DOCSLIB.ORG

PE3001 Tremor

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
PE3001 Tremor Tremor An overview of tremor, including types, causes, diagnosis and treatment What is tremor? Tremor is a common movement disorder that causes rhythmic muscle contractions. These contractions lead to shaking movements in the body that cannot be controlled (they are involuntary). Tremor most often affects the hands or the head. It can also affect the arms, head, vocal cords, torso and legs. Tremor can come and go (it is intermittent) or happen all the time (constant). It can happen on its own or as a result of another disorder. Tremor affects all genders equally. Although it is not life threatening, it can have serious impact on daily life. It can be embarrassing and can make work and daily life tasks very difficult or impossible (it can be disabling). What are the types of tremor? Resting tremor Resting tremor happens while you are sitting or lying down and relaxed. The most common cause of resting tremor is Parkinson’s disease. It can also be caused by diseases or injury that damage parts of the brain. Postural and action These tremors happen when you try to hold a body part still in a non- tremors resting position or when you move on purpose, like when you are writing. Everyone has a little bit of shaking of the hands. This is called ‘physiologic tremor.’ It is the most common cause of this kind of tremor. A little bit of shaking is normal, and people do not usually notice they are doing it. In some cases this can become exaggerated and become a problem. It can happen for many different reasons, including: • Taking certain medicines • Taking stimulants, such as caffeine (like coffee, RedBull, 5 Hour Energy) • Low blood sugar • Anxiety • Excitement • Tiredness • Hyperthyroidism (release of too much thyroid hormone into the blood) • Alcohol withdrawal (when you stop drinking after alcohol abuse) • Fever 1 of 3 To Learn More Free Interpreter Services • Neurology • In the hospital, ask your nurse. 206-987-2078 • From outside the hospital, call the • Ask your child’s healthcare provider toll-free Family Interpreting Line, 1-866-583-1527. Tell the interpreter • seattlechildrens.org the name or extension you need. Tremor Essential tremor Essential tremor is a tremor disorder that causes postural and action tremors. It is different from physiologic tremor, because it is not related to a specific cause, such as medicines, substances or physical conditions. Essential tremor can be passed on in families. Intention tremor Intention tremor gets gradually worse as you get closer to what you are reaching for. This tremor can be seen in people with abnormal function in the structure of the brain that helps coordinate fine motor skills (the cerebellum). How is tremor To diagnose tremor, your child’s doctor will use their health history and the diagnosed? results from physical and neurologic exams. They may ask for more tests to see how tremor affects their daily life and ability to do tasks, such as difficulty with handwriting or the ability to hold a fork or cup (functional limitations). Your doctor may ask your child to do specific tasks or exercises, such as placing a finger on the tip of their nose or drawing a spiral. They may also order blood tests, urine tests or a brain scan to make sure there is no other cause of tremor. What are the There is no cure for most forms of tremor. Treatment options are available treatments for to help manage your child’s symptoms. In some cases, the symptoms may be mild enough that treatment is not required. Early treatment does not tremor? stop or slow the natural changes of the symptoms. Medicine is only necessary when tremor affects your child’s daily activities or causes problems. When tremor is caused by another medical problem, treating that problem sometimes helps reduce the tremor, too. For example, people whose tremor is caused by high thyroid hormone levels often stop shaking when their hormone levels go back to normal. Even when no other medical problems are involved, there are treatments that can help symptoms. Medicines • Beta-blockers, such as propranolol (Inderal), are medicines that are normally used to treat high blood pressure, but they also help treat essential tremor. They can also be used in some people with action tremor. • Anti-seizure medicines, such as primidone (Mysoline), can be effective in people with essential tremor who do not respond to beta-blockers. • Anti-anxiety medicines, such as clonazepam (Klonopin), may temporarily help some people with tremor. However, their use is limited due to side effects that include sleepiness, poor concentration, poor coordination, physical dependence and several withdrawal symptoms when stopped abruptly. • Parkinson’s disease medicines, such as carbidopa-levodopa (Sinemet), are used to treat tremor associated with Parkinson's disease. • Other medicines that doctors prescribe include topiramate (Topamax) and gabapentin (Neurontin). 