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Tavilla, Igor, Roman Kralik, and Marie Roubalova. "Abraham and the tortoise: eleatic variations on Fear and Trembling." XLinguae 12, no. 4 (October 2019): 219–28. http://dx.doi.org/10.18355/xl.2019.12.04.19.
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Sabah najim, Nawras, Abdulnasir H. Ameer, and Azad A. Mohammed. "The Electrophysiological Perspectives of Essential, Enhanced Physiological, and Physiological Tremors." Journal of the Faculty of Medicine Baghdad 64, no. 2 (July 24, 2022): 86–90. http://dx.doi.org/10.32007/jfacmedbagdad.6421921.
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Abstract: Background: The most frequent movement issue seen in clinical practice is tremors. It is known as repetitive, involuntary oscillations. The diagnostic process for tremor patients can be time-consuming and complicated, as the identification of “Essential Tremor” and its distinction from other types of tremor. Objectives: This study aimed to describe the electrophysiological findings of essential, enhanced physiological, and physiological tremors, using surface electromyography and an accelerometer. Patients and Methods: The study included 24 patients with essential tremors, 10 patients with enhanced physiological tremors, and 10 patients with physiological tremors. We assessed the frequency, amplitude, and muscular contraction pattern of tremors during rest, posture, and a 1 kg load. Results: The tremor frequency of essential tremor patients was about 4.2-10.1 Hertz, while enhanced physiological tremor and physiological tremor were increased to 6.1–12.7 Hertz and 5.1-10.2 Hertz, respectively. The essential tremor group muscle contraction pattern was predominantly synchronous, as do all enhanced physiological, and physiological tremor patients, but with more fine low amplitude muscle bursts. By varying the tremor frequency and the weight load effect, tremor analysis could discriminate essential from enhanced physiological, and physiological tremors. Conclusions: The tremor analysis using surface electromyography and an accelerometer is sufficient to differentiate between essential tremors, enhanced physiological tremors, and physiological tremors.
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Radžiūnas, A., O. Laucius, L. Kudrevičius, P. Sėdžius, and I. Čelpačenko. "Gama peilio talamotomija esencialiniam ir Parkinsono tremorui gydyti." Neurologijos seminarai 25, no. 87 (July 1, 2021): 40–45. http://dx.doi.org/10.29014/ns.2021.06.
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Tikslas. Tyrimo tikslas įvertinti gama peilio talamotomijos efektyvumą, stabdant tremorą sergantiesiems Parkinsono liga (PL) ir esencialiniu tremoru, kai kiti invaziniai gydymo metodai nerekomenduotini. Tiriamieji ir tyrimo metodai. Nuo 2019 m. birželio iki 2021 m. sausio dėl esencialinio tremoro ir PL sąlygoto tremoro atitinkamai atlikta 27 ir 20 vienpusių gama peilio talamotomijų. Naudojant Leksell G stereotaksinį rėmą, pagal standartizuotą metodiką, naudojant 4 mm diametro kolimatoriaus šūvį, į n.ventralis intermedius (VIM) zoną paskirta 130-140 Gy dozė. Tyrime pooperacinis vertinimas planuotas atlikti praėjus 6 ir 12 mėnesių po taikyto gydymo. Tačiau dėl besikartojančio karantino dėl COVID-19 buvo apsunkintas ligonių kontaktinis vertinimas, todėl rezultatai vertinti telefoninės apklausos metu. Iš 20 ligonių, sergančių PL, pavyko susisiekti tik su 12, iš kurių aštuoniems gydymas buvo taikytas mažiau nei prieš 6 mėnesius. Nuspręsta PL grupės ligonių gydymo rezultatų analizę atlikti po 6 mėnesių. Rezultatai. Iš 27 sergančiųjų esencialiniu tremoru telefonu pakalbinti pavyko 23 ligonius. Viena ligonė per stebėjimo laikotarpį mirė nuo COVID-19 infekcijos. Iš apklaustų 22 ligonių 16 (72 %) teigė, kad jaučia žymų tremoro rankoje sumažėjimą ar visišką jo išnykimą priešingoje, nei atlikta VIM talamotomija, pusėje. Likę 6 ligoniai (28 %) taikyto gydymo efekto iki šiol ne-jaučia. Iš 22 ligonių 4 (18 %) teigė, kad kurį laiką buvo sutrikusi koordinacija ir vargino laikinas rankos nevikrumas, kuris praėjo per kelis mėnesius. Išvados. Gama peilio talamotomija yra saugi ir efektyvi esencialinio rankų tremoro mažinimo priemonė. Pagrindiniai šio gydymo trūkumai yra kelis ar keliolika mėnesių trunkantis latencinis periodas iki pastebimo klinikinio efekto ir laikina ataksija.
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Brindha, A., K. A. Sunitha, and S. Robert Wilson. "TREMOR CLASSIFICATION USING WEARABLE IOT BASED SENSORS." IOP Conference Series: Materials Science and Engineering 1219, no. 1 (January 1, 2022): 012024. http://dx.doi.org/10.1088/1757-899x/1219/1/012024.
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Abstract Tremors, a significant symptom of movement disorder, affects a part of the body ranging from slight to severe. These Tremors are symptoms of various neurological diseases such as Parkinson’s disease (PD), Essential tremors (ET), Physiological tremors (PT), Cerebellar tremor, Dystonic tremor, Psychogenic tremor, and many more. Tremor features and types differ for various neurological disorders. During the early stages of the disease, clinical examination of tremors plays a significant role in diagnose management. This work aims to develop a wearable assistive system with an Inertial Measurement Unit (IMU) sensor to classify the tremor of three different neurological disorders based on the tremor position and frequency. This research has been carried out in SRM Medical college and Research Centre with 15 patients. The type of neurodegenerative disease of the subject with tremor is evaluated based on the tremor position and tremor frequency level. The data is collected, transmitted, and processed using the IMU sensor with Internet of things (IoT) and Node MCU board. The decision tree algorithm is used for the classification of tremors. ET, PD, and PT tremors are classified based on the tremor frequency and tremor position. A high rate of accuracy is achieved for the developed system when compared with the Neurologist results. The proposed device quantitatively classified the tremor based on the frequency and position among the three different neurological disorders, i.e., ET, PD, and PT tremors.
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Munday-Finch, S. C., and I. Garthwaite. "Toxicology of ryegrass endophyte in livestock." NZGA: Research and Practice Series 7 (January 1, 1999): 63–67. http://dx.doi.org/10.33584/rps.7.1999.3404.
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The ryegrass endophyte/plant interaction produces a number of toxic metabolites responsible for a range of toxicoses including ryegrass staggers. Although lolitrem B has long been considered the toxin responsible for ryegrass staggers in farm animals, it is only recently that we have demonstrated that oral administration of the pure toxin causes tremors in mice consistent with the symptoms of ryegrass staggers. Various levels of the toxin were incorporated into the diet of mice and tremor response measured regularly. Mice were very susceptible to the tremorgenic action of lolitrem B with a dose of only 1.1 mg/kg per day being sufficient to induce a tremor response. Analysis of faeces from a dosed mouse showed that approximately 40% of the toxin ingested was excreted unchanged. The profile of tremor response shows that tremors build up over a 24-hour period and then reach a dose dependent plateau suggesting that toxin turnover reaches a steady state. In experiments designed to test the possibility that tremorgens bind to specific receptors in the brain, mice were injected with the 14C-labelled tremorgen, paxilline. Paxilline was chosen as it is similar in structure and possible action to lolitrem B and could be more easily prepared with an isotopic label. Following injection of 14C-paxilline to mice their brains and spinal cord were sectioned and analysed for 14C content. Localised binding was not detected but rather an even distribution of isotope was observed. This is probably due to the lipophilicity of the tremorgens, which distribute randomly throughout the fatty brain matrix, masking any binding to specific regions or receptors. This study showed, however, that only a minute proportion of the administered tremorgen reached the brain and spinal cord, indicating that, if this is the site of action, the receptors involved in the initiation of staggers are extremely sensitive to the tremorgens. Keywords: endophyte, lolitrem, Lolium perenne, mycotoxin, Neotyphodium lolii, neurotoxin, oral dosing, ryegrass staggers, tremor, tremorgen
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Raethjen and Deuschl. "Tremor." Therapeutische Umschau 64, no. 1 (January 1, 2007): 35–40. http://dx.doi.org/10.1024/0040-5930.64.1.35.
