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Movement Disorders : Official Journal... Jan 2018Consensus criteria for classifying tremor disorders were published by the International Parkinson and Movement Disorder Society in 1998. Subsequent advances with regard... (Review)
Review
BACKGROUND
Consensus criteria for classifying tremor disorders were published by the International Parkinson and Movement Disorder Society in 1998. Subsequent advances with regard to essential tremor, tremor associated with dystonia, and other monosymptomatic and indeterminate tremors make a significant revision necessary.
OBJECTIVES
Convene an international panel of experienced investigators to review the definition and classification of tremor.
METHODS
Computerized MEDLINE searches in January 2013 and 2015 were conducted using a combination of text words and MeSH terms: "tremor", "tremor disorders", "essential tremor", "dystonic tremor", and "classification" limited to human studies. Agreement was obtained using consensus development methodology during four in-person meetings, two teleconferences, and numerous manuscript reviews.
RESULTS
Tremor is defined as an involuntary, rhythmic, oscillatory movement of a body part and is classified along two axes: Axis 1-clinical characteristics, including historical features (age at onset, family history, and temporal evolution), tremor characteristics (body distribution, activation condition), associated signs (systemic, neurological), and laboratory tests (electrophysiology, imaging); and Axis 2-etiology (acquired, genetic, or idiopathic). Tremor syndromes, consisting of either isolated tremor or tremor combined with other clinical features, are defined within Axis 1. This classification scheme retains the currently accepted tremor syndromes, including essential tremor, and provides a framework for defining new syndromes.
CONCLUSIONS
This approach should be particularly useful in elucidating isolated tremor syndromes and syndromes consisting of tremor and other signs of uncertain significance. Consistently defined Axis 1 syndromes are needed to facilitate the elucidation of specific etiologies in Axis 2. © 2017 International Parkinson and Movement Disorder Society.
Topics: Consensus; Humans; International Cooperation; MEDLINE; Societies, Medical; Tremor
PubMed: 29193359
DOI: 10.1002/mds.27121 -
Journal of Neurochemistry Oct 2016In this review, the clinical features of Parkinson's disease, both motor and non-motor, are described in the context of the progression of the disease. Also briefly... (Review)
Review
In this review, the clinical features of Parkinson's disease, both motor and non-motor, are described in the context of the progression of the disease. Also briefly discussed are the major treatment strategies and their complications. Parkinson's disease is a slowly progressing neurodegenerative disorder, causing impaired motor function with slow movements, tremor and gait and balance disturbances. A variety of non-motor symptoms are common in Parkinson's disease. They include disturbed autonomic function with orthostatic hypotension, constipation and urinary disturbances, a variety of sleep disorders and a spectrum of neuropsychiatric symptoms. This article describes the different clinical symptoms that may occur and the clinical course of the disease. This article is part of a special issue on Parkinson disease.
Topics: Animals; Disease Progression; Gait Disorders, Neurologic; Humans; Mental Disorders; Parkinson Disease; Sleep Wake Disorders; Tremor
PubMed: 27401947
DOI: 10.1111/jnc.13691 -
Tremor and Other Hyperkinetic Movements... 2022Tremor is one of the most prevalent symptoms in Parkinson's Disease (PD). The progression and management of tremor in PD can be challenging, as response to dopaminergic... (Review)
Review
BACKGROUND
Tremor is one of the most prevalent symptoms in Parkinson's Disease (PD). The progression and management of tremor in PD can be challenging, as response to dopaminergic agents might be relatively poor, particularly in patients with tremor-dominant PD compared to the akinetic/rigid subtype. In this review, we aim to highlight recent advances in the underlying pathogenesis and treatment modalities for tremor in PD.
METHODS
A structured literature search through Embase was conducted using the terms "Parkinson's Disease" AND "tremor" OR "etiology" OR "management" OR "drug resistance" OR "therapy" OR "rehabilitation" OR "surgery." After initial screening, eligible articles were selected with a focus on published literature in the last 10 years.
DISCUSSION
The underlying pathophysiology of tremor in PD remains complex and incompletely understood. Neurodegeneration of dopaminergic neurons in the retrorubral area, in addition to high-power neural oscillations in the cerebello-thalamo-cortical circuit and the basal ganglia, play a major role. Levodopa is the first-line therapeutic option for all motor symptoms, including tremor. The addition of dopamine agonists or anticholinergics can lead to further tremor reduction. Botulinum toxin injection is an effective alternative for patients with pharmacological-resistant tremor who are not seeking advanced therapies. Deep brain stimulation is the most well-established advanced therapy owing to its long-term efficacy, reversibility, and effectiveness in other motor symptoms and fluctuations. Magnetic resonance-guided focused ultrasound is a promising modality, which has the advantage of being incisionless. Cortical and peripheral electrical stimulation are non-invasive innovatory techniques that have demonstrated good efficacy in suppressing intractable tremor.
