Essential Tremor

Lenka, Abhishek; Pandey, Sanjay

doi:10.1212/cpj.0000000000001145

Cited by 7 publications

(7 citation statements)

References 27 publications

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“…If we broaden the field of observation and include non‐parkinsonian neurological disorders, several clinical studies specifically refer to the presence of bradykinesia in these disorders 17 . Examples of these conditions include motor neuron diseases, psychiatric conditions, other neurodegenerative diseases, and even some hyperkinetic disorders like dystonia (for which the term was originally coined), chorea, and essential tremor (ET), 17 where slowness of movement has even been included among the so‐called “soft signs” needed for the diagnosis of “ET‐plus.” 26,32 In these conditions, experimental studies indicate that bradykinesia can be explained by pathophysiological mechanisms that differ from those observed in parkinsonism 10,16,33‐36 . We can therefore question whether its use is appropriate 17 .…”

Section: Critical Issues With the Current Definition Of Bradykinesiamentioning

confidence: 99%

Redefining Bradykinesia

et al. 2023

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Section: Critical Issues With the Current Definition Of Bradykinesiamentioning

confidence: 99%

Redefining Bradykinesia

et al. 2023

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“…ET can subsequently spread to other parts of the body including head, larynx, and lower limbs in longer disease duration, but not isolated head or vocal tremor that is often seen in DT. Tremor frequency does not change with different positions and weight loadings due to it being a central tremor [ 52 ]. There may be mild ataxia with intentional tremor that can make it difficult to distinguish ET from cerebellar tremor [ 51 , 53 ].…”

Section: Common Tremor Situations In Clinical Practicementioning

confidence: 99%

“…Positive family history of action tremor and alcohol responsiveness are clues that can support a diagnosis of ET. Rest tremor may be present at unilateral upper limb in ET but should not be anatomically separated from action tremor with less severity compared to the action component [ 52 , 54 ]. Rest tremor in ET is often revealed at the flexion and extension of the wrist, which is different from PD tremor ( Table 4 ).…”

Section: Common Tremor Situations In Clinical Practicementioning

confidence: 99%

Bedside clinical assessment of patients with common upper limb tremor and algorithmic approach

Panyakaew,

Phuenpathom,

Bhidayasiri

et al. 2024

Asian Biomedicine

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The diagnostic approach for patients with tremor is challenging due to the complex and overlapping phenotypes among tremor syndromes. The first step in the evaluation of tremor is to identify the tremulous movement and exclude the tremor mimics. The second step is to classify the tremor syndrome based on the characteristics of tremor from historical clues and focused examination (Axis 1). Comprehensive tremor examinations involve the assessment of tremor in different conditions (rest, action or mixed, position or task-specific), distribution of tremor (upper limb, lower limb, head, jaw), positive signs for functional tremor (FT) if suspected (distractibility, entrainment, co-contraction), and associated neurological signs including parkinsonism, dystonic posture, cerebellar/brainstem signs, neuropathy, and cognitive impairment. A pivotal feature in this step is to determine any distinct feature of a specific isolated or combined tremor syndrome. In this review, we propose an algorithm to assess upper limb tremors. Ancillary testing should be performed if clinical evaluation is unclear. The choice of investigation depends on the types of tremors considered to narrow down the spectrum of etiology (Axis 2). Laboratory blood tests are considered for acute onset and acute worsening of tremors, while structural neuroimaging is indicated in unilateral tremors with acute onset, nonclassical presentations, and a combination of neurological symptoms. Neurophysiological study is an important tool that aids in distinguishing between tremor and myoclonus, etiology of tremor and document specific signs of FT. Treatment is mainly symptomatic based depending on the etiology of the tremor and the patient’s disabilities.

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“…Essential tremor (ET) is a chronic, progressive neurological disease; its prevalence in the population is high, making it one of the most common movement disorders among adults [1]. Recent evidence from clinical, neuroimaging, and postmortem studies suggest that the disease could be neurodegenerative [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Although in the past mislabeled as "benign" [19], the impact of ET on patients' as well as caregivers' lives can be significant [20][21][22][23][24][25][26][27], and this reinforces the importance of research that advances the field.…”

Section: Introductionmentioning

confidence: 99%

Developing a Staging Scheme for Essential Tremor: A Discussion of Organizing Principles

Lenka,

Louis

2023

Tremor and Other Hyperkinetic Movements

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Essential tremor (ET) is a chronic, progressive neurological disease that may negatively affect patients' lives. While there has been considerable progress in ET research, some fundamental issues remain unaddressed. One such issue is disease staging. Staging schemes have inherent value and are part of the dialogue that clinicians have with other movement disorders patients. We highlight the value of and challenges with developing a staging system for ET and organize a discussion around the potential steps in developing such a system. Diseases for which there are staging schemes generally have a number of shared characteristics. ET has numerous features that would lend themselves to a staging scheme: emerging evidence supporting the existence of a premotor phase of disease, insidious onset, progressive worsening of arm tremor, spread of tremor to other body regions, the observation that patients seem to be at increased risk for other conditions within the same organ (i.e., emergence of Parkinson's disease and Alzheimer's disease in excessive numbers of ET patients), pathological changes in the cerebellum whose evolution can be ordered from (i) those that compromise the physical integrity and physiological function of Purkinje cells, (ii) subsequent changes that are reparative and regenerative, and (iii) eventual cell death. Challenges to formulating a staging scheme are the absence of both a biological marker and an "end stage" of disease. The sum of combined evidence suggests that a staging scheme would be of value. We provide initial thoughts as to how to begin to structure such a staging scheme.

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Essential Tremor

Cited by 7 publications

References 27 publications

Redefining Bradykinesia

Redefining Bradykinesia

Bedside clinical assessment of patients with common upper limb tremor and algorithmic approach

Developing a Staging Scheme for Essential Tremor: A Discussion of Organizing Principles

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