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Tremor ist eines der häufigsten neurologischen Symptome. Die genaue Diagnose wird in der Regel klinisch gestellt. Der häufigste primär neurologisch bedingte Tremor ist der Essentielle Tremor (Prävalenz 2–5%), der sich überwiegend als relativ symmetrischer Halte- und kinetischer Tremor zeigt. Er folgt in 60% der Fälle einem autosomal dominanten Erbgang, bessert sich bei 60–70% der Patienten unter Alkohol und kann außer den Händen den Kopf und die Stimme betreffen. Der Parkinson-Tremor tritt dagegen überwiegend in Ruhe auf und beginnt asymmetrisch, häufig unter Beteiligung von Beinen und Gesicht. Der cerebelläre Tremor ist ein Intentionstremor. Der hochfrequente Orthostatische Tremor betrifft hauptsächlich die Beine und führt zu einer Standunsicherheit. Der Dystone Tremor ist ein Aktionstremor der betroffenen Körperregion. Die symptomatische medikamentöse Therapie des Tremors wird in erster Linie von der klinischen Erscheinungsform bestimmt. Während Halte- und Aktionstremores hauptsächlich auf nicht-selektive Betablocker (Propranolol), Primidon, manche neuere Antiepileptika (Gabapentin, Topiramat) und Benzodiazepine ansprechen, bessern sich klassische Ruhetremores unter dopaminergen Substanzen (Levodopa, Dopaminagonisten) oder Anticholinergika. Beim Dystonen Tremor sind häufig Botulinum-Toxin Injektionen erfolgreich, der orthostatische Tremor spricht bei einem Teil der Patienten auf Gabapentin oder Benzodiazepine an. Für medikamentös therapierefraktäre, schwer behinderte Patienten besteht bei der Mehrzahl der Tremores die Möglichkeit der Implantation von Stimulationselektroden in den VIM-Kern des Thalamus mit sehr guten Erfolgen aber vorhandenen Risiken.
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Md Zain, Mohd Zarhamdy, Ali Zolfagharian, Moslem Mohammadi, Mahdi Bodaghi, Abd Rahim Abu Bakar, and Abbas Z. Kouzani. "A Portable Non-Contact Tremor Vibration Measurement and Classification Apparatus." Actuators 11, no. 1 (January 17, 2022): 26. http://dx.doi.org/10.3390/act11010026.
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Tremors are the most common type of movement disorder and affect the lives of those experiencing them. The efficacy of tremor therapies varies according to the aetiology of the tremor and its correct diagnosis. This study develops a portable measurement device capable of non-contact measurement of the tremor, which could assist in tremor diagnosis and classification. The performance of this device was assessed through a validation process using a shaker at a controlled frequency to measure human tremors, and the device was able to measure vibrations of 50 Hz accurately, which is more than twice the frequency of tremors produced by humans. Then, the device is tested to measure the tremors for two different activation conditions: rest and postural, for both hand and leg. The measured non-contact tremor vibration data successfully led to tremor classification in the subjects already diagnosed using a contact accelerometer.
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Katlowitz, Kalman, Mia Ko, Alon Y. Mogilner, and Michael Pourfar. "Effect of deep brain simulation on arm, leg, and chin tremor in Parkinson disease." Journal of Neurosurgery 131, no. 5 (November 2019): 1514–19. http://dx.doi.org/10.3171/2018.7.jns18784.
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OBJECTIVEThe efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) in the treatment of Parkinson disease (PD)–related tremor has been well established. However, the relative impact on arm, leg, and chin tremor has been less clearly elucidated. The authors evaluated the distribution of tremors in a PD cohort undergoing STN DBS and sought to evaluate the differential impact of DBS as a function of tremor location.METHODSA retrospective study of patients with PD with tremor who underwent DBS surgery between 2012 and 2016 was performed to evaluate the impact of STN stimulation on overall and regional tremor scores.RESULTSAcross 66 patients the authors found an average of 78% overall reduction in tremor after 6 months. In this cohort, the authors found that tremor reduction was somewhat better for arm than for leg tremors, especially in instances of higher preoperative tremor (84% vs 71% reduction, respectively, for initial tremor scores ≥ 2). No significant difference in response was found between patients with medication-responsive versus medication-nonresponsive tremors.CONCLUSIONSThe authors found that although DBS improved tremor in all regions, the improvement was not uniform between chin, arm, and leg—even within the same patient. The reasons behind these differing responses are speculative but suggest that STN DBS may more reliably reduce arm tremors than leg tremors.
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Rana, Abdul Qayyum, and Mohamad Saleh. "Relationship between resting and action tremors in Parkinson’s disease." Journal of Neurosciences in Rural Practice 07, no. 02 (April 2016): 232–37. http://dx.doi.org/10.4103/0976-3147.176192.
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ABSTRACT Objective: To determine the relationship between resting tremor (RT) and action tremor (AT) in Parkinson’s disease (PD) patients. Methods: A retrospective study of RT and AT severity was conducted in 100 PD patients. The severity rating for each type of tremor in the upper extremities was assessed. The disparity in tremor severity between extremities for each tremor type was compared to that of the other two to identify commonalities in the laterality of the tremor manifestation. Results: Overall, RT is predictive of AT on the same side, but not the opposing side of the body. Patients with less intense resting right upper limb (RRU) tremor and moderately intense RRU tremor were significantly more likely to have an action right upper limb (ARU) tremor (−1.53, P = 0.020; −1.88, P = 0.005, respectively). Similarly, patients with less intense resting left upper limb (RLU) tremor and moderately intense RLU tremors were significantly more likely to have an action left upper limb (ALU) tremor (−3.49, P = 0.000; −1.86, P = 0.017, respectively). In addition, RRU and ALU tremors were associated with an increase in RLU and ARU tremors, respectively. Conclusion: Tremors are common findings in PD patients, and often impair quality of life. By identifying and classifying the relationship between resting and ATs in PD patients, our study sheds light onto the importance of better understanding and future management of this debilitating symptomology.
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Pascual-Valdunciel, Alejandro, Víctor Lopo-Martínez, Alberto J. Beltrán-Carrero, Rafael Sendra-Arranz, Miguel González-Sánchez, Javier Ricardo Pérez-Sánchez, Francisco Grandas, et al. "Classification of Kinematic and Electromyographic Signals Associated with Pathological Tremor Using Machine and Deep Learning." Entropy 25, no. 1 (January 5, 2023): 114. http://dx.doi.org/10.3390/e25010114.
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Peripheral Electrical Stimulation (PES) of afferent pathways has received increased interest as a solution to reduce pathological tremors with minimal side effects. Closed-loop PES systems might present some advantages in reducing tremors, but further developments are required in order to reliably detect pathological tremors to accurately enable the stimulation only if a tremor is present. This study explores different machine learning (K-Nearest Neighbors, Random Forest and Support Vector Machines) and deep learning (Long Short-Term Memory neural networks) models in order to provide a binary (Tremor; No Tremor) classification of kinematic (angle displacement) and electromyography (EMG) signals recorded from patients diagnosed with essential tremors and healthy subjects. Three types of signal sequences without any feature extraction were used as inputs for the classifiers: kinematics (wrist flexion–extension angle), raw EMG and EMG envelopes from wrist flexor and extensor muscles. All the models showed high classification scores (Tremor vs. No Tremor) for the different input data modalities, ranging from 0.8 to 0.99 for the f1 score. The LSTM models achieved 0.98 f1 scores for the classification of raw EMG signals, showing high potential to detect tremors without any processed features or preliminary information. These models may be explored in real-time closed-loop PES strategies to detect tremors and enable stimulation with minimal signal processing steps.
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Luft, Frauke, Sarvi Sharifi, Winfred Mugge, Alfred C. Schouten, Lo J. Bour, Anne-Fleur van Rootselaar, Peter H. Veltink, and Tijtske Heida. "A Power Spectral Density-Based Method to Detect Tremor and Tremor Intermittency in Movement Disorders." Sensors 19, no. 19 (October 4, 2019): 4301. http://dx.doi.org/10.3390/s19194301.
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There is no objective gold standard to detect tremors. This concerns not only the choice of the algorithm and sensors, but methods are often designed to detect tremors in one specific group of patients during the performance of a specific task. Therefore, the aim of this study is twofold. First, an objective quantitative method to detect tremor windows (TWs) in accelerometer and electromyography recordings is introduced. Second, the tremor stability index (TSI) is determined to indicate the advantage of detecting TWs prior to analysis. Ten Parkinson’s disease (PD) patients, ten essential tremor (ET) patients, and ten healthy controls (HC) performed a resting, postural and movement task. Data was split into 3-s windows, and the power spectral density was calculated for each window. The relative power around the peak frequency with respect to the power in the tremor band was used to classify the windows as either tremor or non-tremor. The method yielded a specificity of 96.45%, sensitivity of 84.84%, and accuracy of 90.80% of tremor detection. During tremors, significant differences were found between groups in all three parameters. The results suggest that the introduced method could be used to determine under which conditions and to which extent undiagnosed patients exhibit tremors.
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Garcia, Lawrence George P., and Raymond L. Rosales. "Botulinum Neurotoxin A for Hand Tremors in Parkinson’s Disease: A Meta-Analytic Study." Journal of Medicine, University of Santo Tomas 6, no. 1 (April 30, 2022): 814–22. http://dx.doi.org/10.35460/2546-1621.2020-0018.