2 of 3 Tremor Botulinum toxin Botulinum toxin injections (Botox) are most effective for head tremor, injections which generally does not respond to other medicines. Occupational and Occupational and physical therapy (OT/PT) can help some people control physical therapy tremor. A therapist can help your child improve their muscle control, functioning and strength through coordination, balancing and other exercises. Some therapists recommend the use of weights, splints, other adaptive equipment, and special plates and utensils for eating. Eliminating or Avoiding or reducing certain substances can help improve tremor. This reducing tremor- includes anything that can induce tremor, such as caffeine or medicines inducing substances that are stimulants. Though small amounts of alcohol can improve tremor for some people with essential tremor, tremor can become worse when the alcohol wears off. Surgery When people do not respond to medicines or therapies or have a severe tremor that significantly impacts their daily life, a doctor may recommend surgery, such as deep brain stimulation (DBS). The benefits of surgery should always be weighed carefully against its risks. What can I do if my If your child has tremor, please discuss it with your child’s healthcare child has tremor? provider to get a referral to the Neurology Clinic. Seattle Children’s offers interpreter services for Deaf, hard of hearing or non-English speaking patients, family members and legal representatives free of charge. Seattle Children’s will make this information available in alternate formats upon request. Call the 8/21 Family Resource Center at 206-987-2201. This handout has been reviewed by clinical staff at Seattle Children’s. However, your child’s PE3001 needs are unique. Before you act or rely upon this information, please talk with your child’s healthcare provider. © 2020 Seattle Children’s, Seattle, Washington. All rights reserved. Patient and Family Education | Neurology 3 of 3 .
Load more

Recommended publications
  • Tardive Dyskinesia
    Tardive Dyskinesia Tardive Dyskinesia Checklist The checklist below can be used to help determine if you or someone you know may have signs associated with tardive dyskinesia and other movement disorders. Movement Description Observed? Rhythmic shaking of hands, jaw, head, or feet Yes Tremor A very rhythmic shaking at 3-6 beats per second usually indicates extrapyramidal symptoms or side effects (EPSE) of parkinsonism, even No if only visible in the tongue, jaw, hands, or legs. Sustained abnormal posture of neck or trunk Yes Dystonia Involuntary extension of the back or rotation of the neck over weeks or months is common in tardive dystonia. No Restless pacing, leg bouncing, or posture shifting Yes Akathisia Repetitive movements accompanied by a strong feeling of restlessness may indicate a medication side effect of akathisia. No Repeated stereotyped movements of the tongue, jaw, or lips Yes Examples include chewing movements, tongue darting, or lip pursing. TD is not rhythmic (i.e., not tremor). These mouth and tongue movements No are the most frequent signs of tardive dyskinesia. Tardive Writhing, twisting, dancing movements Yes Dyskinesia of fingers or toes Repetitive finger and toe movements are common in individuals with No tardive dyskinesia (and may appear to be similar to akathisia). Rocking, jerking, flexing, or thrusting of trunk or hips Yes Stereotyped movements of the trunk, hips, or pelvis may reflect tardive dyskinesia. No There are many kinds of abnormal movements in individuals receiving psychiatric medications and not all are because of drugs. If you answered “yes” to one or more of the items above, an evaluation by a psychiatrist or neurologist skilled in movement disorders may be warranted to determine the type of disorder and best treatment options.
