Seed-to-voxel resting state connectivity analysis revealed significant alterations in the cerebello-thalamo-cortical network in patients with ET. These alterations correlated with the overall FTM scores as well as the subscores for limb tremor and head tremor in patients with ET. These results further support the previous evidence of cerebellar pathology in ET.
Essential tremor (ET) is a pathologically heterogeneous neurodegenerative disorder with both motor and increasingly recognized non-motor features. It is debated whether the non-motor manifestations in ET result from widespread neurodegeneration or are merely secondary to impaired motor functions and decreased quality of life due to tremor. It is important to review these features to determine how to best treat the non-motor symptoms of patients and to understand the basic pathophysiology of the disease and develop appropriate pharmacotherapies. In this review, retrospective and prospective clinical studies were critically analyzed to identify possible correlations between the severities of non-motor features and tremor. We speculated that if such a correlation existed, the non-motor features were likely to be secondary to tremor. According to the current literature, the deficits in executive function, attention, concentration, and memory often observed in ET are likely to be a primary manifestation of the disease. It has also been documented that patients with ET often exhibit characteristic personality traits. However, it remains to be determined whether the other non-motor features often seen in ET, such as anxiety, depression, and sleep disturbances are primary or secondary to motor manifestations of ET and subsequent poor quality of life. Finally, there is evidence that patients with ET can also have impaired color vision, disturbances of olfaction, and hearing impairments, though there are few studies in these areas. Further investigations of large cohorts of patients with ET are required to understand the prevalence, nature, and true significance of the non-motor features in ET.
Background: Essential tremor (ET) is the most common tremor disorder in adults. In addition to upper limbs, the tremor in ET may also involve head, jaw, voice, tongue, and trunk. Though head tremor (HT) is commonly present in patients with ET, large comparative studies of ET patients with HT (HT+) and without HT (HT−) are few. Methods: To determine whether ET with HT is a distinct clinical subtype by comparing ET patients with and without HT, a chart review of 234 consecutive patients with ET attending the neurology clinics of the National Institute of Mental Health and Neurosciences, India, was done. A movement disorder specialist confirmed the diagnosis of ET in all patients using the National Institutes of Health collaborative genetic criteria. Results: HT was present in 44.4% of the patients. Comparison between HT+ and HT− showed that the HT+ group patients: (1) were older, (2) had later onset of tremor, (3) had unimodal distribution of age at onset with a single peak in the fifth decade, (4) had more frequent voice tremor, and (5) were more likely to have mild cervical dystonia. HT was part of presenting symptoms in nearly two thirds of the ET patients and in the rest it was detected during clinical examination. Conclusions: Several demographic and clinical variables suggest that ET patients with HT have a distinct clinical phenotype.RÉSUMÉ: Le tremblement des membres et de la tête constitue-t-il un sous-type de tremblement essentiel? Contexte: Le tremblement essentiel (TE) est le type de tremblement le plus fréquent chez les adultes. En plus des membres supérieurs, le tremblement essentiel peut également toucher la tête, la mâchoire, la voix, la langue et le tronc. Bien que le tremblement de la tête (TT) soit présent en général chez les patients atteints de TE, il y a peu de grandes études comparatives portant sur des patients atteints de TE avec TT (TT + ) et sans TT (TT-). Méthode: Nous avons effectué une revue des dossiers de 234 patients consécutifs atteints de TE suivis à la clinique de neurologie du National Institute of Mental Health and Neurosciences en Inde afin de déterminer si le TE avec TT est un sous-type clinique distinct en comparant les patients atteints de TE avec et sans TT. Résultats: Le TT était présent chez 44,4% des patients. La comparaison entre le groupe TT + et le groupe TT-a montré que les patients du groupe TT + étaient plus âgés, que le début du tremblement était tardif, que la distribution de leur âge de début était unimodale avec un seul pic dans la cinquième décennie, que le tremblement de la voix était plus fréquent et qu'ils étaient plus susceptibles d'avoir une légère dystonie cervicale. Le TT faisait partie des symptômes initiaux chez presque les deux tiers des patients atteints de TE et chez les autres, il avait été détecté au cours de l'examen clinique. Conclusions: Plusieurs variables démographiques et cliniques suggèrent que les patients atteints de TE qui présentent un TT ont un phénotype clinique distinct. Essential tremor (ET) is a chronic neurologic diso...
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