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Background: Resting tremor is a prominent cardinal motor symptom of Parkinson’s disease (PD). In some cases, the tremor may be refractory to dopaminergic and anticholinergic treatment. Multiple studies were previously done to evaluate the effectiveness of Botulinum Neurotoxin A (BoNT/A) with essential tremors and dystonia, but data regarding its use on tremors of PD is still lacking. Objective: This meta-analytic study aims to determine the effectiveness of BoNT/A in treating tremors of patients with PD. Data Sources: Researches were searched at PubMed, ScienceDirect and EBSCO Host. Review Methods: Articles on the effect of BoNT/A on PD hand tremors were searched. Studies and data pertaining to non-PD tremors like essential tremors excluded in the analysis due to difference in pathophysiology. Standardized mean difference was used as the effect measure and was computed with Review Manager version 5.4 software. Results: Three open label studies were used for final analysis in this study. Studies included are those pertaining to tremors due to PD. Pooled estimates showed a significant change in decreasing tremor score after BoNT/A injection. Conclusion: Botulinum Toxin A injections can be used to manage PD tremors effectively. Keywords: Botulinum neurotoxin A, Botox A, Btx, tremors, Parkinson’s disease
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Radović, Klara, and Vladimira Vuletić. "Dubinska mozgovna stimulacija i esencijalni tremor u pacijenta starije dobi s izraženom atrofijom mozga." Medicina Fluminensis 58, no. 2 (June 1, 2022): 177–82. http://dx.doi.org/10.21860/medflum2022_275139.
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Cilj: Prikazati slučaj pacijenta s medikamentozno refrakternim esencijalnim tremorom kod kojega je duboka mozgovna stimulacija dovela do uspješne kontrole tremora i značajno popravila kvalitetu života unatoč starijoj dobi, izraženoj atrofiji mozga, perioperacijskim i poslijeoperacijskim komplikacijama. Prikaz slučaja: Muškarac u dobi od 72 godine došao je na drugo mišljenje zbog dugogodišnjeg bilateralnog tremora ruku, vođenog kao Parkinsonova bolest, koji mu je onemogućavao svakodnevno funkcioniranje. Fizikalnim i neurološkim pregledom utvrđen je posturalni i akcijski tremor, bez bradikineze i povišenog tonusa. Magnetska rezonancija mozga pokazala je atrofiju, a Dopamin Active Transfer scan i laboratorijske pretrage bili su uredni. Postavljena je dijagnoza esencijalnog tremora. Tijekom dvije godine pacijent je u terapiji uzimao propranolol, klonazepam, primidon te topiramate, što nije pokazalo učinka. Detaljnom evaluacijom multidisciplinarnog tima indicirana je duboka mozgovna stimulacija ventralne intermedijarne jezgre talamusa bilateralno. Međutim, dok je donosio odluku o zahvatu, u godinu dana pacijent se kognitivno pogoršao. Stanje se intraoperacijski kompliciralo visokim vrijednostima krvnog tlaka. Poslije operacije pacijent je bio smeten, s halucinacijama, što je najvjerojatnije uzrokovano hipertenzivnom encefalopatijom. Za vrijeme boravka na klinici modificirani su stimulacijski parametri i određena je kronična medikamentozna terapija. Unatoč pokazateljima da konačni ishod duboke mozgovne stimulacije možda neće biti dobar, tremor je manji i kvaliteta života ovog pacijenta značajno je bolja. Zaključak: U razmatranju pacijenta za duboku mozgovnu stimulaciju nužna je temeljita individualna multidisciplinarna evaluacija. Pažljivim perioperacijskim i poslijeoperacijskim praćenjem i prilagođavanjem stimulacija uz ispravno medikamentozno vođenje može se povoljno utjecati na ishode duboke mozgovne stimulacije kod rizičnih pacijenata. Za vrijeme operacije treba strogo kontrolirati krvni tlak jer on može uvelike zakomplicirati stanje.
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CAVALLAZI, LUIS OTÁVIO, SUSANA NUNES MACHADO, PAULO MATOSINHO, and FABRÍCIO J. PIO. "Tremor ortostático primário: relato de quatro casos." Arquivos de Neuro-Psiquiatria 58, no. 1 (March 2000): 146–49. http://dx.doi.org/10.1590/s0004-282x2000000100022.
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Relatamos quatro casos de tremor ortostático primário. O motivo do relato está na raridade da doença e no seu diagnóstico diferencial com outros tremores, muitas vezes confuso. Nossos casos foram estudados eletrofisiologicamente e a frequência dos tremores variou entre 15 e 20 Hz. Existem diferenças clínicas, eletrofisiológicas e terapêuticas entre o tremor ortostático primário e outros tremores de membros inferiores, de acordo com a literatura e com as características de nossos quatro casos.
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Fujikawa, Joji, Ryoma Morigaki, Nobuaki Yamamoto, Hiroshi Nakanishi, Teruo Oda, Yuishin Izumi, and Yasushi Takagi. "Diagnosis and Treatment of Tremor in Parkinson’s Disease Using Mechanical Devices." Life 13, no. 1 (December 27, 2022): 78. http://dx.doi.org/10.3390/life13010078.
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Background: Parkinsonian tremors are sometimes confused with essential tremors or other conditions. Recently, researchers conducted several studies on tremor evaluation using wearable sensors and devices, which may support accurate diagnosis. Mechanical devices are also commonly used to treat tremors and have been actively researched and developed. Here, we aimed to review recent progress and the efficacy of the devices related to Parkinsonian tremors. Methods: The PubMed and Scopus databases were searched for articles. We searched for “Parkinson disease” and “tremor” and “device”. Results: Eighty-six articles were selected by our systematic approach. Many studies demonstrated that the diagnosis and evaluation of tremors in patients with PD can be done accurately by machine learning algorithms. Mechanical devices for tremor suppression include deep brain stimulation (DBS), electrical muscle stimulation, and orthosis. In recent years, adaptive DBS and optimization of stimulation parameters have been studied to further improve treatment efficacy. Conclusions: Due to developments using state-of-the-art techniques, effectiveness in diagnosing and evaluating tremor and suppressing it using these devices is satisfactorily high in many studies. However, other than DBS, no devices are in practical use. To acquire high-level evidence, large-scale studies and randomized controlled trials are needed for these devices.
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Camargos, Ana Cristina Resende, Nathália Melo Silva, Ana Flávia Souza Pascoal, and Karoline Tury Mendonça. "ASSOCIAÇÃO ENTRE FATORES CLÍNICOS E MOVIMENTOS GERAIS COM TREMORES EM RECÉM-NASCIDOS PRETERMO NA UNIDADE DE TERAPIA INTENSIVA NEONATAL." Movimenta (ISSN 1984-4298) 15, no. 2 (September 8, 2022): e2022024. http://dx.doi.org/10.31668/movimenta.v15i2.13046.
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Objetivo: Identificar e caracterizar a ocorrência de tremores e explorar a associação entre fatores clínicos e movimentos gerais com o número de membros acometidos e o tempo de tremor em recém-nascidos pretermo (RNPT) de uma Unidade de Terapia Intensiva Neonatal (UTIN). Métodos: Foi realizado um estudo transversal em uma UTIN com 26 leitos, com internação média anual de 120 RNPT. Os tremores foram identificados por observação de vídeos dos recém-nascidos, registrando-se o número de membros acometidos e o tempo máximo de tremor. Os fatores clínicos foram registrados a partir dos prontuários e a classificação dos movimentos gerais foi dicotomizada nas categorias normal e anormal, através da General Movements Assessment. A associação entre as variáveis foi verificada pelo teste de correlação de Spearman. Resultados: Foram avaliados 29 RNPT. Todos apresentaram tremor na 36a semana de idade gestacional. Foi verificada associação significativa entre o número de membros que apresentavam tremor e o uso de fenobarbital (rho=0,51; p=0,005) e entre o tempo de tremor e a classificação anormal dos movimentos gerais (rho=0,47; p=0,01). Conclusão: O uso de fenobarbital e a classificação anormal dos movimentos gerais foram associados às características dos tremores em RNPT da UTIN, o que endossa a importância de avaliar os movimentos gerais em lactentes com tremores e de realizar mais estudos para investigar o efeito do uso de medicações nessa população.
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Zhang, Manyu, Wei Li, Lan Hu, Li Chen, Liu Yang, Tian Zhang, Hui Shen, et al. "Oral propranolol for treatment of the subgroups of essential tremor: a systematic review and meta-analysis protocol." BMJ Open 10, no. 1 (January 2020): e032096. http://dx.doi.org/10.1136/bmjopen-2019-032096.
