Non-motor features of essential tremor with midline distribution

Rekik, Arwa; Nasri, Amina; Mrabet, S.; Gharbi, Alya; Souissi, Amira; Gargouri, Amina; Kacem, Imen; Gouider, Riadh

doi:10.1007/s10072-022-06262-x

Cited by 3 publications

(1 citation statement)

References 40 publications

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“…It is increasingly recognized that essential tremor is not a monosymptomatic disorder but is frequently associated with gait and cognitive changes. 24,25 These nonmotor abnormalities arguably justify the label "essential tremor is a tremor syndrome," as proposed by the Movement Disorders Society. 1 Some have advocated that essential tremor should be regarded as a disease or a family of diseases.…”

Section: Gait and Cognitionmentioning

confidence: 99%

Diagnosis and Treatment of Essential Tremor

Shukla¹

2022

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW: Essential tremor is a chronic, progressive syndrome that primarily presents with an action tremor involving the arms and hands. This article reviews the history and physical examination features pertinent for diagnosis, differential diagnoses, and treatments and approaches for optimal control of symptoms.RECENT FINDINGS: Essential tremor is a syndrome with symptoms extending beyond tremor to involve disturbances in gait, speech, cognition, and mood. Although the new guidelines on the definition and biaxial classification scheme have provided clarity, some tremor experts have critiqued the recently coined term essential tremor plus. For treatment, new orthotic devices and peripheral stimulation devices are now available in addition to pharmacologic and surgical options. SUMMARY: Essential tremor has a rich clinical phenomenology with many subtleties and nuances. A detailed history with open-ended questions and focused questions encompassing medical history, social history, and family history is key for establishing the diagnosis. The presence of bilateral action tremor for 3 years and absence of isolated head and voice tremor and absence of task-and position-dependent tremor are necessary for diagnosis. Dystonic tremor, Parkinson disease tremor, physiologic tremor, and drug-induced tremor are common differential diagnoses. Differentiating these tremor disorders from essential tremor based on phenomenology and physical examination alone could be challenging; thus, clinicians should seek additional clues from a detailed history. Treatment could begin with noninvasive and nonpharmacologic therapies, especially in mild cases. As the severity increases, they can advance stepwise to include pharmacotherapies and surgical interventions. With the growing recognition that essential tremor is not a monosymptomatic disorder, management should involve a multidisciplinary team. Furthermore, treatment selection should be based on shared decision making between patients and providers that gives due consideration to severity of symptoms, level of functional disability, impact on social interactions, patient preferences, and patient expectations.

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Section: Gait and Cognitionmentioning

confidence: 99%

Diagnosis and Treatment of Essential Tremor

Shukla¹

2022

CONTINUUM: Lifelong Learning in Neurology

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Thalamic ventral-Oralis complex/rostral zona incerta deep brain stimulation for midline tremor

Scerrati,

Gozzi,

Cavallo

et al. 2024

J Neurol

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Background Midline Tremor is defined as an isolated or combined tremor that affects the neck, trunk, jaw, tongue, and/or voice and could be part of Essential Tremor (ET), or dystonic tremor. The clinical efficacy of deep brain stimulation for Midline Tremor has been rarely reported. The Ventral Intermediate Nucleus and Globus Pallidus Internus are the preferred targets, but with variable outcomes. Thalamic Ventral-Oralis (VO) complex and Zona Incerta (ZI) are emerging targets for tremor control in various etiologies. Objective To report on neuroradiological, neurophysiological targeting and long-term efficacy of thalamic Ventral-Oralis complex and Zona Incerta deep brain stimulation in Midline Tremor. Methods Three patients (two males and one female) with Midline Tremor in dystonic syndromes were recruited for this open-label study. Clinical, surgical, neurophysiological intraoperative testing and long-term follow-up data are reported. Results Intraoperative testing and reconstruction of volume of tissue activated confirmed the position of the electrodes in the area stimulated between the thalamic Ventral-Oralis complex and Zona Incerta in all patients. All three patients showed optimal control of both tremor and dystonic features at short-term (6 months) and long-term follow-up (up to 6 years). No adverse events occurred. Conclusion In the syndromes of Midline Tremor of various origins, the best target for DBS might be difficult to identify. Our results showed that thalamic Ventral-Oralis complex/Zona Incerta may be a viable and safe option even in specific forms of tremor with axial distribution.

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Evaluating deep learning techniques for identifying tongue features in subthreshold depression: a prospective observational study

Han,

Chang,

Tan

et al. 2024

Front. Psychiatry

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ObjectiveThis study aims to evaluate the potential of using tongue image features as non-invasive biomarkers for diagnosing subthreshold depression and to assess the correlation between these features and acupuncture treatment outcomes using advanced deep learning models.MethodsWe employed five advanced deep learning models—DenseNet169, MobileNetV3Small, SEResNet101, SqueezeNet, and VGG19_bn—to analyze tongue image features in individuals with subthreshold depression. These models were assessed based on accuracy, precision, recall, and F1 score. Additionally, we investigated the relationship between the best-performing model’s predictions and the success of acupuncture treatment using Pearson’s correlation coefficient.ResultsAmong the models, SEResNet101 emerged as the most effective, achieving an impressive 98.5% accuracy and an F1 score of 0.97. A significant positive correlation was found between its predictions and the alleviation of depressive symptoms following acupuncture (Pearson’s correlation coefficient = 0.72, p<0.001).ConclusionThe findings suggest that the SEResNet101 model is highly accurate and reliable for identifying tongue image features in subthreshold depression. It also appears promising for assessing the impact of acupuncture treatment. This study contributes novel insights and approaches to the auxiliary diagnosis and treatment evaluation of subthreshold depression.

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Non-motor features of essential tremor with midline distribution

Cited by 3 publications

References 40 publications

Diagnosis and Treatment of Essential Tremor

Diagnosis and Treatment of Essential Tremor

Thalamic ventral-Oralis complex/rostral zona incerta deep brain stimulation for midline tremor

Evaluating deep learning techniques for identifying tongue features in subthreshold depression: a prospective observational study

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