Topics: Botulinum Toxins; Cholinergic Antagonists; Dopamine Agents; Dopamine Agonists; Humans; Levodopa; Parkinson Disease; Tremor
PubMed: 36211804
DOI: 10.5334/tohm.712 -
Journal of the Neurological Sciences Apr 2022Tremor is one of the most common movement disorders, though it can arise in the context of several unrelated neurological disorders whose pharmacology and anatomical... (Review)
Review
Tremor is one of the most common movement disorders, though it can arise in the context of several unrelated neurological disorders whose pharmacology and anatomical origins differ greatly. Treatment of tremors can take advantage of several medications and neurosurgical treatments. Medications useful for treating tremor are discussed in this review, including those for action tremor as seen in essential tremor, the resting tremor of Parkinson's disease, orthostatic tremor, cerebellar tremor, Holmes tremor, dystonic tremor, and drug-induced tremors. A medication that is useful for most types of tremors is the beta-blocker propranolol, though even in essential tremor it can fail to be effective at tremor control. This article is part of the Special Issue "Tremor" edited by Daniel D. Truong, Mark Hallett, and Aasef Shaikh.
Topics: Ataxia; Essential Tremor; Humans; Parkinson Disease; Propranolol; Tremor
PubMed: 35279634
DOI: 10.1016/j.jns.2022.120194 -
Journal of Internal Medicine Nov 2022Parkinson's disease (PD) is a progressive neurodegenerative illness with both motor and nonmotor symptoms. Deep brain stimulation (DBS) is an established safe... (Review)
Review
Parkinson's disease (PD) is a progressive neurodegenerative illness with both motor and nonmotor symptoms. Deep brain stimulation (DBS) is an established safe neurosurgical symptomatic therapy for eligible patients with advanced disease in whom medical treatment fails to provide adequate symptom control and good quality of life, or in whom dopaminergic medications induce severe side effects such as dyskinesias. DBS can be tailored to the patient's symptoms and targeted to various nodes along the basal ganglia-thalamus circuitry, which mediates the various symptoms of the illness; DBS in the thalamus is most efficient for tremors, and DBS in the pallidum most efficient for rigidity and dyskinesias, whereas DBS in the subthalamic nucleus (STN) can treat both tremors, akinesia, rigidity and dyskinesias, and allows for decrease in doses of medications even in patients with advanced stages of the disease, which makes it the preferred target for DBS. However, DBS in the STN assumes that the patient is not too old, with no cognitive decline or relevant depression, and does not exhibit severe and medically resistant axial symptoms such as balance and gait disturbances, and falls. Dysarthria is the most common side effect of DBS, regardless of the brain target. DBS has a long-lasting effect on appendicular symptoms, but with progression of disease, nondopaminergic axial features become less responsive to DBS. DBS for PD is highly specialised; to enable adequate selection and follow-up of patients, DBS requires dedicated multidisciplinary teams of movement disorder neurologists, functional neurosurgeons, specialised DBS nurses and neuropsychologists.
Topics: Deep Brain Stimulation; Dyskinesias; Humans; Parkinson Disease; Quality of Life; Treatment Outcome; Tremor
PubMed: 35798568
DOI: 10.1111/joim.13541 -
Neurology India 2018Among the involuntary movement disorders, tremor is a common phenomenology seen in clinical practice. The important factors that need to be determined while assessing a... (Review)
Review
Among the involuntary movement disorders, tremor is a common phenomenology seen in clinical practice. The important factors that need to be determined while assessing a patient with tremor include the phenomenology of tremor, presence or absence of other neurologic signs, and the effect of medications or alcohol. Tremor can broadly be classified based on the circumstances under which it occurs, i.e., rest or action. The basal ganglia-cerebello-thalamic and dentate-olivary circuits are involved in the generation of tremor. Experimental data have suggested the olivocerebellar system as the site of the central oscillator in essential tremor. Generation of tremor in Parkinson's disease results from loss of dopaminergic neurons of the retrorubral area causing dysfunction of the globus pallidus, which finally leads to abnormal firing pattern of the ventrolateral posterior neurons of the thalamus. Involvement of the cerebello-thalamic pathways leads to orthostatic tremor. Palatal tremor is thought to be generated by the cells of the inferior olive. Holmes tremor usually results from the disruption of the dentate-rubro-thalamic circuit and also the nigro-striatal circuit. Multiple drugs can cause tremors. Demyelinating neuropathies are associated with tremors. Involvement of the deep cerebellar nuclei, cerebellar outflow tracts and the cerebrocerebellar loops has been postulated in the cerebellar tremor production. Electrophysiological methods are valuable in characterizing tremors. In addition to the pharmacological therapy including botulinum toxin therapy, surgical therapies in form of DBS or lesional surgeries are beneficial in reducing the symptoms.