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IntroductionEssential tremor (ET), a tremor disorder, is one of the most common movement disorders. Only oral drugs (propranolol, primidone, topiramate, etc）are still the first-line treatment recommended by the Food and Drug Administration. Propranolol is thought to potentially reduce upper limb action tremor. However, it has a poor effect on axial tremor symptoms, such as essential head tremor and voice tremor. Studies have shown that tremor severity develops over time, possibly producing other clinical tremors and neurological soft signs (such as memory loss, gait abnormalities, balance disorders, etc), which further increases the difficulty of treating tremors. However, some recent studies provide emerging evidence for oral propranolol on subgroups of ET, which is based on the anatomical distribution of ET (lower extremities, head, sound, tongue, etc). This systematic review aims to synthesise these new data to improve the efficacy of propranolol in ET subgroups.Methods and analysisWe will search for randomised controlled trials from the PubMed, MEDLINE, EMBASE, Cochrane Library, UptoDate and PEDro databases from inception to June 2019. All data will be extracted independently by two reviewers and compared at the end of the review. The two reviewers will screen the study quality, and the Cochrane Collaboration’s tool in Review Manager (RevMan) V.5.3.3 will be used to evaluate risk of bias. Our primary outcome will be the functional disability component related to tremors, as measured by the Fahn-Tolosa-Marin Tremor Rating Scale subscales B and C. Secondary outcomes will include severity of tremors and quality of life. Narrative and meta-analytical syntheses are planned.Ethics and disseminationPublished aggregated data will be used in this review analysis and therefore no ethical approval is required. The results will be published in peer-reviewed journals, and proliferation activities will include diverse social stakeholders, non-academic groups and patients.PROSPERO registration numberCRD42018112580
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Nagaseki, Yoshishige, Tohru Shibazaki, Tatsuo Hirai, Yasuhiro Kawashima, Masafumi Hirato, Hirochiyo Wada, Mizuho Miyazaki, and Chihiro Ohye. "Long-term follow-up results of selective VIM-thalamotomy." Journal of Neurosurgery 65, no. 3 (September 1986): 296–302. http://dx.doi.org/10.3171/jns.1986.65.3.0296.
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✓ The authors report the results of a long-term follow-up study of the effects of the physiologically defined selective VIM (nucleus ventralis intermedius)-thalamotomy on tremor of Parkinson's disease in 27 patients and essential tremor in 16 patients. The follow-up period ranged from 3.25 to 10 years (mean 6.58 years). In 43 patients a total of 50 operations (including four bilateral operations and three reoperations) were carried out. The early (2 to 4 weeks after surgery) and late effects on the tremors were determined clinically and electromyographically. Fourteen parkinsonian cases were treated with minimal lesions (about 40 cu mm). Their late results were very similar to the early results: in 10, the tremors were completely abolished, three had a slight residual tremor, and one underwent reoperation 3 months after the first surgery. Eleven essential tremor cases were treated with minimal lesions. Six of these tremors were completely abolished, four patients had slight residual tremors, and one patient with a recurrence underwent reoperation 2 years after the initial surgery. In these 23 successful operations with minimal lesions (excluding two cases with reoperation), the tremor was abolished without discernible long-lasting side effects. The other 23 operations on 16 patients with Parkinson's disease (including one reoperation) and on seven with essential tremor (one of whom also had a minimal lesion on the other side) involved relatively large lesions. In this group, the surgery was successful in almost every case. It was concluded that radiographically and physiologically monitored selective VIM-thalamotomy for parkinsonian and essential tremor is effective even when lesioning is minimal. Moreover, the beneficial effect is maintained over a long period of time.
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Mitsui, Yuichi, Thi Thi Zin, Nobuyuki Ishii, and Hitoshi Mochizuki. "Imaging Tremor Quantification for Neurological Disease Diagnosis." Sensors 20, no. 22 (November 22, 2020): 6684. http://dx.doi.org/10.3390/s20226684.
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In this paper, we introduce a simple method based on image analysis and deep learning that can be used in the objective assessment and measurement of tremors. A tremor is a neurological disorder that causes involuntary and rhythmic movements in a human body part or parts. There are many types of tremors, depending on their amplitude and frequency type. Appropriate treatment is only possible when there is an accurate diagnosis. Thus, a need exists for a technique to analyze tremors. In this paper, we propose a hybrid approach using imaging technology and machine learning techniques for quantification and extraction of the parameters associated with tremors. These extracted parameters are used to classify the tremor for subsequent identification of the disease. In particular, we focus on essential tremor and cerebellar disorders by monitoring the finger–nose–finger test. First of all, test results obtained from both patients and healthy individuals are analyzed using image processing techniques. Next, data were grouped in order to determine classes of typical responses. A machine learning method using a support vector machine is used to perform an unsupervised clustering. Experimental results showed the highest internal evaluation for distribution into three clusters, which could be used to differentiate the responses of healthy subjects, patients with essential tremor and patients with cerebellar disorders.
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Röösli, Claudia, Fabian Walter, Stephan Husen, Lauren C. Andrews, Martin P. Lüthi, Ginny A. Catania, and Edi Kissling. "Sustained seismic tremors and icequakes detected in the ablation zone of the Greenland ice sheet." Journal of Glaciology 60, no. 221 (2014): 563–75. http://dx.doi.org/10.3189/2014jog13j210.
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AbstractDuring summer 2011, seismic activity in the ablation zone of the western Greenland ice sheet (GrIS) was monitored using a network of three-component seismometers. The seismic record includes a large variety of icequakes and seismic tremors that demonstrate a clear correlation with subglacial water flow. We verified the existence of well-known shallow icequakes (related to surface crevasse formation), deep icequakes (located at 100–160 m depth) and narrow-banded short-term seismic tremors (tens of seconds in duration). In addition, we present previously unreported long-term tremors lasting several hours. Using attenuation of the measured tremor amplitude, we locate the epicentre of this long-term tremor to a large moulin within our study area. Between 3 and 11 Hz, our continuous seismic record is dominated by this ‘moulin tremor’ and shows strong correlation with the water level of the generating moulin. We argue that monitoring of icequake and glacial tremor sources bears high potential for investigating glacier hydraulics and dynamics, and is thus an ideal supplement to traditional glaciological measurements.
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Murata, Jun-ichi, Mayumi Kitagawa, Haruo Uesugi, Hisatoshi Saito, Yoshinobu Iwasaki, Seiji Kikuchi, Kunio Tashiro, and Yutaka Sawamura. "Electrical stimulation of the posterior subthalamic area for the treatment of intractable proximal tremor." Journal of Neurosurgery 99, no. 4 (October 2003): 708–15. http://dx.doi.org/10.3171/jns.2003.99.4.0708.
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Object. Tremors, including its proximal component, are often refractory to standard thalamic surgery. In the 1960s the posterior part of the subthalamic white matter was reported to be a promising target in treating various forms of tremor, but was also found to be associated with adverse effects. Advances involving a less invasive method, that is, deep brain stimulation (DBS), has led to a reappraisal of this target. Methods. Eight patients with severe essential tremor involving the proximal arm were treated using unilateral stimulation of the posterior part of the subthalamic white matter. The tentative target was situated in the area lateral to the red nucleus and posteromedial to the subthalamic nucleus. Macrostimulation was used to find the optimal site to suppress tremor. Through a quadripolar DBS lead, somatosensory evoked potentials (SSEPs) were recorded. Improvement of tremor was evaluated based on a modified clinical tremor rating scale. Anatomical locations of all contacts were assessed using stereotactic guidance and represented on the Schaltenbrand—Wahren atlas. Conclusions. A characteristic diphasic pattern of SSEPs reaffirmed the electrophysiological endorsement of this target. Tremors, both proximal and distal, were remarkably improved in all patients. The rate of improvement, as indicated by the total tremor score, was a mean of 81%. Axial tremors in the legs and head were also improved. Most of the contacts associated with remarkable improvement were located in the posterior part of the subthalamic white matter (the zona incerta and prelemniscal radiation). Neither major complications nor neurological deterioration was observed. The authors concluded that DBS of the posterior part of the subthalamic white matter together with SSEP recording is a safe and effective method to ameliorate severe intractable tremors.
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Pretzer-Aboff, Ingrid, R. K. Elswick, Amanda Watson, Minglong Sun, Woosub Jung, Ken Koltermann, Gang Zhou, and Leslie Cloud. "IMPACT OF VIBRATION ON TREMOR IN OLDER ADULTS WITH PARKINSON’S DISEASE." Innovation in Aging 6, Supplement_1 (November 1, 2022): 596. http://dx.doi.org/10.1093/geroni/igac059.2228.
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Abstract This was a randomized trial to explore the safety and efficacy of the RMBand (Resonate Forward LLC, Delaware) device to alleviate Parkinson’s Disease (PD) tremors. The RMBand applies vibration to the proximal arm and was worn on the side of tremor dominance. Thirty subjects with PD and associated tremors were randomized to receive high vs. low-frequency vibration. Tremor assessments occurred for 20 minutes before, during 20 minutes of continuous vibration, and for 20 minutes immediately post-vibration in a single 60-minute session. Assessments (MDS-UPDRS part 3 and FTM tremor scale) were performed during each of the 3 phases by blinded raters. A quantitative assessment of tremor was performed throughout the session using wearable sensors on the distal arms. Linear mixed models were used for group comparisons. No significant difference was observed between the high and low dose groups in the MDS-UPDRS part 3 or FTM tremor scale (p=0.83 and 0.48 respectively), which may be due to the crude nature of these scales. Quantitative wearable sensor data were used to assess total time with tremors during the pre-vibration, vibration, and post-vibration periods. Time with tremor during the pre-vibration period was significantly greater than that during and post-vibration (p< 0.0001) for both dose groups, suggesting that vibration therapy applied to the proximal arm may suppress PD tremor. No significant adverse events related to vibration therapy occurred. In conclusion, the RMBand appears safe and possibly effective for suppressing PD tremor. Further study is warranted.
