Diagnóstico diferencial dos tremores

Mattos, James Pitágoras de

doi:10.1590/s0004-282x1998000200027

Cited by 8 publications

(4 citation statements)

References 5 publications

(15 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Embora no parkinsonismo, o tremor possa ser postural, a paciente apresentava um tremor de ação determinado por atividade de músculos sincrônicos, na eletromiografi a (Mattos, 1998).…”

Section: Discussionunclassified

Demência reversível e quedas associadas ao biperideno

Rigo¹,

Rigo²,

Faria³

et al. 2006

Rev. psiquiatr. clín.

View full text Add to dashboard Cite

ResumoAs drogas anticolinérgicas podem causar efeitos adversos, mais freqüentemente nos pacientes idosos. Relatamos um caso de demência reversível e quedas, associadas ao uso de biperideno. A paciente, com 82 anos, foi admitida em lar geriátrico devido a quedas freqüentes no domicílio, acentuado défi cit cognitivo, tremores de extremidades ao movimento e perda de autonomia. Na verdade, era portadora de tremor essencial, que foi confundido com doença de Parkinson e tratado com biperideno; posteriormente, desenvolveu défi cit cognitivo que foi erroneamente diagnosticado como demência do tipo Alzheimer. Após submeter-se à avaliação especializada, foi suspensa a droga anticolinérgica e houve reversão completa do quadro demencial; o tremor essencial foi controlado com uso de propranolol. Ao avaliar um paciente com défi cit cognitivo, o clínico deve descartar possíveis causas de demência reversível, em especial, o grupo das iatrogênicas.Palavras-chaves: Biperideno, demência reversível, drogas anticolinérgicas, idoso, quedas. AbstractAnticholinergic drugs may cause adverse effects, more often in the aged patients. We describe a case of reversible dementia and falls, associated with the use of biperiden. The patient was an 82-year old woman, admitted in a geriatric home because of frequent falls at home, progressive cognitive defi cit and tremor of extremities with movement, in addition to remarkable loss of autonomy. As a matter of fact, she presented an essential tremor, which was mistakenly diagnosed as Parkinson disease and treated with biperiden; furthermore, she developed a drug-induced cognitive defi cit, erroneously interpreted as Alzheimer disease. After submitted to the specialized evaluation, the anticholinergic drug was discontinued and there was a complete improvement of cognition changes; the essential tremor is under control with use of propranolol. When evaluating a patient with cognitive defi cit, the clinician must discard possible causes of reversible dementia, especially the iatrogenic group.

show abstract

“…Embora no parkinsonismo, o tremor possa ser postural, a paciente apresentava um tremor de ação determinado por atividade de músculos sincrônicos, na eletromiografi a (Mattos, 1998).…”

Section: Discussionunclassified

Demência reversível e quedas associadas ao biperideno

Rigo¹,

Rigo²,

Faria³

et al. 2006

Rev. psiquiatr. clín.

View full text Add to dashboard Cite

show abstract

“…O tremor postural é avaliado com o paciente sentado ou em pé, com os braços estendidos e com a utilização da manobra de esgrima. O tremor cinético simples pode ser testado durante os movimentos de flexão/ extensão das mãos, e o tremor intencional através da manobra de index-naso ou dedo-dedo 9,10 . Testes adicionais para a avaliação de tremor que podem ser utilizados são a tarefa de escrever uma sentença e a de desenhar uma espiral 8 .…”

Section: Métodounclassified

Uso do propranolol de ação prolongada em 40 pacientes com tremor essencial e virgens de tratamento: um ensaio clínico não controlado

Troiano

Teive

Fabiani

et al. 2004

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

RESUMO -O tremor essencial (TE) é o distúrbio do movimento mais frequente. Entre os tratamentos de primeira escolha está o uso de beta-bloqueadores. O objetivo deste trabalho é relatar os resultados do uso de propranolol de ação prolongada (PAP) em 40 pacientes com TE e virgens de tratamentos anteriores. Método: 40 pacientes com TE foram submetidos a um protocolo de avaliação pré-estabelecido em que constavam escalas de classificação para o tremor e escalas de avaliação da severidade do tremor. Todos os pacientes foram submetidos a avaliação inicial e após 1 mês de tratamento. Resultados: com relação ao tipo de tremor, 36 pacientes (90% do total) tinham o tipo 2; os tipos 3 e 4 ocorreram em dois pacientes cada (10% do total). Houve história familiar de tremor em 25 casos (62,5%). A média de idade dos pacientes foi 43,1 anos e a média de idade de início dos sintomas foi 27,4 anos. Dos 40 indivíduos avaliados, 33 ou 82,5% apresentaram algum grau de melhora com PAP; em 52,5 % a melhora foi considerada ótima ou boa. Conclusão: o PAP mostrou ser uma medicação adequada para o tratamento do TE nesta amostra de 40 pacientes avaliados. PALAVRAS-CHAVE: tremor essencial, tratamento, propranolol de ação prolongada.Clinical response to long action propranolol in 40 patients diagnosed with essential tremor with no previous treatment: an open, non-controlled study ABSTRACT -Essential tremor (ET) is the most common movement disorder and betablockers are still consideres the first line of treatment. The aim of our study is to report the clinical response to long action propranolol (LAP) of 40 patients diagnosed with essential tremor with no previous treatment. Method: 40 patients with ET were evaluated with rating scales for severity of tremor and clinical classification of ET. All patients were evaluated at least twice, at enlrollment and one month after starting treatment. Results: thirty-six patients (90%) had type 2 ET and types 3 and 4 ocurred in two patients each (10%). Familiar history was positive in 25 patients (62.5%). Mean age at first evaluation was 43.1 years and mean age at onset was 27.4 years. Of all patients, 33 (82.5%) had some degree of benefit and in 52,5 % this benefit was either good or excelent. Conclusion: LAP seems to be a good treatment option for ET in our series of 40 patients.KEY WORDS: essential tremor, treatment, long action propranolol.O tremor essencial (TE) é o distúrbio do movimento mais freqüente, afetando de 0,08 a 220 indivíduos por 1000 habitantes, dependendo dos critérios diagnósticos utilizados, com prevalência de até 5% da população após os 40 anos de idade 1 . Esta condição pode ser classificada como hereditária ou esporádica. Estudos genéticos de análise de ligação têm demonstrado pelo menos dois loci que podem estar implicados na gênese do TE nas suas formas autossômicas dominantes; os principais genes candidatos localizar-se-iam em 3q13 2 e 2p22-25 3 . Entretanto, a fisiopatologia do TE não está ainda bem estabelecida. Várias estruturas cerebrais têm sido implicadas na gênese do TE, ...