    [Show full text]
  • Rest Tremor Revisited: Parkinson's Disease and Other Disorders
    Chen et al. Translational Neurodegeneration (2017) 6:16 DOI 10.1186/s40035-017-0086-4 REVIEW Open Access Rest tremor revisited: Parkinson’s disease and other disorders Wei Chen1,2, Franziska Hopfner2, Jos Steffen Becktepe2 and Günther Deuschl1,2* Abstract Tremor is the most common movement disorder characterized by a rhythmical, involuntary oscillatory movement of a body part. Since distinct diseases can cause similar tremor manifestations and vice-versa,itischallengingtomakean accurate diagnosis. This applies particularly for tremor at rest. This entity was only rarely studied in the past, although a multitude of clinical studies on prevalence and clinical features of tremor in Parkinson’s disease (PD), essential tremor and dystonia, have been carried out. Monosymptomatic rest tremor has been further separated from tremor-dominated PD. Rest tremor is also found in dystonic tremor, essential tremor with a rest component, Holmes tremor and a few even rarer conditions. Dopamine transporter imaging and several electrophysiological methods provide additional clues for tremor differential diagnosis. New evidence from neuroimaging and electrophysiological studies has broadened our knowledge on the pathophysiology of Parkinsonian and non-Parkinsonian tremor. Large cohort studies are warranted in future to explore the nature course and biological basis of tremor in common tremor related disorders. Keywords: Tremor, Parkinson’s disease, Essential tremor, Dystonia, Pathophysiology Background and clinical correlates of tremor in common tremor re- Tremor is defined as a rhythmical, involuntary oscillatory lated disorders. Some practical clinical cues and ancillary movement of a body part [1]. Making an accurate diagnosis tests for clinical distinction are found [3]. Besides, accu- of tremor disorders is challenging, since similar clinical mulating structural and functional neuroimaging, as well entities may be caused by different diseases.
    [Show full text]
  • Diagnostic Clues in Multiple System Atrophy
    DO I:10.4274/Tnd.82905 Case Report / Olgu Sunumu Diagnostic Clues in Multiple System Atrophy: A Case Report and Literature Review Multisistem Atrofi Tanısında İpuçları: Bir Olgu Sunumu ve Literatürün Gözden Geçirilmesi Mehmet Yücel, Oğuzhan Öz, Hakan Akgün, Semai Bek, Tayfun Kaşıkçı, İlter Uysal, Yaşar Kütükçü, Zeki Odabaşı Gülhane Military Medical Academy, Ankara, Turkey Sum mary Multiple system atrophy (MSA) is an adult-onset, sporadic, progressive neurodegenerative disease. Based on the consensus criteria, patients with MSA are clinically classified into cerebellar (MSA-C) and parkinsonian (MSA-P) subtypes. In addition to major diagnostic criteria including poor response to levodopa, and presence of pyramidal or cerebellar signs (ataxia) or autonomic failure, certain clinical features or ‘‘red flags’’ may raise the clinical suspicion for MSA. In our case report we present a 67-year-old female patient admitted to our hospital due to inability to walk, with poor response to levodopa therapy, whose neurological examination revealed severe Parkinsonism, ataxia and who fulfilled all criteria for MSA, as rarely seen in clinical practice.(Turkish Journal of Neurology 2013; 19:28-30) Key Words: Multiple system atrophy, autonomic failure, diagnostic criteria Özet Multisistem atrofi (MSA) erişkin dönemde başlayan, ilerleyici, nedeni bilinmeyen sporadik nörodejeneratif bir hastalıktır. MSA kabul görmüş tanı kriterlerine göre klinik olarak serebellar (MSA-C) ve parkinsoniyen (MSA-P) alt tiplerine ayrılmaktadır. Düşük levadopa yanıtı, piramidal, serebellar bulguların (ataksi) ya da otonomik bozukluk olması gibi majör tanı kriterlerininin yanında “red flags” olarak isimlendirilen belirgin klinik bulgular ya da uyarı işaretlerinin olması MSA tanısı için klinik şüpheyi oluşturmalıdır. Olgu sunumunda 67 yaşında yürüyememe şikayeti ile polikliniğimize müracaat eden ve levadopa tedavisine düşük yanıt gösteren ciddi parkinsonizm bulguları ile ataksi bulunan kadın hasta MSA tanı kriterlerini tam olarak karşıladığı ve klinik pratikte nadir görüldüğü için sunduk.