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Zahed, Karim, Farzan Sasangohar, Ranjana Mehta, Madhav Erraguntla, Mark Lawley, and Khalid Qaraqe. "Investigating the Efficacy of Using Hand Tremors for Early Detection of Hypoglycemic Events: A Scoping Literature Review." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 62, no. 1 (September 2018): 1211–15. http://dx.doi.org/10.1177/1541931218621278.
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Diabetes is a prevalent condition affecting millions of patients globally. Some diabetic patients suffer from a deadly condition called Hypoglycemia (sudden drop in blood glucose levels). Continuous Glucose Monitors (CGMs) have been the most pervasive tool used to track blood glucose levels but these tools are invasive and costly. While early detection of hypoglycemia has been studied, current approaches do not leverage tremors; which are a primary symptom of hypoglycemia. A scoping review was conducted to understand the relationship between tremors and hypoglycemia, and to document any efforts that utilized tremor signatures non-invasively to detect hypoglycemic events. Findings suggest that hypoglycemic tremors are a medium frequency tremor, more resistant to hypoglycemic impairment than other symptoms, and have not been fully explored yet. This paper also documents the work in progress to utilize a novel wearable device that predicts the onsets of hypoglycemia using hand tremor sensing.
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Louis, Elan D., and Chris C. Palmer. "Tremble and tremor." Neurology 88, no. 7 (February 13, 2017): 706–10. http://dx.doi.org/10.1212/wnl.0000000000003576.
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Miskin, Chandrabhaga, and Karen S. Carvalho. "Tremors: Essential Tremor and Beyond." Seminars in Pediatric Neurology 25 (April 2018): 34–41. http://dx.doi.org/10.1016/j.spen.2018.02.002.
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Lukšys, Donatas, Gintaras Jonaitis, and Julius Griškevičius. "Quantitative Analysis of Parkinsonian Tremor in a Clinical Setting Using Inertial Measurement Units." Parkinson's Disease 2018 (June 21, 2018): 1–7. http://dx.doi.org/10.1155/2018/1683831.
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Background. Parkinson’s disease (PD) is a neurodegenerative disorder that affects human voluntary movements. Tremor is one of the most common symptoms of PD and is expressed as involuntary oscillation of the body. Tremors can be analysed in the frequency domain. Objective. The aim of the current study was to examine selected tremor parameters (frequency, root mean square, and approximated entropy) in order to quantify the characteristics of patients diagnosed with PD, compared to a healthy control group, and to compare the parameters by dividing the subjects according to UPDRS assessment. Methods. The subjects were divided into two groups: a group of people diagnosed with PD (n = 19) and a control group consisting of healthy volunteers (CO = 12). Each subject performed motor tasks specific to certain tremors: the finger-to-nose test. Each subject performed a motor task three times. A nine degree of freedom (DOF) wireless inertial measurement unit was used for the measurement of upper limb motor tasks. For the quantitative estimation of kinetic and postural tremors, dominant frequency, root means square, and approximation entropy were selected and calculated from the measured angular velocity and linear acceleration signals. A one-way ANOVA with a significance level of α = 0.05 was used to test the null hypothesis that the means of the tremor metrics were the same between the PD and CO groups. Results. Statistically significant differences between PD patients and control groups were observed in ApEn acceleration signal of kinetic tremor, ApEn angular velocity signal of kinetic tremor, ApEn angular velocity of postural tremor, frequency acceleration signal of postural tremor, and RMS angular speed kinetic tremor. Conclusion. Application of inertial measurement units for clinical research of patients and PD tremor evaluation allows providing quantitative information for diagnostic purposes, during screening in a clinical setting that differentiates between PD patients and controls.
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Fasano, Alfonso, Maheleth Llinas, Renato P. Munhoz, Eugen Hlasny, Walter Kucharczyk, and Andres M. Lozano. "MRI-guided focused ultrasound thalamotomy in non-ET tremor syndromes." Neurology 89, no. 8 (July 26, 2017): 771–75. http://dx.doi.org/10.1212/wnl.0000000000004268.
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Objective:To report the 6-month single-blinded results of unilateral thalamotomy with MRI-guided focused ultrasound (MRgFUS) in patients with tremors other than essential tremor.Methods:Three patients with tremor due to Parkinson disease, 2 with dystonic tremor in the context of cervicobrachial dystonia and writer's cramp, and 1 with dystonia gene–associated tremor underwent MRgFUS targeting the ventro-intermedius nucleus (Vim) of the dominant hemisphere. The primary endpoint was the reduction of lateralized items of the Tremor Rating Scale of contralateral hemibody assessed by a blinded rater.Results:All patients achieved a statistically significant, immediate, and sustained improvement of the contralateral tremor score by 42.2%, 52.0%, 55.9%, and 52.9% at 1 week and 1, 3, and 6 months after the procedure, respectively. All patients experienced transient side effects and 2 patients experienced persistent side effects at the time of last evaluation: hemitongue numbness and hemiparesis with hemihypoesthesia.Conclusions:Vim MRgFUS is a promising, incision-free, but nevertheless invasive technique to effectively treat tremors other than essential tremor. Future studies on larger samples and longer follow-up will further define its effectiveness and safety.Clinicaltrials.gov identifier:NCT02252380.Classification of evidence:This study provides Class IV evidence that for patients with tremor not caused by essential tremor, MRgFUS of the Vim improves the tremor of the contralateral hemibody at 6 months.
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Shelan Khudhur Saleh, Saleem Lateef Mohammed, and Ali Al-Askery. "A Review of Techniques Used to Suppress Tremor." Journal of Techniques 4, no. 4 (December 31, 2022): 61–70. http://dx.doi.org/10.51173/jt.v4i4.774.
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The most frequent movement disorder is Tremor, which has an increased incidence and prevalence in people over 65 who have Parkinson's disease or essential tremors. Although not life-threatening, it prevents patients from performing their daily activities. An overview of different types of tremors and their treatment in medical and surgical views are discussed in this paper with a review of the stimulation nerves and muscles technique. Then a look at tremor detection and measurement methods are considered with a review of the medical devices' mechanism of action that is placed as a substitute treatment for patients that have a low response to medications and surgical treatment to provide effective and safe tremor suppression.
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Griškevičius, Julius, and Jurgita Žižienė. "RESEARCH OF UPPER LIMB BIOMECHANICS OF SUBJECTS WITH PARKINSON‘S DISEASE AND ESSENTIAL TREMMOR / SERGANČIŲJŲ PARKINSONO IR ESENCIALINIO TREMORO LIGA VIRŠUTINĖS GALŪNĖS BIOMECHANIKOS TYRIMAS." Mokslas - Lietuvos ateitis 5, no. 6 (December 31, 2013): 587–90. http://dx.doi.org/10.3846/mla.2013.93.
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Parkinson’s disease (PD) is a common neurodegenerative diseasewith symptoms of bradykinesia, rest tremor, rigidity and posturalinstability. PL is diagnosed by a clinician who qualitativelyevaluates patient’s visible symptoms during a physical exam. Inaddition, differentiating PD from essential tremor (ET) can bechallenging because their clinical symptoms are similar. Oncediagnosed, only qualitative tools such as the UPDRS are availableto monitor symptom severity and disease progression. Thepurpose of this study is to evaluate the changes of biomechanicalparameters of upper limb of subjects diagnosed either PD or ET,estimate differences and compare them with healthy subjectsin facilitate a creation of an additional instrumental clinical assessmentof PD subjects via biomechanical evaluation of motorfunction tool and develop methods and indices for differentiatingPD from ET. Santrauka Parkinsono liga (PL) yra lėtinė progresuojanti neurologinė liga, kuri išoriškai pasireiškia galvos bei galūnių drebėjimu, judesių sulėtėjimu, sukaustymu ir eisenos pasikeitimu. Esencialinis tremoras – laipsniškai progresuojanti liga, kuriai būdingas nevalingas kūno dalies drebėjimas. Tai daug dažnesnė būklė negu PL judėjimo sutrikimas. Neretai ankstyvoje ligos stadijoje šios abi patologinės būklės yra painiojamos. Šio straipsnio tikslas yra įvertinti žmonių, sergančių Parkinsono liga ir esencialiniu tremoru, viršutinės galūnės biomechanikos parametrų pokyčius, skirtumus ir palyginti juos su sveiko žmogaus viršutinės galūnės biomechanika.
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Menezes, Krishe, Milind Deogaonkar, and Vatsal Bajpai. "Vim stimulation as a predictor of response to deep brain stimulation in patients of severe tremor undergoing dual stimulation." Translation: The University of Toledo Journal of Medical Sciences 2 (June 27, 2018): 7–10. http://dx.doi.org/10.46570/utjms.vol2-2015-103.
