Distinguishing essential tremor from Parkinson's disease: bedside tests and laboratory evaluations

Thenganatt, Mary Ann; Louis, Elan D.

doi:10.1586/ern.12.49

Cited by 125 publications

(96 citation statements)

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“…23 As a result, Jain et al reported that # LD+DA, number of patients using both levodopa and dopamine agonists; LD, number of patients using only levodopa; DA, number of patients using only dopamine agonist. ## P+B, number of patients using both primidone and β-blockers; P, number of patients using only primidone; B, number of patients using only β-blockers.…”

Section: Discussionmentioning

confidence: 99%

Sleep Disturbances in Essential Tremor and Parkinson Disease: A Polysomnographic Study

Barut

Taşçılar

Varo

2015

Journal of Clinical Sleep Medicine

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are prone to error. Importantly, the study performed by Gerbin recommended a combination of sleep diaries and polysomnography be used in future studies to investigate sleep problems in patients with ET. 6 The aim of our study was to evaluate sleep disturbances and sleep-related events in patients with ET, PD, and controls, using both self-assessment tools and polysomnographic readings. METHODS Study SampleThe ethics committee of Bülent Ecevit University approved this prospective study, and informed consent was obtained from all participants. Between 2010 and 2012, 21 patients with PD who fulfi lled the Parkinson Disease Society Bank criteria, 9 and 16 patients with ET who fulfi lled Movement Disorders BRIEF SUMMARY Current Knowledge/Study Rationale: Sleep problems in ET and PD patients had been investigated in few studies by using subjective assessment tools like self-report questionnaires previously. This study was conducted to evaluate and to compare sleep problems in these two common movement disorders by using PSG which is an objective assessment tool. Study Impact: This study will improve the knowledge about sleep problems in ET and PD patients. Furthermore this is the fi rst study comparing sleep problems in ET and PD patients using PSG.Objective: Sleep problems are a common non-motor complication of Parkinson disease (PD), and patients with essential tremor (ET) share a number of motor and non-motor features of PD. To clarify the relationship between these disorders, we evaluated the sleep problems in patients with ET and PD using assessment scales and objective polysomnographic (PSG) testing. Method: Twenty-one consecutive patients with PD, 16 with ET, and 14 healthy subjects participated in this study and were compared in terms of sleep related complaints, fi nal sleep related diagnosis, and polysomnographic features. Results:The results of our study have shown that patients with PD were more likely than were those with ET to have a history of REM sleep behavior disorders (RBD) (p = 0.001) and excessive daytime sleepiness (p ≤ 0.05). Additionally, PSG data revealed that ET patients had lower mean SpO 2 values (p ≤ 0.05) and REM without atonia (RWA) (p = 0.032) than did patients with PD. Conclusion: This is the fi rst study to use PSG to evaluate sleep problems both in ET and PD patients. The results point out different sleep problems in these two common movement disorders which should be investigated in further studies. Keywords: essential tremor, Parkinson disease, sleep, REM behavior disorder (RBD), REM without atonia (RWA) Citation: Barut BO, Tascilar N, Varo A. Sleep disturbances in essential tremor and Parkinson disease: a polysomnographic study.

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Section: Discussionmentioning

confidence: 99%

Sleep Disturbances in Essential Tremor and Parkinson Disease: A Polysomnographic Study

Barut

Taşçılar

Varo

2015

Journal of Clinical Sleep Medicine

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“…In fact, all the core features of PD (resting tremor, rigidity and bradykinesia) are more pronounced unilaterally at disease onset and generally persist asymmetrically throughout the course of the illness (Lee et al, 1995). In patients with ET, unilateral tremor is unusual and reportedly occurs at rates of 2-10%, depending on the criteria applied (Thenganatt and Louis, 2012). In patients with DT, unilateral presentation is common in focal forms, whereas bilateral presentation prevails in multifocal, segmental and generalized dystonia (Jedynak et al, 1991).…”

Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L I F Bove mentioning

confidence: 99%

“…Resting tremor is a cardinal feature of PD, occurring in 70-90% of patients. Although the reported prevalence of action tremor in patients with PD is as high as 88-92%, its amplitude is lower than that of resting tremor (Thenganatt and Louis, 2012). On the other hand, resting tremor occurs in 20-30% of patients with ET, even though it shows a lower amplitude than the action tremor seen in these patients (Cohen et al, 2003).…”

Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L I F Bove mentioning

confidence: 99%

A role for accelerometry in the differential diagnosis of tremor syndromes

Bove¹

2018

Functional Neurology

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SummaryAccelerometry is a reliable tool for gauging the occurrence, amplitude and frequency of tremor. However, there is no consensus on criteria for accelerometric diagnosis of tremor syndromes. We enrolled 20 patients with essential tremor (ET), 20 with dystonic tremor (DT), and 20 with classic parkinsonian tremor (PD-T), all meeting accepted clinical criteria. All the patients underwent dopamine transporter imaging (by means of single-photon emission computed tomography) and triaxial accelerometric tremor analysis. The latter revealed groupwise differences in tremor frequency, peak dispersion, spectral coherence, unilaterality and resting vs action tremor amplitude. From the above, five diagnostic criteria were extrapolated for each condition. Receiver operating characteristic curves, depicting criteriabased scoring of each tremor type, showed negligible declines in specificity for scores ≥4 in patients with ET or DT and scores ≥3 in patients with PD-T, thus providing a simple scoring method (accelerometrically derived) for differential diagnosis of the principal tremor syndromes.

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“…Despite their potentially different origins, ET and PD frequently demonstrate similar symptoms and are often difficult to discriminate, especially at early stages. Up to 20% of patients with ET develop the signs typical for PD, whereas 30 to 50% of patients diagnosed with ET do not have ET [2,7,8].…”

Section: Introductionmentioning

confidence: 99%

New Perspectives for Computer-Aided Discrimination of Parkinson’s Disease and Essential Tremor

et al. 2017

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Pathological tremor is a common but highly complex movement disorder, affecting ∼5% of population older than 65 years. Different methodologies have been proposed for its quantification. Nevertheless, the discrimination between Parkinson's disease tremor and essential tremor remains a daunting clinical challenge, greatly impacting patient treatment and basic research. Here, we propose and compare several movement-based and electromyography-based tremor quantification metrics. For the latter, we identified individual motor unit discharge patterns from high-density surface electromyograms and characterized the neural drive to a single muscle and how it relates to other affected muscles in 27 Parkinson's disease and 27 essential tremor patients. We also computed several metrics from the literature. The most discriminative metrics were the symmetry of the neural drive to muscles, motor unit synchronization, and the mean log power of the tremor harmonics in movement recordings. Noteworthily, the first two most discriminative metrics were proposed in this study. We then used decision tree modelling to find the most discriminative combinations of individual metrics, which increased the accuracy of tremor type discrimination to 94%. In summary, the proposed neural drive-based metrics were the most accurate at discriminating and characterizing the two most common pathological tremor types.

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Distinguishing essential tremor from Parkinson's disease: bedside tests and laboratory evaluations

Cited by 125 publications

References 69 publications

Sleep Disturbances in Essential Tremor and Parkinson Disease: A Polysomnographic Study

Sleep Disturbances in Essential Tremor and Parkinson Disease: A Polysomnographic Study

A role for accelerometry in the differential diagnosis of tremor syndromes

New Perspectives for Computer-Aided Discrimination of Parkinson’s Disease and Essential Tremor

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