show abstract

“…It was first described as a clinicopathological entity by Steele, Richardson and Olszewski 3 in 1964. Clinically, PSP must be considered in any levodopa-unresponsive parkinsonian patient at middle-to-late age with progressive unexplained prominent postural instability with falls and supranuclear vertical gaze palsy 1,2 . The latter is characterized by limitation of upward, downward or lateral gaze, mainly downward.…”

mentioning

confidence: 99%

Progressive supranuclear palsy - like syndrome induced by amiodarone and flunarizine

Mattos

Nicaretta

Rosso

2009

Arq. Neuro-Psiquiatr.

Self Cite

View full text Add to dashboard Cite

Progressive supranuclear palsy (PSP) is a taupathy of unknown etiology, representing 7.5% of all cases of Parkinsonism and 50% of atypical Parkinsonism 1,2 . It was first described as a clinicopathological entity by Steele, Richardson and Olszewski 3 in 1964. Clinically, PSP must be considered in any levodopa-unresponsive parkinsonian patient at middle-to-late age with progressive unexplained prominent postural instability with falls and supranuclear vertical gaze palsy 1,2 . The latter is characterized by limitation of upward, downward or lateral gaze, mainly downward. Other features are also important, such as: astonished face, retrocollis, lid freezing, monotonal speech, disartria, dysphagia, dementia and sloppy eaters 1,2 . We report a patient with signs and symptoms suggestive of PSP who markedly improve six months after discontinuation of amiodarone and flunarizine. CASEA 74-year-old Caucasian woman presented rapid progression of an akinetic-rigid syndrome, with frequent falls, and became wheelchair-bound after only four months. At the age of 77 she was first seen by one of the authors (JPM). At that time her medications were levothyroxin (50 mcg/day), captopril (75 mg/ day), trimetadizine (60 mg/day), levodopa + benserazide (600 + 150 mg/day), biperiden (4 mg/day) and amantadine (200 mg/ day). She has a past medical history of hypothyroidism, essential hypertension, ventricular tachycardia with low cardiac output and dizziness. She has taken amiodarone 400 mg/day and flunarizine 10 mg/day since the age of 73 which had been discontinued a month before her first visit. On neurological examination, she was unable to stand or walk without assistance, and she had chin tremor, severe symmetric limb bradikinesia, axial rigidity, dysarthria and marked dysphagia. There were no pyramidal or cerebellar signs, or autonomic failure. Eye movements were normal and vertical gaze was preserved as were cognitive functions. The MRI showed moderate cortical and subcortical atrophy and ventricular enlargement. At that time biperiden and amantadine were discontinued, and pramipexole and tolcapone were titrated up to 3 mg/day and 300 mg/day, respectively. She underwent a percutaneous endoscopic gastrostomy (PEG) after an episode of aspiration pneumonia. In spite of adequate doses of antiparkinsonian medication, there was no improvement in three months. In fact, there was further deterioration of her neurological condition with the presence of retrocollis, vertical and lateral gaze palsy, lid opening apraxia (lid freezing) and cognitive decline. All these features were suggestive of PSP. Pramipexole was discontinued due to side effects (edema and somnolence), and memantine was added up to 20 mg/day. After a few weeks she gradually improved, which was initially attributed to the memantine. After a five month interval with no news, surprisingly she reappeared with dramatic improvement in all her neurological features. She was able to walk without assistance, with slight postural instability. Mild asymmetric rigidity and bradikines...

show abstract

Diagnóstico diferencial dos tremores

Cited by 8 publications

References 5 publications

Demência reversível e quedas associadas ao biperideno

Demência reversível e quedas associadas ao biperideno

Uso do propranolol de ação prolongada em 40 pacientes com tremor essencial e virgens de tratamento: um ensaio clínico não controlado

Progressive supranuclear palsy - like syndrome induced by amiodarone and flunarizine

Contact Info

Product

Resources

About