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Deep brain stimulation, targeting the ventral intermediate nucleus of the thalamus (Vim), has been shown to be an effective management tool for tremors refractory to other therapies. There is some variance in response to Vim stimulation for severe essential and rubral tremors. This study looked at dual stimulations (addition, in which the Vim is stimulated along with an additional nucleus or augmentation, in which a second lead is placed within the Vim itself) for these types of tremors. A total of eight patients, four with rubral and four with severe essential tremors, were treated with deep brain stimulation. The responses of the patients were characterized on a scale from excellent improvement to worsening of condition. Two of the four patients with rubral tremor had an excellent response to Vim stimulation. These patients showed additional benefits when the prelemniscal radiation (Raprl) was stimulated, in addition to the Vim. Three of the four patients with severe essential tremor reported either a good or excellent response to Vim stimulation. One of these patients had the Raprl stimulated in addition to the Vim while another had an augmentation of the Vim, with ventralis oralis posterior (Vop) stimulation. Both showed additional benefits with the addition or augmentation performed. We conclude that if a patient with severe medically refractory tremor (essential or rubral tremor) responds to Vim stimulation but is still disabled he will likely also have a response to dual stimulation with an additional lead in the Raprl or an augmentation with an additional lead in the Vop. Patients who did not initially respond to Vim stimulation did not respond to the placement of a second lead. We also conclude that for severe essential tremor, Raprl stimulation showed a better response than Vim stimulation.
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Grimes, D. A. "Tremor - Easily Seen but Difficult to Describe and Treat." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 30, S1 (February 2003): S59—S63. http://dx.doi.org/10.1017/s0317167100003255.
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Tremor is a common movement disorder yet many physicians struggle with its terminology as well as with its treatment. Attempts have been made to develop standard terminology and criteria for tremors but this process continues to evolve. In this review, a summary of the currently-proposed phenomenology and syndromic classification of all types of tremor is presented. The diagnosis and management of essential tremor is presented in more detail, as it is the most commonly encountered tremor.
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Kreiman, Jody, Brian Gabelman, and Bruce R. Gerratt. "Perception of Vocal Tremor." Journal of Speech, Language, and Hearing Research 46, no. 1 (February 2003): 203–14. http://dx.doi.org/10.1044/1092-4388(2003/016).
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Vocal tremors characterize many pathological voices, but acoustic-perceptual aspects of tremor are poorly understood. To investigate this relationship, 2 tremor models were implemented in a custom voice synthesizer. The first modulated fundamental frequency (F0) with a sine wave. The second provided irregular modulation. Control parameters in both models were the frequency and amplitude of the F0 modulating waveform. Thirty-two 1-s samples of /a/, produced by speakers with vocal pathology, were modeled in the synthesizer. Synthetic copies of each vowel were created by using tremor parameters derived from different features of F0 versus time plots of the natural stimuli or by using parameters chosen to match the original stimuli perceptually. Listeners compared synthetic and original stimuli in 3 experiments. Sine wave and irregular tremor models both provided excellent matches to subsets of the voices. The perceptual importance of the shape of the modulating waveform depended on the severity of the tremor, with the choice of tremor model increasing in importance as the tremor increased in severity. The average frequency deviation from the mean F0 proved a good predictor of the perceived amplitude of a tremor. Differences in tremor rates were easiest to hear when the tremor was sinusoidal and of small amplitude. Differences in tremor rate were difficult to judge for tremors of large amplitude or in the context of irregularities in the pattern of frequency modulation. These results suggest that difference limens are larger for modulation rates and amplitudes when the tremor pattern is complex. Further, tremor rate, regularity, and amplitude interact, so that the perceptual importance of any one dimension depends on values of the others.
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HEO, JAE-HOON, HYEONG-MIN JEON, EUI-BUM CHOI, DO-YOUNG KWON, and GWANG-MOON EOM. "EFFECT OF SENSORY ELECTRICAL STIMULATION ON RESTING TREMORS IN PATIENTS WITH PARKINSON’S DISEASE AND SWEDDs." Journal of Mechanics in Medicine and Biology 19, no. 07 (November 2019): 1940033. http://dx.doi.org/10.1142/s0219519419400335.
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Patients with scans without evidence of dopaminergic deficits (SWEDDs) show symptoms (e.g., tremors) similar to those of Parkinson’s disease (PD) patients, so they are often misdiagnosed. Sensory electrical stimulation (SES) was reported to suppress essential tremor in patients, but SES was never applied to patients with PD and SWEDDs. As the pathophysiological mechanisms of PD and SWEDDs are likely to be different, we hypothesized that the effect of SES would also be different in the two patient groups. This study aimed to test that hypothesis. Fourteen patients with PD and nine with SWEDDs participated in this study. Three wrist muscles were stimulated for 15[Formula: see text]s using SES with a stimulation intensity lower than the motor threshold. Angular motion of the index finger was measured via a triaxial gyrosensor before, during, and after stimulation. Outcome measures included the amplitude and peak frequency of the angular motion of the index finger. Tremor amplitude decreased during and after SES in patients with PD ([Formula: see text]). However, tremor amplitudes during and after SES were not different from the base level in SWEDDs patients. The peak frequency of tremors temporarily decreased during stimulation in PD patients, but not in SWEDDs patients. SES suppressed tremors in patients with PD, but not with SWEDDs. The results could help understand the pathophysiological differences of tremors between PD and SWEDDs.
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Louis, Elan D. "Essential tremor: a nuanced approach to the clinical features." Practical Neurology 19, no. 5 (July 4, 2019): 389–98. http://dx.doi.org/10.1136/practneurol-2018-002183.
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Essential tremor is the most common form of tremor in humans. Given neurologists’ high exposure to this condition, and its seemingly straightforward phenotype, it might seem easy to diagnose. However, 30%–50 % of patients labelled as having ‘essential tremor’ have other diagnoses, mostly Parkinson’s disease and dystonia. The tremor of essential tremor is neither non-descript nor featureless but is multifaceted and highly patterned. This review focuses on its clinical features, beginning with a discussion of tremors and then briefly discussing its additional motor features, and presents several aids to help distinguish essential tremor from Parkinson’s disease and dystonia. Careful attention to certain clinical nuances will aid the diagnosis and care of patients with essential tremor.
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Pereira, João S., Maria Lúcia V. Pimentel, and Denise H. Nicaretta. "Essential tremor: clinical observations." Arquivos de Neuro-Psiquiatria 51, no. 3 (September 1993): 337–40. http://dx.doi.org/10.1590/s0004-282x1993000300008.
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The authors have studied 53 patients with essential tremor, focusing its clinical and epidemiological aspects. There were familial history in 37.70% of all cases, prevailing in females (56.60%) and white people (69.80%); nevertheless this difference can not be assured from the statistical point of view due to lack of population data. We agreed that the main incidence of this syndrome occurred beyond the 5th decade, specially during the 6th and 7th decades. Topographically, we could observe that the hand tremor predominated, with an incidence of 96.20% of the total number of cases, followed by head tremor (28.30%), voice tremor (16.99%), leg tremor (11.30%), tongue tremor (3.78%) and trunk tremor (1.88%). These focal tremors were seldom observed alone and we noted frequent association with hand tremor.
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Souza, Ricardo de Oliveira, and Sergio Antonio Ribeiro. "Tremor ortostático." Arquivos de Neuro-Psiquiatria 45, no. 3 (September 1987): 324–28. http://dx.doi.org/10.1590/s0004-282x1987000300013.
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Tremor ortostático (TO) é v.m novo tipo de tremor, irregular e de alta freqüência, recentemente descrito, que afeta grupamentos musculares antagonistas nos membros inferiores, desde que seja mantida a postura ereta. Descrevemos dois novos casos deste tipo peculiar de tremor, que pode não ser tão incomum quanto até então suposto. Enfatizamos suas principais características diagnosticas e semiológicas. O TO pode compartilhar algum mecanismo fisiopatológico básico com os tremores da variedade heredofamilial essencial clássica.
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Gebai, Sarah, Mohammad Hammoud, Gwendal Cumunel, Gilles Foret, Emmanuel Roze, and Elodie Hainque. "Experimental Testing of Passive Linear TMD for Postural Tremor Attenuation." Applied Sciences 11, no. 21 (October 20, 2021): 9809. http://dx.doi.org/10.3390/app11219809.
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Research interest to provide a mechanical solution for involuntary tremors is increasing due to the severe side effects caused by the medications used to lessen its symptoms. This paper deals with the design of a cantilever-type tuned mass damper (TMD) used to prove the effectiveness of passive controllers in reducing the involuntary tremor’s vibrational signals transmitted by the muscles to the hand segment. TMD is tested on an experimental arm, reflecting the flexion-extension motion of the wrist, excited by a mechanical shaker with the measured tremor signal of a patient with essential tremor. The designed TMD provides a new operational frequency for each position of the screw fixed to its beam. Modal damping ratios are also calculated using different methods for each position. The effectiveness of the TMD is quantified by measurements using a vibrometer and inertial measurement unit. Three TMDs, representing 15.7% total mass ratio, cause a reduction of 29% for the acceleration, 69% for the velocity, 79% for the displacement, 67% for the angular velocity, and 82% for the angular displacement signals. These encouraging results will allow the improvement of the design of the passive controller in the form of a wearable bracelet suitable for daily life.
