Shaky and unsteady: Dynamic posturography in essential tremor

Prasad, Shweta; Velayutham, Selva Ganapathy; Reddam, Venkateswara Reddy; Stezin, Albert; Jhunjhunwala, Ketan; Pal, Pramod Kumar

doi:10.1016/j.jns.2017.12.003

Cited by 11 publications

(5 citation statements)

References 29 publications

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“…All these data point to the increased risk of falls in ET patients and the different pathogenic effect induced by ET on the three sensory components of balance. These results are in accordance with that of Prasad and colleagues, 2018 [22] who concluded that CDP reveals significant balance impairment in ET patients which adds to the growing body evidence of cerebellar involvement in ET.…”

Section: Discussionsupporting

confidence: 93%

Essential tremor: what is beyond the oscillatory monosymptomatic illness?

Elhassanien

Rashed

Bahnasy

et al. 2020

Egypt J Neurol Psychiatry Neurosurg

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Background Essential tremor (ET) is now considered as a slowly progressive neurodegenerative disorder with a variety of motor and non-motor manifestations. The objectives of this work were to study the existence of cognitive, mood, olfactory, and balance dysfunctions in ET patients and their relation to tremor severity as well as patients’ activity of daily livings. Methods This study was performed on 36 ET patients and 24 healthy controls subjects (HCS) submitted to The Essential Tremor Rating Assessment Scale (TETRAS), advanced activity of daily living scale (AADLs), Montreal cognitive assessment scale (MoCA), Montgomery–Åsberg Depression Rating Scale (MADRS), auditory mismatch negativity (MMN), Sniffin’ Sticks test (SST), computerized dynamic posturography (CDP), and brain MRI diffusion tensor tractography (DTT). Results ET patients showed significant decrease in AADLs, MoCA, SST (threshold, identification, and discrimination subscales) as well as visual and vestibular ratios of CDP compared to HCS. Auditory MMN showed significant reduction in the amplitude and prolongation of latencies while corticospinal tracts, thalamo-cortical connectivity, and middle cerebellar peduncles DTT revealed reduced fractional anisotropy in ET patients with normal tracts densities. Conclusion ET patients exhibit a wide variety of non-motor manifestations including cognitive impairment, depressive symptoms, hyposmia, and increased risk of falls with consecutive reduced activity of daily living beyond the deleterious effects of the kinetic tremor.

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Section: Discussionsupporting

confidence: 93%

Essential tremor: what is beyond the oscillatory monosymptomatic illness?

Elhassanien

Rashed

Bahnasy

et al. 2020

Egypt J Neurol Psychiatry Neurosurg

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“…Some patients with essential tremor report balance difficulties. Studies have tested balance by assessing tandem gait and using posturography 464748. Patients with essential tremor perform worse than age matched controls in balance testing.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Essential tremor: diagnosis and management

Shanker

2019

BMJ

113

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Essential tremor is one of the most common movement disorders in adults and can affect both children and adults. An updated consensus statement in 2018 redefined essential tremor as an isolated action tremor present in bilateral upper extremities for at least three years. Tremor may also be present in other locations, commonly the neck or the vocal cords. Patients with additional neurologic symptoms are now categorized as “essential tremor plus.” Additional clinical features associated with the condition include but are not limited to cognitive impairment, psychiatric disorders, and hearing loss. When treatment is needed, propranolol and primidone are considered first line treatments. Patients who are severely affected are often offered deep brain stimulation. Although the ventral intermediate nucleus of the thalamus is the traditional surgical target, the caudal zona incerta is also being studied as a possible superior alternative. Magnetic resonance imaging guided high intensity focused ultrasound is a newer surgical alternative that may be ideal for patients with substantial medical comorbidities. Current research explores novel oral treatments, chemodenervation, and noninvasive neuromodulation for treatment of essential tremor.

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“…2 Additionally, a rest tremor and a variety of symptoms ranging from gait and balance impairments to alterations in cognition have also been reported. [3][4][5] Epidemiological studies in ET have demonstrated a bimodal age at onset (AAO) with "early onset" that peaks in late 20s and "late onset" with a peak in 50s. 6,7 The possibility of clinical or pathophysiological differences between these groups has been repeatedly hypothesized but seldom explored.…”

Section: Introductionmentioning

confidence: 99%

Phenotypic Variability of Essential Tremor Based on the Age at Onset

Prasad

Bhalsing

Jhunjhunwala

et al. 2019

Can. J. Neurol. Sci.

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ABSTRACT:Background: Essential tremor (ET) is reported to have a bimodal distribution of age at onset (AAO) with phenotypic variability based on the AAO. This study aims to explore the distribution of AAO based on mathematical modeling and ascertain the differences, if any, in the clinical features of groups. Methods: A chart review was conducted for 252 patients with ET diagnosed based on the Consensus statement of the Movement Disorder Society on Tremor. Finite mixture modeling was performed to identify groups of the cohort based on the AAO. Results: Three groups were defined: early onset (EO): AAO ≤ 22 years, n = 63, intermediate onset (IO): 23 ≤ AAO ≤ 35 years, n = 43, and late onset (LO): AAO ≥ 36 years, n = 146. There were no significant differences related to family history or responsiveness to alcohol. The EO group had significantly higher prevalence of upper limb and lower limb tremor. Head tremor and voice tremor was more prevalent in the IO and LO groups. Cerebellar signs showed a significant increase with an increase in AAO. Conclusions: ET shows significant phenotypic variability based on the AAO. Patients with an early AAO are more likely to develop an appendicular tremor, whereas the probability of axial tremor and cerebellar signs increases with increasing AAO.

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Shaky and unsteady: Dynamic posturography in essential tremor

Cited by 11 publications

References 29 publications

Essential tremor: what is beyond the oscillatory monosymptomatic illness?

Essential tremor: what is beyond the oscillatory monosymptomatic illness?

Essential tremor: diagnosis and management

Phenotypic Variability of Essential Tremor Based on the Age at Onset

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