    [Show full text]
  • THE MANAGEMENT of TREMOR Peter G Bain
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.72.suppl_1.i3 on 1 March 2002. Downloaded from THE MANAGEMENT OF TREMOR Peter G Bain *i3 J Neurol Neurosurg Psychiatry 2002;72(Suppl I):i3–i9 remor is defined as a rhythmical, involuntary oscillatory movement of a body part.1 The Tformulation of a clinical diagnosis for an individual’s tremor involves two discrete steps2: c The observed tremor is classified on phenomenological grounds c An attempt is made to find the cause of the tremor by looking for aetiological clues in the patient’s history and physical examination and also, in some cases, by investigation. c PHENOMENOLOGICAL CLASSIFICATION OF TREMOR The phenomenological classification of tremor is determined by finding out: c which parts of the patient’s body are affected by tremor? c what types (or components) of tremor, classified by state of activity, are present at those anatomical sites? The following definitions are used to describe the various tremor components evident on exam- ination1: c Rest tremor is a tremor present in a body part that is not voluntarily activated and is completely supported against gravity (ideally resting on a couch) copyright. c Action tremor is any tremor that is produced by voluntary contraction of a muscle. It includes pos- tural, kinetic, intention, task specific, and isometric tremor: – Postural tremor is present while voluntarily maintaining a position against gravity – Kinetic tremor is tremor occurring during any voluntary movement. Simple kinetic tremor occurs during voluntary movements that are not target directed – Intention tremor or tremor during target directed movement is present when tremor amplitude increases during visually guided movements towards a target at the termination of that movement, when the possibility of position specific tremor or postural tremor produced at the beginning and end of a movement has been excluded – Task specific kinetic tremor—kinetic tremor may appear or become exacerbated during specific activities.
    [Show full text]
  • Characteristics of Tremor Induced by Lesions of the Cerebellum
    The Cerebellum (2019) 18:705–720 https://doi.org/10.1007/s12311-019-01027-3 ORIGINAL PAPER Characteristics of Tremor Induced by Lesions of the Cerebellum Andrea Kovács1,2 & Máté Kiss3 & Nándor Pintér4 & Imre Szirmai5 & Anita Kamondi1,5 Published online: 8 April 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract It is a clinical experience that acute lesions of the cerebellum induce pathological tremor, which tends to improve. However, quantitative characteristics, imaging correlates, and recovery of cerebellar tremor have not been systematically investigated. We studied the prevalence, quantitative parameters measured with biaxial accelerometry, and recovery of pathological tremor in 68 patients with lesions affecting the cerebellum. We also investigated the correlation between the occurrence and characteristics of tremor and lesion localization using 3D T1-weighted MRI images which were normalized and segmented according to a spatially unbiased atlas template for the cerebellum. Visual assessment detected pathological tremor in 19% while accelerometry in 47% of the patients. Tremor was present both in postural and intentional positions, but never at rest. Two types of pathological tremor were distinguished: (1) low-frequency tremor in 36.76% of patients (center frequency 2.66 ± 1.17 Hz) and (2) normal frequency– high-intensity tremor in 10.29% (center frequency 8.79 ± 1.43 Hz). The size of the lesion did not correlate with the presence or severity of tremor. Involvement of the anterior lobe and lobule VI was related to high tremor intensity. In all followed up patients with acute cerebellar ischemia, the tremor completely recovered within 8 weeks. Our results indicate that cerebellar lesions might induce pathological postural and intentional tremor of 2–3 Hz frequency.