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Samotus, Olivia, Jack Lee, and Mandar Jog. "Developing a Consistent, Reproducible Botulinum Toxin Type A Dosing Method for Upper Limb Tremor by Kinematic Analysis." Toxins 13, no. 4 (April 8, 2021): 264. http://dx.doi.org/10.3390/toxins13040264.
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Botulinum toxin type A (BoNT-A) injection patterns customized to each patient’s unique tremor characteristics produce better efficacy and lower adverse effects compared to the fixed-muscle-fixed-dose approach for Essential Tremor (ET) and Parkinson’s disease (PD) tremor therapy. This article outlined how a kinematic-based dosing method to standardize and customize BoNT-A injections for tremors was developed. Seven ET and eight PD participants with significant tremor reduction and minimal perceived weakness using optimized BoNT-A injections determined by clinical and kinematic guidance were retrospectively selected to develop the kinematic-based dosing method. BoNT-A dosages allocated per joint were paired to baseline tremor amplitudes per joint. The final kinematic-based dosing method was prospectively utilized to validate BoNT-A injection pattern selection without clinical/visual assessments in 31 ET and 47 PD participants with debilitating arm tremors (totaling 122 unique tremor patterns). Whole-arm kinematic tremor analysis was performed at baseline and 6-weeks post-injection. Correlation and linear regression analyses between baseline tremor amplitudes and the change in tremor amplitude 6-weeks post-injection, with BoNT-A dosages per joint, were performed. Injection patterns determined using clinical assessment and interpretation of kinematics produced significant associations between baseline tremor amplitudes and optimized BoNT-A dosages in all joints. The change in elbow tremor was only significantly associated with the elbow total dose as the change in the wrist and shoulder tremor amplitudes were not significantly associated with the wrist and shoulder dosages from the selected 15 ET and PD participants. Using the kinematic-based dosing method, significant associations between baseline tremor amplitudes and the change (6-weeks post-first treatment) in tremor at each joint with BoNT-A dosages for all joints was observed in all 78 ET and PD participants. The kinematic-based dosing method provided consistency in dose selection and subsequent tremor reduction and can be used to standardize tremor assessments for whole-arm tremor treatment planning.
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Caramalac, S. M., S. M. Caramalac, F. O. Frazílio, and M. I. P. Palumbo. "Tremor de cabeça idiopático em cães - relato de dois casos." Arquivo Brasileiro de Medicina Veterinária e Zootecnia 70, no. 6 (December 2018): 1731–35. http://dx.doi.org/10.1590/1678-4162-10276.
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RESUMO Tremor de cabeça idiopático é uma forma de discinesia paroxística reconhecida como hereditária e associada a determinadas raças, sendo relatado, sobretudo, em Buldogue Inglês, Dobermann Pinscher e Boxer. Conhecido também como head bobbing ou tremor de cabeça episódico, os cães acometidos apresentam crises caracterizadas por tremores limitados à região de cabeça, de direção horizontal, vertical ou ambos, sendo geralmente relacionados a um evento desencadeante. Foram atendidos, no Hospital Veterinário da UFMS, dois caninos da raça Buldogue Inglês (um macho de um ano e uma fêmea de sete meses) com histórico de tremores episódicos restritos à região de cabeça. Exames físicos e neurológicos completos foram realizados, não sendo constatada qualquer alteração. Com base na raça, no histórico, na ausência de outros sinais clínicos e na exclusão de outras causas de tremores, foi dado o diagnóstico de head bobbing. Tal enfermidade caracteriza-se por tremores restritos à região de cabeça, associados a uma condição genética benigna. Não é considerada uma forma de convulsão, uma vez que o animal permanece alerta e responsivo aos estímulos ambientais, os tremores podem ser interrompidos por distrações ou qualquer interação com o ambiente, não sendo responsivos à terapia com anticonvulsivantes. De acordo com a revisão de literatura realizada, estes são os primeiros casos diagnosticados e relatados no Brasil.
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Ferenčík, Norbert, Miroslav Jaščur, Marek Bundzel, and Filippo Cavallo. "The Rehapiano—Detecting, Measuring, and Analyzing Action Tremor Using Strain Gauges." Sensors 20, no. 3 (January 24, 2020): 663. http://dx.doi.org/10.3390/s20030663.
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We have developed a device, the Rehapiano, for the fast and quantitative assessment of action tremor. It uses strain gauges to measure force exerted by individual fingers. This article verifies the device’s capability to measure and monitor the development of upper limb tremor. The Rehapiano uses a precision, 24-bit, analog-to-digital converter and an Arduino microcomputer to transfer raw data via a USB interface to a computer for processing, database storage, and evaluation. First, our experiments validated the device by measuring simulated tremors with known frequencies. Second, we created a measurement protocol, which we used to measure and compare healthy patients and patients with Parkinson’s disease. Finally, we evaluated the repeatability of a quantitative assessment. We verified our hypothesis that the Rehapiano is able to detect force changes, and our experimental results confirmed that our system is capable of measuring action tremor. The Rehapiano is also sensitive enough to enable the quantification of Parkinsonian tremors.
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Gieler, U., and M. Henning. "Essenzieller Tremor zwischen Klinefelter-Syndrom und Konflikt." Nervenheilkunde 33, no. 06 (2014): 468–71. http://dx.doi.org/10.1055/s-0038-1627693.
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ZusammenfassungEine mögliche Assoziation von Klinefelter-Syndrom und essenziellem Tremor legten wenige Kasuistiken nahe. Wir geben eine Übersicht über die Publikationen von Fallberichten zur Prävalenz des essenziellen Tremors bei Patienten mit Klinefelter-Syndrom, zu den tremorverstärkenden Faktoren und zur Substitutionsbehandlung mit Testosteron bei Klinefelter-Syndrom sowie zur Behandlung des Tremors durch Entspannungsverfahren und Biofeedback. Wir stellen den Fall eines Patienten mit essenziellem Tremor vor, der vergesellschaftet ist mit einem von dem Patienten verleugneten Klinefelter-Syndrom und einer Migräne. Eine stationäre psychosomatische Komplexbehandlung mit tiefenpsychologisch fundierter Psychotherapie half dem Patienten, die hinter den tremorverstärkenden Affekten stehende Psychodynamik zu erarbeiten und so mehr Akzeptanz für die Erkrankung und mehr Kontrolle über die Symptomatik zu erreichen, sodass es zu tremorfreien Intervallen von mehreren Stunden kam.
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Obwegeser, Alois A., Ryan J. Uitti, Robert J. Witte, John A. Lucas, Margaret F. Turk, and Robert E. Wharen. "Quantitative and Qualitative Outcome Measures after Thalamic Deep Brain Stimulation to Treat Disabling Tremors." Neurosurgery 48, no. 2 (February 1, 2001): 274–84. http://dx.doi.org/10.1097/00006123-200102000-00004.
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Abstract OBJECTIVE We studied outcome measures after unilateral and bilateral thalamic stimulation to treat disabling tremor resulting from essential tremor and Parkinson's disease. The surgical technique, qualitative and quantitative tremor assessments, stimulation parameters, locations of active electrodes, complications, and side effects are described and analyzed. METHODS Forty-one patients with essential tremor or Parkinson's disease underwent implantation of 56 thalamic stimulators. Preoperative qualitative and quantitative tremor measurements were compared with those obtained after unilateral and bilateral surgery, with activated and deactivated stimulators. Stimulation parameters and stimulation-related side effects were recorded, and outcome measures were statistically analyzed. RESULTS Qualitative measurements demonstrated significant improvement of contralateral upper-limb (P < 0.001), lower-limb (P < 0.01), and midline (P < 0.001) tremors after unilateral surgery. Ipsilateral arm tremor also improved (P < 0.01). No differences were observed with the Purdue pegboard task. Quantitative accelerometer measurements were correlated with qualitative assessments and confirmed improvements in contralateral resting (P < 0.001) and postural (P < 0.01) tremors and ipsilateral postural tremor (P < 0.05). Activities of daily living improved after unilateral surgery (P < 0.001) and additionally after bilateral surgery (P < 0.05). Adjustments of the pulse generator were required more frequently for tremor control than for amelioration of side effects. Bilateral thalamic stimulation caused more dysarthria and dysequilibrium than did unilateral stimulation. Stimulation-related side effects were reversible for all patients. Stimulation parameters did not change significantly with time. A significantly lower voltage and greater pulse width were used for patients with bilateral implants. CONCLUSION Unilateral thalamic stimulation and bilateral thalamic stimulation are safe and effective procedures that produce qualitative and quantitative improvements in resting, postural, and kinetic tremor. Thalamic stimulation-related side effects are mild and reversible.
