Pathophysiology and Management of Parkinsonian Tremor

Helmich, Rick C.; Dirkx, Michiel F.

doi:10.1055/s-0037-1601558

Cited by 15 publications

(4 citation statements)

References 71 publications

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“…Apart from dopaminergic dysfunction, which can manifest with different patterns in the nigrostriatal and mesolimbocortical pathways in BD (33) and PD, the two disorders might potentially share the involvement of additional pathophysiological processes. Impairment in the serotoninergic and glutamatergic circuitries has been classically described in BD disorder (34) and is involved in certain motor and non-motor symptoms of PD such as tremor (35) and mood dysfunction (36). Therefore, future studies are warranted to unravel the putative role of other neurotransmitter involvement in BD patients developing degenerative parkinsonism.…”

Section: Discussionmentioning

confidence: 99%

Bipolar Disorder and Parkinson's Disease: A 123I-Ioflupane Dopamine Transporter SPECT Study

et al. 2021

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Objectives: Bipolar disorder (BD) has been suggested to be a risk factor for the development of Parkinson's disease (PD). Standard treatment of BD includes drugs that are known to induce drug-induced parkinsonism (DIP). Clinical differentiation between PD and DIP is crucial and might be aided by functional neuroimaging of the dopaminergic nigrostriatal pathway.Methods: Twenty consecutive BD patients with parkinsonism were clinically assessed and underwent 123I-ioflupane dopamine transporter single-photon emission computer tomography (SPECT). Imaging data of BD patients with pathological scans were further compared to a population of 40 de novo PD patients.Results: Four BD patients had abnormal scans, but their clinical features and cumulative exposure to both antipsychotic drugs and lithium were similar to those of BD patients with normal dopamine transporter imaging. BD patients with pathological scans had putaminal binding ratio and putamen-to-caudate ratios higher than those of PD patients despite a similar motor symptom burden.Conclusions: Up to 20% of BD patients with parkinsonism might have an underlying dopaminergic deficit, which would not be due to cumulative exposure to offending drugs and is ostensibly higher than expected in the general population. This supports the evidence that BD represents a risk factor for subsequent development of neurodegenerative parkinsonism, the nature of which needs to be elucidated.

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Section: Discussionmentioning

confidence: 99%

Bipolar Disorder and Parkinson's Disease: A 123I-Ioflupane Dopamine Transporter SPECT Study

et al. 2021

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“…The pathophysiology of action tremor is uncertain but has a clear difference from other motor symptoms of PD [ 9 ] as it is thought to be modulated by nondopaminergic pathways and does not correlate with dopamine depletion in the striatum; rather, serotonin, noradrenaline, and acetylcholine appear to play more of a role [ 9 ]. It may be caused by oscillations that occur within internal sensorimotor feedback circuits during movement [ 10 , 11 ] or by abnormal activity within the basal ganglia and cerebello-thalamo-cortical circuit [ 9 , 12 ] Action tremor frequency usually displays a 1.5 Hz higher frequency than that of rest tremor, which is ~4-6 Hz [ 9 ]. Interventions for the management of action tremor have been limited.…”

Section: Introductionmentioning

confidence: 99%

“…Deep brain stimulation to the subthalamic nucleus and globus pallidus have shown improvement in action tremor severity at 6 and 12 months post implantation, but is invasive, can lead to adverse events, and is not suitable for everyone [ 11 ]. Dopaminergic medications also have limited efficacy in improving action tremor-related motor dysfunction [ 5 , 8 , 9 , 13 ], leaving a pressing need to address these functional sequelae.…”

Section: Introductionmentioning

confidence: 99%

A Wearable Vibratory Device (The Emma Watch) to Address Action Tremor in Parkinson Disease: Pilot Feasibility Study

Pacheco¹,

Schaik²,

Paleyes³

et al. 2023

JMIR Biomed Eng

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Background Parkinson disease (PD) is a neurodegenerative disease that has a wide range of motor symptoms, such as tremor. Tremors are involuntary movements that occur in rhythmic oscillations and are typically categorized into rest tremor or action tremor. Action tremor occurs during voluntary movements and is a debilitating symptom of PD. As noninvasive interventions are limited, there is an ever-increasing need for an effective intervention for individuals experiencing action tremors. The Microsoft Emma Watch, a wristband with 5 vibrating motors, is a noninvasive, nonpharmaceutical intervention for tremor attenuation. Objective This pilot study investigated the use of the Emma Watch device to attenuate action tremor in people with PD. Methods The sample included 9 people with PD who were assessed on handwriting and hand function tasks performed on a digitized tablet. Tasks included drawing horizontal or vertical lines, tracing a star, spiral, writing “elelelel” in cursive, and printing a standardized sentence. Each task was completed 3 times with the Emma Watch programmed at different vibration intensities, which were counterbalanced: high intensity, low intensity (sham), and no vibration. Digital analysis from the tablet captured kinematic, dynamic, and spatial attributes of drawing and writing samples to calculate mathematical indices that quantify upper limb motor function. APDM Opal sensors (APDM Wearable Technologies) placed on both wrists were used to calculate metrics of acceleration and jerk. A questionnaire was provided to each participant after using the Emma Watch to gain a better understanding of their perspectives of using the device. In addition, drawings were compared to determine whether there were any visual differences between intensities. Results In total, 9 people with PD were tested: 4 males and 5 females with a mean age of 67 (SD 9.4) years. There were no differences between conditions in the outcomes of interest measured with the tablet (duration, mean velocity, number of peaks, pause time, and number of pauses). Visual differences were observed within a small subset of participants, some of whom reported perceived improvement. The majority of participants (8/9) reported the Emma Watch was comfortable, and no problems with the device were reported. Conclusions There were visually depicted and subjectively reported improvements in handwriting for a small subset of individuals. This pilot study was limited by a small sample size, and this should be taken into consideration with the interpretation of the quantitative results. Combining vibratory devices, such as the Emma Watch, with task specific training, or personalizing the frequency to one’s individual tremor may be important steps to consider when evaluating the effect of vibratory devices on hand function or writing ability in future studies. While the Emma Watch may help attenuate action tremor, its efficacy in improving fine motor or handwriting skills as a stand-alone tool remains to be demonstrated.

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“…Mais recentemente, evidências mostram que o tremor surge de uma ativação anormal na integração entre a circuitaria de núcleos da base e a via cerebelo-tálamo-cortical, devido a uma redução das projeções dopaminérgicas e serotoninérgicas nestas regiões associada com um aumento de influências noradrenérgicas. Todavia o papel específico desempenhado por essas vias na frequência e amplitude do tremor e no contexto em que este ocorre permanece em aberto(HELMICH; DIRKX, 2017;HESS; HALLETT, 2017).…”

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Efeitos da realimentação cinestésica promovida pelo fisioterapeuta durante o treinamento com video games sobre a funcionalidade de pessoas com doença de Parkinson: um ensaio clínico randomizado cego

Barbosa¹

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Pathophysiology and Management of Parkinsonian Tremor

Cited by 15 publications

References 71 publications

Bipolar Disorder and Parkinson's Disease: A 123I-Ioflupane Dopamine Transporter SPECT Study

Bipolar Disorder and Parkinson's Disease: A 123I-Ioflupane Dopamine Transporter SPECT Study

A Wearable Vibratory Device (The Emma Watch) to Address Action Tremor in Parkinson Disease: Pilot Feasibility Study

Efeitos da realimentação cinestésica promovida pelo fisioterapeuta durante o treinamento com video games sobre a funcionalidade de pessoas com doença de Parkinson: um ensaio clínico randomizado cego

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