    [Show full text]
  • Clinical Manifestations of Essential Tremor
    Journial of Neurology, Neurosurgery, and Psychiatry, 1972, 35, 365-372 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.35.3.365 on 1 June 1972. Downloaded from Clinical manifestations of essential tremor EDMUND CRITCHLEY From the Royal Infirmary, Preston SUMMARY A clinical study of 42 patients with essential tremor is presented. In the case of 12 patients the family history strongly suggested an autosomal dominant mode of transmission, in four the mode of inheritance was indeterminate, and the remaining 26 patients were sporadic cases without an established genetic basis. The tremor involved the upper extremities in 41 patients, the head in 25, lower limbs in 15, and trunk in two. Seven patients showed involvement of speech. Variations were found in the speed and regularity of the tremor. Leg involvement took a variety of forms: (1) direct involvement by tremor; (2) a painful limp associated with forearm tremor; (3) associated dyskinetic movements; (4) ataxia; (5) foot clubbing; and (6) evidence of peroneal muscular atrophy. Several minor symptoms hyperhidrosis, cramps, dyskinetic movements, and ataxia-were associated with essential tremor. Other features were linked phenotypically to the ataxias and system degenerations. Apart from minor alterations in tone, expression, and arm swing, features of Parkinsonism were notably absent. Protected by copyright. Essential tremor has been recognized as an or- much variation. It is occasionally present at rest ganic peculiarity of the nervous system, mimick- and inhibited by action, but is more usually de- ing neurotic and neural disorders with equal creased or absent at rest and present on volun- facility. Many synonyms-for example, benign, tary increase in muscle tonus, as in holding a limb hereditary, and senile tremor-describe its varied in a definite position (static, sustained-postural presentation.
    [Show full text]
  • Tremor in X-Linked Recessive Spinal and Bulbar Muscular Atrophy (Kennedy’S Disease)
    CLINICS 2011;66(6):955-957 DOI:10.1590/S1807-59322011000600006 CLINICAL SCIENCE Tremor in X-linked recessive spinal and bulbar muscular atrophy (Kennedy’s disease) Francisco A. Dias,I Renato P. Munhoz,I Salmo Raskin,II Lineu Ce´sar Werneck,I He´lio A. G. TeiveI I Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clı´nicas, Federal University of Parana´ , Curitiba, PR, Brazil. II Genetika Laboratory, Curitiba, PR, Brazil. OBJECTIVE: To study tremor in patients with X-linked recessive spinobulbar muscular atrophy or Kennedy’s disease. METHODS: Ten patients (from 7 families) with a genetic diagnosis of Kennedy’s disease were screened for the presence of tremor using a standardized clinical protocol and followed up at a neurology outpatient clinic. All index patients were genotyped and showed an expanded allele in the androgen receptor gene. RESULTS: Mean patient age was 37.6 years and mean number of CAG repeats 47 (44-53). Tremor was present in 8 (80%) patients and was predominantly postural hand tremor. Alcohol responsiveness was detected in 7 (88%) patients with tremor, who all responded well to treatment with a b-blocker (propranolol). CONCLUSION: Tremor is a common feature in patients with Kennedy’s disease and has characteristics similar to those of essential tremor. KEYWORDS: Kennedy’s disease; X-linked recessive bulbospinal neuronopathy; Spinal and bulbar muscular atrophy; Motor neuron disease; Tremor. Dias FA, Munhoz RP, Raskin S, Werneck LC, Teive HAG. Tremor in X-linked recessive spinal and bulbar muscular atrophy (Kennedy’s disease). Clinics. 2011;66(6):955-957. Received for publication on December 24, 2010; First review completed on January 18, 2011; Accepted for publication on February 25, 2011 E-mail: [email protected] Tel.: 55 41 3019-5060 INTRODUCTION compatible with a long life.