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Lee, Myung-Ki. "Transcutaneous afferent patterned stimulation therapy at the wrist for essential tremor relief." Journal of the Korean Society of Stereotactic and Functional Neurosurgery 18, no. 2 (September 30, 2022): 67–71. http://dx.doi.org/10.52662/jksfn.2022.00220.
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Transcutaneous afferent patterned stimulation (TAPS), also referred to as non-invasive peripheral nerve stimulation, at the wrist provides a promising option for the management of essential tremor. This new wrist-worn neuromodulation method avoids the risks of surgical interventions and can be easily used at home. TAPS therapy is indicated to aid in the temporary relief of hand tremors following stimulation in adults with essential tremor. No serious device-related side effects have been reported. Future studies will be needed to determine the optimal parameters of stimulation. This article introduces a wrist-worn TAPS device and reviews the tremor-reducing mechanism and the clinical effectiveness of TAPS therapy for essential tremor.
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Cichaczewski, Ederson, Renato P. Munhoz, Joaquim M. Maia, Percy Nohama, Edison M. Nóvak, and Helio A. Teive. "Electrophysiologic characteristics of tremor in Parkinson?s disease and essential tremor." Arquivos de Neuro-Psiquiatria 72, no. 4 (April 2014): 301–6. http://dx.doi.org/10.1590/0004-282x20140006.
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Tremor in essential tremor (ET) and Parkinson’s disease (PD) usually present specific electrophysiologic profiles, however amplitude and frequency may have wide variations. Objective: To present the electrophysiologic findings in PD and ET. Method: Patients were assessed at rest, with posture and action. Seventeen patients with ET and 62 with PD were included. PD cases were clustered into three groups: predominant rest tremor; tremor with similar intensity at rest, posture and during kinetic task; and predominant kinetic tremor. Results: Patients with PD presented tremors with average frequency of 5.29±1.18 Hz at rest, 5.79±1.39 Hz with posture and 6.48±1.34 Hz with the kinetic task. Tremor in ET presented with an average frequency of 5.97±1.1 Hz at rest, 6.18±1 Hz with posture and 6.53±1.2 Hz with kinetic task. Seven (41.2%) also showed rest tremor. Conclusion: The tremor analysis alone using the methodology described here, is not sufficient to differentiate tremor in ET and PD.
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Carvalho, Vanessa, and João Massano. "Tremor: Um Guia Clínico Para Não Neurologistas." Acta Médica Portuguesa 32, no. 2 (February 28, 2019): 149. http://dx.doi.org/10.20344/amp.11352.
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Tremor is the commonest involuntary movement. The differential diagnosis is wide, and can be challenging even for experienced neurologists. Nonetheless, many tremors have a benign etiology and clinical course and, in many cases, non-neurologists are able to clinically manage these situations. This manuscript approaches the different types of tremor, their diagnosis, main differential diagnoses, the desired clinical approach, and therapeutic options of the most important conditions in clinical practice.
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Hwang, Ing-Shiou, Zong-Ru Yang, Chien-Ting Huang, and Mei-Chun Guo. "Reorganization of multidigit physiological tremors after repetitive contractions of a single finger." Journal of Applied Physiology 106, no. 3 (March 2009): 966–74. http://dx.doi.org/10.1152/japplphysiol.90851.2008.
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In light of the interplay among physiological finger tremors, this study was undertaken to investigate the transfer effect of fatigue on coordinative strategies of multiple fingers. Fourteen volunteers performed prolonged position tracking with a loaded middle finger while measures of neuromuscular function, including electromyographic activities of the extensor digitorum (ED)/flexor digitorum superficialis (FDS) and physiological tremors of the index, middle, ring, and little fingers, were monitored. The subjects exhibited inferior tracking congruence and an increase in ED activity at the end of the tracking. Fatigue spread was manifested in a remarkable increase in tremor across fingers, in association with enhanced involuntary tremor coupling among fingers that was topologically organized in relation to the distance of the digits from the middle finger. Principal component analysis suggested that an enhanced 8- to 12-Hz central rhythm contributed primarily to the tremor restructure following fatigue spread. The observed tremor reorganization validated the hypothesis that the effect of fatigue was not limited to the instructed finger and that fatigue functionally decreased independence of the digits. The spreading of fatigue weakens neural inputs that diverge to motor units acting on various digits because of fatigue-related enhancement of common drive at the supraspinal level.
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Kinfe, Thomas M., Hans-Holger Capelle, and Joachim K. Krauss. "Impact of surgical treatment on tremor due to posterior fossa tumors." Journal of Neurosurgery 108, no. 4 (April 2008): 692–97. http://dx.doi.org/10.3171/jns/2008/108/4/0692.
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Object The object of this study was to investigate the impact of surgical treatment on tremor caused by posterior fossa tumors. Methods The authors performed a retrospective evaluation of 6 cases involving patients with tremors due to posterior fossa tumors. Patients who had been treated with neuroleptic medication or had a family history of movement disorders were excluded. All patients had postural or kinetic tremors. Tremor was mainly unilateral. The study group included 5 women and 1 man. Mean age at surgery was 59 years. Five patients underwent total or subtotal tumor resection, and 1 patient underwent stereotactic biopsy only. The histological diagnosis was epidermoid tumor in 2 patients, metastasis in 2 others, and vestibular schwannoma and low-grade glioma in 1 each. Results Two patients had no improvement of tremor, postoperatively. In both of these patients the tumor (low-grade glioma in 1, metastasis in the other) involved the dentate nucleus directly. In the other patients, a compressive effect on the dentate nucleus or the dentatothalamic pathways was present without invasion of the cerebellar structures, and immediate or gradual amelioration of the tremor was observed postoperatively. Conclusions The prognosis of tremor due to posterior fossa tumors appears to depend mainly on the involvement of tremor-generating structures. The prognosis appears to be favorable in those patients with compression of these substrates, whereas primary invasion by tumor has a poor prognosis. Caution must be used in generalizing the findings of this study because of the small number of cases in the series.
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Dirkx, Michiel F., Heidemarie Zach, Bastiaan R. Bloem, Mark Hallett, and Rick C. Helmich. "The nature of postural tremor in Parkinson disease." Neurology 90, no. 13 (February 23, 2018): e1095-e1103. http://dx.doi.org/10.1212/wnl.0000000000005215.
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ObjectiveTo disentangle the different forms of postural tremors in Parkinson disease (PD).MethodsIn this combined observational and intervention study, we measured resting and postural tremor characteristics in 73 patients with tremulous PD by using EMG of forearm muscles. Patients were measured both “off” medication (overnight withdrawal) and after dispersible levodopa-benserazide 200/50 mg. We performed an automated 2-step cluster analysis on 3 postural tremor characteristics: the frequency difference with resting tremor, the degree of tremor suppression after posturing, and the dopamine response.ResultsThe cluster analysis revealed 2 distinct postural tremor phenotypes: 81% had re-emergent tremor (amplitude suppression, frequency difference with resting tremor 0.4 Hz, clear dopamine response) and 19% had pure postural tremor (no amplitude suppression, frequency difference with resting tremor 3.5 Hz, no dopamine response). This finding was manually validated (accuracy of 93%). Pure postural tremor was not associated with clinical signs of essential tremor or dystonia, and it was not influenced by weighing.ConclusionThere are 2 distinct postural tremor phenotypes in PD, which have a different pathophysiology and require different treatment. Re-emergent tremor is a continuation of resting tremor during stable posturing, and it has a dopaminergic basis. Pure postural tremor is a less common type of tremor that is inherent to PD, but has a largely nondopaminergic basis.
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Miyagi, Yasushi, Fumio Shima, Katsuya Ishido, Masashi Moriguchi, and Kazufumi Kamikaseda. "Posteroventral pallidotomy for midbrain tremor after a pontine hemorrhage." Journal of Neurosurgery 91, no. 5 (November 1999): 885–88. http://dx.doi.org/10.3171/jns.1999.91.5.0885.
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✓ 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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Chen, Jack. "Zonisamide for the Management of Essential Tremor: An Illustrative Case Report on Long-Term Effectiveness." Journal of Contemporary Pharmacy Practice 64, no. 1 (March 1, 2017): 11–14. http://dx.doi.org/10.37901/jcphp16-00007.
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Essential tremor, a common adult pathologic tremor disorder, is characterized by action tremors. Mainstays of treatment include gabapentin, primidone, and propranolol. However, many patients obtain insufficient benefit or do not tolerate these medications (especially the elderly). Short-term studies demonstrate that zonisamide may be effective for essential tremor; however, long-term data are lacking. This is a case report of an 83-year-old, right-handed man with essential tremor of the upper extremities and head who previously failed several pharmacological treatments (defined as obtaining inadequate benefit from maximum tolerated dose) with gabapentin, nadalol, propranolol, and primidone and was initiated on zonisamide monotherapy. Long-term zonisamide therapy (200 mg daily) was well tolerated in this elderly patient and associated with clinically significant improvement of upper extremity tremor and clinically modest improvement in head tremor. The beneficial effects and tolerability were sustained over nearly 28 months of follow-up treatment.