shirtz J. Treatment of post-traumatic midbrain resting-kinetic tremor with combined levodopa/carbidopa and carbamazepine. Brain Inj 1991; 5:213-8. [PMID: 1873607 DOI: 10.3109/02699059109008092] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A patient with a post-traumatic midbrain haemorrhagic lesion documented by magnetic resonance imaging (MRI) presented with a combined resting-kinetic contralateral upper extremity tremor. The resting tremor component responded to levodopa/carbidopa, while the kinetic component improved with the addition of carbamazepine.
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Affiliation(s)
- R L Harmon
- Bryn Mawr Rehabilitation Hospital, Malvern, PA 19355
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Della Sala S, Mazzini L. Post-traumatic extrapyramidal syndrome: case report. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1990; 11:65-9. [PMID: 2332328 DOI: 10.1007/bf02334908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We report the case of a young man with possible post-traumatic extrapyramidal syndrome. Some features of this case have a bearing on the controversy surrounding the existence of post-traumatic Parkinson disease.
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Affiliation(s)
- S Della Sala
- Servizio di Neuropsicologia Clinica, Centro Medico di Veruno, Fondazione Clinica del Lavoro
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37
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Abstract
In this article, normal tremor and common types of pathologic tremors seen in the elderly are defined and described along with a review of current treatments. Problems of differential diagnosis are emphasized.
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Affiliation(s)
- L Cleeves
- MRC Neuro-Otology Unit, National Hospital, London
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38
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Abstract
Trauma to the head and neck can cause minor head injury with a brief alteration in consciousness. Generally, neurologic examination yields normal findings. In some patients, however, postconcussion syndrome marked by headache, dizziness, and neuropsychological deficits (eg, fatigue, cognitive impairment, emotional symptoms) results. This acceleration-deceleration injury with cerebral axonal dysfunction is an organic disease having objective abnormalities that necessitate early neurologic testing and treatment to prevent serious complications.
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Affiliation(s)
- S Mandel
- Thomas Jefferson University Hospital, Philadelphia
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