Tremor postural e distonia: aspectos clínicos e considerações fisiopatológicas

Abstract

RESUMO -A presença de tremor e distonia de torção no mesmo paciente é frequente mas não há uma explicação satisfatória para isso. Suspeita-se que haja uma associação da distonia idiopática (DI) com o tremor essencial (TE). O objetivo deste estudo é analisar a frequência de tremor postural das mãos em pacientes com DI e distonia sintomática (DS). Foram estudados os prontuários de 185 pacientes com o diagnóstico sindrômico de distonia atendidos no Setor de Investigação em Moléstias Extrapiramidais da Escola Paulista de Medicina. DI foi diagnosticada quando não havia anormalidade no exame neurológico além da distonia e havia exames laboratoriais e de neuroimagem, relacionados à distonia, normais e história pregressa negativa para fatores causais de distonia. Foram analisadas as características clínicas da distonia e a presença de tremor postural nas mãos. Havia 185 pacientes, 120 com DI e 65 com DS. Tremor postural das mãos ocorreu em 27 (22,5%) das DI e 14 (21,5%) das DS. Tremor esteve presente nos quadros focais, segmentares e generalizados e também nos diversos tipos clínicos de DI e DS em proporções semelhantes. História familiar de TE estava ausente em todos os casos com tremor. A presença de tremor postural das mãos em pacientes com DI e DS pode sugerir que a desorganização fisiopatológica que produz a distonia pode favorecer o aparecimento do tremor. PALAVRAS-CHAVE: distonia, dystonia musculorum deformans, tremor. Postural tremor and dystonia: clinical correlates and pathophysiological considerationsSUMMARY -The coexistence of tremor and dystonia is usually seen but there is not a satisfactory explanation for it. Some consider that essential tremor (ET) and idiopathic dystonia (ID) may be genetically linked. To clarify this relationship we evaluated the frequency of postural hand tremor in ID and symptomatic dystonia (SD) patients. We studied the records of patients with dystonia seen in our Movement Disorders Unit. ID was considered when there was no other neurological abnormality in the examination aside from dystonia, normal laboratorial tests and neuroimaging related to dystonia, and a negative past history for any known cause for it, except for genetic predisposition. We analyzed the clinical characteristics of dystonia and the occurrence of postural tremor. We collected 185 patients, being 120 with ID and 65 with SD. Tremor was seen in 27 (22.5%) of ID and 14 (21.5%) of SD. Tremor was present in either focal, segmental or generalized dystonia in both ID and SD. Family history for ET was absent in all patients. The similar frequency of tremor in ID and SD patients suggests that the pathophysiologic derangement resulting in dystonia can favor the development of tremor.KEY WORDS: dystonia, dystonia musculorum deformans, tremor.O aparecimento simultâneo de tremor e distonia tem sido observado, mas ainda não há uma explicação satisfatória para isso U 8 . Imagina-se que isto ocorra devido a associação de duas doenças

Cervical dystonia: clinical and therapeutic features in 85 patients

“…We found some type of tremor in 23.5% of the patients, less than the 33% to 71% found in other studies of cervical dystonia patients 9,15 . We found postural tremor in the upper limbs in 3.5% of our patients while Ferraz et al 17 observed the same type of tremor in 22.2% of their study population. our finding of dystonic head tremor in 20% of the patients was similar to the 28% found by Chan et al 8 .…”

Essential Tremor and Other Tremors

“…197 This proportion does not differ between primary and secondary dystonia, but seems to be more common in cervical dystonia than other locations. In one Brazilian cross-sectional study, it has been estimated that approximately 20% of patients with dystonia present with postural tremor.…”

Tremor

“…123 This proportion does not differ between primary and secondary dystonia but seems to be more common in cervical dystonia than in other locations. In one Brazilian cross-sectional study, it was estimated that around 20% of patients with dystonia present with postural tremor.…”