Temporal Discrimination is Altered in Patients With Isolated Asymmetric and Jerky Upper Limb Tremor

Gövert, Felix; Becktepe, Jos S.; Balint, Bettina; Rocchi, Lorenzo; Brugger, Florian; Garrido, Alícia; Walter, Tim; Hannah, Ricci; Rothwell, John C.; Elble, Rodger J.; Deuschl, Günther; Bhatia, Kailash P.

doi:10.1002/mds.27880

Cited by 18 publications

(17 citation statements)

References 67 publications

(179 reference statements)

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“…In recent studies, the "canonical" findings of dystonia, such as reduced inhibition and increased plasticity, have been questioned, giving therefore further importance to the network model. For instance, in some studies SICI has been found to be normal (Kojovic et al 2013;Ganos et al 2017;Govert et al 2020) and others have shown a variable response to plasticity protocols in patients with dystonia (Sadnicka et al 2014a). The lack of reproducibility of some results can be attributed to the different reliability of the TMS measures, but the interindividual variability to plasticity-inducing paradigm needs also to be taken into account (Latorre et al 2019).…”

Section: Conclusion: the Network Modelmentioning

confidence: 99%

Delineating the electrophysiological signature of dystonia

2020

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Over the last 30 years, the concept of dystonia has dramatically changed, from being considered a motor neurosis, to a pure basal ganglia disorder, to finally reach the definition of a network disorder involving the basal ganglia, cerebellum, thalamus, and sensorimotor cortex. This progress has been possible thanks to the collaboration between clinicians and scientists, and the development of increasingly sophisticated electrophysiological techniques able to non-invasively investigate pathophysiological mechanisms in humans. This review is a chronological excursus of the electrophysiological studies that laid the foundation for the understanding of the pathophysiology of dystonia and delineated its electrophysiological signatures. Evidence for neurophysiological abnormalities are grouped according to the neural system involved, and a unifying theory, bringing together all the hypothesis and evidence provided to date, is proposed at the end.

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Section: Conclusion: the Network Modelmentioning

confidence: 99%

Delineating the electrophysiological signature of dystonia

2020

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“…18 For instance, in large samples, although a trend toward a smaller SICI was noticed, this technique could not discriminate dystonic tremor from ET and HS. 21 The same was true FIG. 2.…”

Section: Discussionmentioning

confidence: 62%

The Signature of Primary Writing Tremor Is Dystonic

et al. 2021

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Background It has been debated for decades whether primary writing tremor is a form of dystonic tremor, a variant of essential tremor, or a separate entity. We wished to test the hypothesis that primary writing tremor and dystonia share a common pathophysiology. Objectives The objective of the present study was to investigate the pathophysiological hallmarks of dystonia in patients affected by primary writing tremor. Methods Ten patients with idiopathic dystonic tremor syndrome, 7 with primary writing tremor, 10 with essential tremor, and 10 healthy subjects were recruited. They underwent eyeblink classic conditioning, blink recovery cycle, and transcranial magnetic stimulation assessment, including motor‐evoked potentials and short‐ and long‐interval intracortical inhibition at baseline. Transcranial magnetic stimulation measures were also recorded after paired‐associative plasticity protocol. Results Primary writing tremor and dystonic tremor syndrome had a similar pattern of electrophysiological abnormalities, consisting of reduced eyeblink classic conditioning learning, reduced blink recovery cycle inhibition, and a lack of effect of paired‐associative plasticity on long‐interval intracortical inhibition. The latter 2 differ from those obtained in essential tremor and healthy subjects. Although not significant, slightly reduced short‐interval intracortical inhibition and a larger effect of paired‐associative plasticity in primary writing tremor and dystonic tremor syndrome, compared with essential tremor and healthy subjects, was observed. Conclusions Our initial hypothesis of a common pathophysiology between dystonia and primary writing tremor has been confirmed. Primary writing tremor might be considered a form of dystonic tremor. © 2021 International Parkinson and Movement Disorder Society

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“…33 Neurophysiological measures, such as temporal discrimination thresholds, also cannot provide clear distinctions between ET and dystonic tremor, although this may be useful when classifying indeterminate tremors. 34 These findings show that the borders between some clinical tremor syndromes are not fixed, which may indicate a shared pathophysiological basis. 3 Accordingly, it has been argued that 'ET plus' may represent a state condition, such that additional signs emerge during certain stages of ET, 35 or a temporary label, such that patients with ET plus transition to a more definite diagnosis.…”

Section: Movement Disordersmentioning

confidence: 92%

Systematic clinical approach for diagnosing upper limb tremor

Wardt

Stouwe

Dirkx

et al. 2020

J Neurol Neurosurg Psychiatry

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Tremor is the most common movement disorder worldwide, but diagnosis is challenging. In 2018, the task force on tremor of the International Parkinson and Movement Disorder Society published a consensus statement that proposes a tremor classification along two independent axes: a clinical tremor syndrome and its underlying aetiology. In line with this statement, we here propose a stepwise diagnostic approach that leads to the correct clinical and aetiological classification of upper limb tremor. We also describe the typical clinical signs of each clinical tremor syndrome. A key feature of our algorithm is the distinction between isolated and combined tremor syndromes, in which tremor is accompanied by bradykinesia, cerebellar signs, dystonia, peripheral neuropathy or brainstem signs. This distinction subsequently informs the selection of appropriate diagnostic tests, such as neurophysiology, laboratory testing, structural and dopaminergic imaging and genetic testing. We highlight treatable metabolic causes of tremor, as well as drugs and toxins that can provoke tremor. The stepwise approach facilitates appropriate diagnostic testing and avoids unnecessary investigations. We expect that the approach offered in this article will reduce diagnostic uncertainty and increase the diagnostic yield in patients with tremor.

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Temporal Discrimination is Altered in Patients With Isolated Asymmetric and Jerky Upper Limb Tremor

Cited by 18 publications

References 67 publications

Delineating the electrophysiological signature of dystonia

Delineating the electrophysiological signature of dystonia

The Signature of Primary Writing Tremor Is Dystonic

Systematic clinical approach for diagnosing upper limb tremor

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