An update on tremors

Department of Neurology, Christian- Albrechts- University Kiel, Kiel, Germany.
Current opinion in neurology (Impact Factor: 5.73). 08/2012; 25(4):475-82. DOI: 10.1097/WCO.0b013e3283550c7e
Source: PubMed

ABSTRACT This review describes the most recent advances in epidemiology, classification, genetics, pathology and treatment of essential tremor. In addition, recent advances in more rare forms of tremor are summarized.
Clinical, biochemical, pathological and imaging studies suggest an abnormal functioning of the cerebellum in essential tremor. Minor changes of cognition and personality may be due to secondary effects. Dementia and possible shortened life span seem to be limited to late-onset essential tremor. Many of these issues are not yet finally settled and need confirmation in further studies. The current essential tremor classification seems not to reflect the variety of phenotypic expressions. Regarding treatment, there is now a level B evidence for topiramate. Levetiracetam may induce a positive response in Holmes tremor, but is ineffective in orthostatic tremor.
These findings have extended our knowledge about essential tremor. It appears that a new, more distinct classification system is required. Recent treatments have remained unchanged.

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    • "In certain types of dystonia, cerebellar dysfunction (such as compensatory activity) may play a primary role in the pathology of the disorder [3]. Clinical, biochemical, pathological, and imaging studies suggest an abnormal functioning of the cerebellum in ET [4]. Movement disorders can be classified as hyperkinesias (excess of movements), dyskinesias (unnatural movements), and abnormal involuntary movements [1]. "
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    ABSTRACT: Movement disorders are neurological conditions affecting speed, fluency, quality, and ease of movement. Deep brain stimulation (DBS) is used to treat advanced Parkinson's disease, essential tremor, and dystonia. Possible target sites for DBS include the ventral intermediate nucleus of the thalamus, the globus pallidus internus, and the subthalamic nucleus. High-frequency DBS leads to a kind of functional deafferentation of the stimulated structure and to the modulation of cortical activity. This has a profound effect on the efficiency of movement. Indications for the use of DBS include the need to improve function, reduce medication dependency, and avoid ablative neurosurgery. Appropriate patient selection is critical for success. The implantation technique is briefly described. Programming stimulation parameters are performed via telemetry. The adverse effects of DBS are discussed. The future should see the development of "closed-loop" systems. Its use has promoted interdisciplinary team work and provided an improved understanding of the complex neurocircuitry associated with these disorders. DBS is a highly effective, safe, and reversible surgical treatment for advanced Parkinson's disease, tremor, and dystonia. It is a useful therapeutic option in carefully selected patients that significantly improves motor symptoms, functional status, and quality of life.
    09/2012; 2012:309431. DOI:10.1155/2012/309431
  • Brain 06/2013; DOI:10.1093/brain/awt141
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    ABSTRACT: Holmes tremor is a rare movement phenomenon, with atypical low-frequency tremor at rest and when changing postures, often related to brainstem pathology. We report a 70-year-old female patient who was presented with dystonic head and upper limb tremor after brainstem hemorrhage. The patient had experienced a sudden onset of left hemiparesis and right facial paralysis. Brain magnetic resonance imaging showed an acute hemorrhage from the brachium pontis through the dorsal midbrain on the right side. Several months later, the patient developed resting tremor of the head and left arm, which was exacerbated by a sitting posture and intentional movement. The tremor showed a regular low-frequency (1-2 Hz) for the bilateral sternocleidomastoid and cervical paraspinal muscles at rest. The patient's symptoms did not respond to propranolol or clonazepam, but gradually improved with levodopa administration. Although various remedies were attempted, overall, the results were poor. We suggest that levodopa might be a useful remedy for Holmes tremor. The curative or relieving effect of the dopaminergic agent in Holmes tremor needs more research.
    08/2013; 37(4):591-4. DOI:10.5535/arm.2013.37.4.591
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