    [Show full text]
  • Part Ii – Neurological Disorders
    Part ii – Neurological Disorders CHAPTER 14 MOVEMENT DISORDERS AND MOTOR NEURONE DISEASE Dr William P. Howlett 2012 Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania BRIC 2012 University of Bergen PO Box 7800 NO-5020 Bergen Norway NEUROLOGY IN AFRICA William Howlett Illustrations: Ellinor Moldeklev Hoff, Department of Photos and Drawings, UiB Cover: Tor Vegard Tobiassen Layout: Christian Bakke, Division of Communication, University of Bergen E JØM RKE IL T M 2 Printed by Bodoni, Bergen, Norway 4 9 1 9 6 Trykksak Copyright © 2012 William Howlett NEUROLOGY IN AFRICA is freely available to download at Bergen Open Research Archive (https://bora.uib.no) www.uib.no/cih/en/resources/neurology-in-africa ISBN 978-82-7453-085-0 Notice/Disclaimer This publication is intended to give accurate information with regard to the subject matter covered. However medical knowledge is constantly changing and information may alter. It is the responsibility of the practitioner to determine the best treatment for the patient and readers are therefore obliged to check and verify information contained within the book. This recommendation is most important with regard to drugs used, their dose, route and duration of administration, indications and contraindications and side effects. The author and the publisher waive any and all liability for damages, injury or death to persons or property incurred, directly or indirectly by this publication. CONTENTS MOVEMENT DISORDERS AND MOTOR NEURONE DISEASE 329 PARKINSON’S DISEASE (PD) � � � � � � � � � � �
    [Show full text]
  • Tremor, Abnormal Movement and Imbalance Differential
    Types of involuntary movements Tremor Dystonia Chorea Myoclonus Tics Tremor Rhythmic shaking of muscles that produces an oscillating movement Parkinsonian tremor Rest tremor > posture > kinetic Re-emergent tremor with posture Usually asymmetric Pronation-supination tremor Distal joints involved primarily Often posturing of the limb Parkinsonian tremor Other parkinsonian features Bradykinesia Rigidity Postural instability Many, many other motor and non- motor features Bradykinesia Rigidity Essential tremor Kinetic > postural > rest Rest in 20%, late feature, only in arms Intentional 50% Bringing spoon to mouth is challenging!! Mildly asymmetric Gait ataxia – typically mild Starts in the arms but can progress to neck, voice and jaw over time Jaw tremor occurs with action, not rest Neck tremor should resolve when patient is lying flat Essential tremor Many other tremor types Physiologic tremor Like ET but faster rate and lower amplitude Drug-induced tremor – Lithium, depakote, stimulants, prednisone, beta agonists, amiodarone Anti-emetics (phenergan, prochlorperazine), anti-psychotics (except clozapine and Nuplazid) Many other tremor types Primary writing tremor only occurs with writing Orthostatic tremor leg tremor with standing, improves with walking and sitting, causes imbalance Many other tremor types Cerebellar tremor slowed action/intention tremor Holmes tremor mid-brain lesion, unilateral Dystonia Dystonia Muscle contractions that cause sustained or intermittent torsion of a body part in a repetitive
    [Show full text]
  • The Clinical Approach to Movement Disorders Wilson F
    REVIEWS The clinical approach to movement disorders Wilson F. Abdo, Bart P. C. van de Warrenburg, David J. Burn, Niall P. Quinn and Bastiaan R. Bloem Abstract | Movement disorders are commonly encountered in the clinic. In this Review, aimed at trainees and general neurologists, we provide a practical step-by-step approach to help clinicians in their ‘pattern recognition’ of movement disorders, as part of a process that ultimately leads to the diagnosis. The key to success is establishing the phenomenology of the clinical syndrome, which is determined from the specific combination of the dominant movement disorder, other abnormal movements in patients presenting with a mixed movement disorder, and a set of associated neurological and non-neurological abnormalities. Definition of the clinical syndrome in this manner should, in turn, result in a differential diagnosis. Sometimes, simple pattern recognition will suffice and lead directly to the diagnosis, but often ancillary investigations, guided by the dominant movement disorder, are required. We illustrate this diagnostic process for the most common types of movement disorder, namely, akinetic –rigid syndromes and the various types of hyperkinetic disorders (myoclonus, chorea, tics, dystonia and tremor). Abdo, W. F. et al. Nat. Rev. Neurol. 6, 29–37 (2010); doi:10.1038/nrneurol.2009.196 1 Continuing Medical Education online 85 years. The prevalence of essential tremor—the most common form of tremor—is 4% in people aged over This activity has been planned and implemented in accordance 40 years, increasing to 14% in people over 65 years of with the Essential Areas and policies of the Accreditation Council age.2,3 The prevalence of tics in school-age children and for Continuing Medical Education through the joint sponsorship of 4 MedscapeCME and Nature Publishing Group.