Topics: Basal Ganglia; Deep Brain Stimulation; Humans; Movement Disorders; Tremor
PubMed: 29503326
DOI: 10.4103/0028-3886.226440 -
Journal of the Neurological Sciences Apr 2022Tremor is one of the primary motor symptoms of Parkinson's disease (PD), and it is characterized by a highly phenomenological heterogeneity. Clinical and experimental... (Review)
Review
Tremor is one of the primary motor symptoms of Parkinson's disease (PD), and it is characterized by a highly phenomenological heterogeneity. Clinical and experimental observations suggest that tremor in PD cannot be interpreted merely as an expression of dopaminergic denervation of the basal ganglia. Accordingly, other neurotransmitter systems and brain areas are involved. We here review neurochemical, neurophysiological, and neuroimaging data as the basis of the presence of a dysfunctional network underlying tremor in PD. We will discuss the role of altered oscillations and synchronization in two partially overlapping central motor circuitries, e.g., the cerebello-thalamo-cortical and the basal ganglia-cortical loops. We will also emphasize the pathophysiological consequences of the abnormal interplay between the two systems. While there are many currently unknown and controversial aspects in the field, we will highlight the possible translational and practical implications of research advances in understanding tremor pathophysiology in PD. A better understanding of this issue is likely facilitating future therapeutic approaches to PD patients based on medications and invasive and non-invasive stimulation techniques. This article is part of the Special Issue "Tremor" edited by Daniel D. Truong, Mark Hallett, and Aasef Shaikh.
Topics: Basal Ganglia; Brain; Humans; Neuroimaging; Parkinson Disease; Tremor
PubMed: 35240491
DOI: 10.1016/j.jns.2022.120196 -
Journal of the Neurological Sciences Apr 2022Functional tremor is the most common functional movement disorder. It can be diagnosed with clinically definite certainty at the bedside by ascertaining its inconsistent... (Review)
Review
Functional tremor is the most common functional movement disorder. It can be diagnosed with clinically definite certainty at the bedside by ascertaining its inconsistent (distractibility, frequency variability) and incongruent features (entrainment, ballistic suppression), requiring no additional neurological investigations except, in selected cases, those serving to elevate the diagnostic category to laboratory supported using accelerometry and surface electromyography. In the background of excessive attention to the affected body part and abnormal beliefs and expectations, functional correlates include the impairment of emotion processing, sense of agency, and abnormal connectivity between limbic and motor regions. While the treatment options remain under-studied, promising interventions in physiotherapy, cognitive behavioral therapy, and other psychotherapies are under evaluation to assessing their efficacy in attenuating this important source of neurological disability. This article is part of the Special Issue "Tremor" edited by Daniel D. Truong, Mark Hallett, and Aasef Shaikh.
Topics: Accelerometry; Electromyography; Emotions; Humans; Neurologic Examination; Tremor
PubMed: 35306423
DOI: 10.1016/j.jns.2022.120208 -
American Family Physician Oct 2003Tremor, a rhythmic, involuntary, oscillatory movement of body parts, is the most common movement disorder. Tremors are classified as rest or action tremors. Rest tremor... (Review)
Review
Tremor, a rhythmic, involuntary, oscillatory movement of body parts, is the most common movement disorder. Tremors are classified as rest or action tremors. Rest tremor occurs when the affected body part is completely supported against gravity. Action tremors are produced by voluntary muscle contraction and are further divided into postural, isometric, or kinetic tremors. This article describes clinical signs and symptoms of six tremor syndromes, including physiologic tremor, essential tremor, Parkinson's disease, toxic and drug-induced tremor, cerebellar tremor, and psychogenic tremor, and presents a detailed diagnostic approach to tremor. Although new technologies such as positron emission tomography and single photon emission computed tomography are under investigation for possible use in diagnosing specific tremor syndromes, they have no widespread applicability or use at this time. The history and physical examination remain the most important diagnostic tools available to clinicians in identifying and classifying tremor syndromes.
Topics: Algorithms; Cerebellar Diseases; Essential Tremor; Humans; Parkinson Disease; Tremor
PubMed: 14596441
DOI: No ID Found -
Canadian Medical Association Journal Jun 1981Essential tremor, including the juvenile and senile variations, may be a result of a disorder of the servomechanism that controls physiologic tremor. Hands and arms are... (Review)
Review
Essential tremor, including the juvenile and senile variations, may be a result of a disorder of the servomechanism that controls physiologic tremor. Hands and arms are affected most commonly, and the tremor can vary in amplitude as well as frequency. Long-term treatment with propranolol has been helpful for some patients, although older patients are less likely to benefit. Other drugs and behaviour modification therapy have been less successful. Surgical treatment is effective but should probably be reserved for severe cases. An effective instrument for measuring the subjective and objective aspects of the tremor is still needed, as is an effective long-term method of treatment.
Topics: Ethanol; Humans; Prognosis; Propranolol; Tremor
PubMed: 7018658
DOI: No ID Found