    [Show full text]
  • Tremor in Multiple System Atrophy – a Review
    Freely available online Reviews Tremor in Multiple System Atrophy – a review 1 1 1* Christine Kaindlstorfer , Roberta Granata & Gregor Karl Wenning 1 Division of Neurobiology, Department of Neurology, Medical University Innsbruck, Innsbruck, Austria. Abstract Background: Multiple system atrophy (MSA) is a rare neurodegenerative movement disorder characterized by a rapidly progressive course. The clinical presentation can include autonomic failure, parkinsonism, and cerebellar signs. Differentiation from Parkinson’s disease (PD) is difficult if there is levodopa- responsive parkinsonism, rest tremor, lack of cerebellar ataxia, or mild/delayed autonomic failure. Little is known about tremor prevalence and features in MSA. Methods: We performed a PubMed search to collect the literature on tremor in MSA and considered reports published between 1900 and 2013. Results: Tremor is a common feature among MSA patients. Up to 80% of MSA patients show tremor, and patients with the parkinsonian variant of MSA are more commonly affected. Postural tremor has been documented in about half of the MSA population and is frequently referred to as jerky postural tremor with evidence of minipolymyoclonus on neurophysiological examination. Resting tremor has been reported in about one-third of patients but, in contrast to PD, only 10% show typical parkinsonian ‘‘pill-rolling’’ rest tremor. Some patients exhibit intention tremor associated with cerebellar dysmetria. In general, MSA patients can have more than one tremor type owing to a complex neuropathology that includes both the basal ganglia and pontocerebellar circuits. Discussion: Tremor is not rare in MSA and might be underrecognized. Rest, postural, action and intention tremor can all be present, with jerky tremulous movements of the outstretched hands being the most characteristic.
    [Show full text]
  • Atypical Parkinsonism from Parkinson Disease Is Important
    Introduction The diagnosis of Parkinson disease in the early stages can be challenging. Symptoms overlap with other movement disorders such as essential tremor and atypical parkinsonian disorders. Differentiating atypical parkinsonism from Parkinson disease is important. Helps predict how well patients will respond to therapy. How the disease will progress. what the prognosis is compared to idiopathic Parkinson disease. Parkinsonism Diagnostic Criteria Tremor at rest Bradykinesia Rigidity Loss of postural reflexes Flexed posture Freezing (motor blocks) Definite: At least two of these features must be present, one of them being 1 or 2. Probable: Feature 1 or 2 alone is present. Possible: At least two of features 3 to 6 must be present Queen Square Brain Bank Criteria Presence of Bradykinesia and of either: 1- Resting tremor 4-6Hz 2- Extrapyramidal rigidity 3- Postural instability not caused by visual, cerebellar, vestibular, or proprioceptive dysfunction. Features of typical PD At least 3 Unilateral onset Excellent response to levodopa ( 70%-100%) Development of dyskinesia Levodopa response for 5 yrs or more Clinical course of 10 yrs or more Progressive disorder Rest tremor present Persistent asymmetry affecting side of onset most Exclusion Pyramidal signs Stepwise deterioration Repeated head injury History of encephalitis or oculogyric crisis Neuroleptic treatment at onset Strictly unilateral features after 3 yrs Supranuclear gaze palsy Cerebellar signs Early severe autonomic dysfunction Early severe cognitive dysfunction Early freezing & postural falls Negative response to levodopa Imaging evidence of communicating hydrocephalus Parkinson’s Disease Diagnostic Criteria RED FLAGS Early autonomic dysregulation. Early postural instability. Symmetric onset. Brainstem symptoms & signs. Pyramidal signs. Early cognitive decline.
    [Show full text]