Tremor Distribution and the Variable Clinical Presentation of Essential Tremor

Bologna, Matteo; Berardelli, Isabella; Paparella, Giulia; Ferrazzano, Gina; Angelini, Luca; Giustini, P.; Alunni-Fegatelli, Danilo; Berardelli, Alfredo

doi:10.1007/s12311-019-01070-0

Cited by 33 publications

(56 citation statements)

References 38 publications

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“…Our results were similar to the previous findings 4,7–10 with regard to motor symptoms. As previously described in a Northern Manhattan study, 4 our ET patients with MT either had the lowest or highest action arm tremor score.…”

Section: Discussionsupporting

confidence: 93%

“…In our previous study, we explored the correlation between affective symptoms and MT, which revealed MT to be associated with anxiety and depression symptoms in ET 22 . Recently, Bologna et al 9 reported patients with head tremor to have a higher occurrence of psychiatric disorders, and Peng et al 23 showed that ET patients with head tremor had a higher incidence of memory and affective disorders than patients without head tremor. Several mechanisms could explain the pronounced mental symptoms observed in ET patients with MT.…”

Section: Discussionmentioning

confidence: 99%

“…We speculate that our ET patients with head tremor and relatively mild arm tremor may progress from such cases. Besides, MT could also occur in patients with more severe arm tremor 4,7–10 . The heterogeneity evidence in the disease duration and severity of arm tremor between patients with MT suggests that some patients develop MT in the early stage, while others develop MT in an advanced stage.…”

Section: Discussionmentioning

confidence: 99%

“…Partly, tremor distribution differences contribute to the heterogeneity in ET syndrome. On the one hand, factors, such as female gender, late onset of tremor, advanced age, longer tremor duration, and more severe arm tremor, are significantly correlated with MT 4–11 . Therefore, the difference between an ET patient with, and without MT can mainly be explained by the progression of the disease.…”

Section: Introductionmentioning

confidence: 99%

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Non‐motor symptoms are associated with midline tremor in essential tremor

et al. 2020

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including cognition deficiency, psychiatry symptoms, sleep disruption, and sensory abnormalities, has recently been reported in ET syndrome. 2 Besides, accumulating evidence on different etiologies, pathophysiologies, and clinical features has demonstrated the heterogeneity of ET syndrome, even giving rise to a new placeholder, ET-plus. 2,3 Due to such heterogeneity, its disease sub-types should be extensively studied to understand the inherent mechanisms of ET syndrome.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Non‐motor symptoms are associated with midline tremor in essential tremor

et al. 2020

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“…Louis et al 2,4 reported that patients with ETh might present with various distinct phenotypes of both motor symptoms and NMS. The pathology and etiology of ETh remains unclear though neuroimaging studies and post‐mortem studies 5‐7 indicated its relationship with more sever cerebellum dysfunction 8 …”

Section: Introductionmentioning

confidence: 99%

Distinct non‐motor features of essential tremor with head tremor patients

Peng

et al. 2020

Acta Neurol Scand

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Background There have been few comprehensive scale studies on the non‐motor symptoms (NMS) of patients with essential tremor (ET) with head tremor (ETh) and those with ET without head tremor (ETol). We aimed to explore the motor symptoms and NMS of these two subgroups. Methods We enrolled 199 patients with ET (125, ETol; 74 ETh) and 132 healthy controls. We evaluated motor symptoms using the Fahn‐Tolosa‐Marin Tremor Rating Scale (TRS) and NMS using the Non‐Motor Symptom Scale (NMSS). We compared NMSS scores and the prevalence of each NMS between the patient subgroups. Finally, we conducted a logistic regression analysis of the correlation between head tremor and NMS severity, as well as other determinants. Results There were no significant between‐subgroup differences in demographic characteristics. Further, they presented similar tremor clinical manifestation; however, the ETh subgroup showed a higher prevalence of rest tremor, feeling of sadness, forgetting things or events, and swallowing difficulty, as well as TRS scores, compared with the ETol subgroup. Both patient subgroups showed high scores and prevalence (>50%) in difficulty falling asleep. Logistic regression analysis indicated age as a tremor severity determinant; further, head tremor and tremor severity were NMS determinants. Conclusion Both patient subgroups presented various NMS including sleep disturbances, cognitive deficits, and affective disorders. The ETh subgroup showed a high prevalence of certain NMS aspects including memory and affective disorder; further, they had aggravated NMS. ET with both upper limb tremor and head tremor may be regarded as a more severe clinical subtype.

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Tremor and Movement Slowness Are Two Unrelated Adverse Effects Induced by Valproate Intake

Biase

Paparella

Angelini

et al. 2022

Movement Disord Clin Pract

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Background To date, only a few clinical and neurophysiological studies have assessed the features of valproate‐induced tremor (VIT), and whether valproate (VPA) affects voluntary movements is underinvestigated. Objective To better characterize the clinical and neurophysiological features of VIT in patients with epilepsy and the effect of VPA on the execution of voluntary movement. Methods We tested 29 patients with VIT (13 taking VPA alone and 16 taking VPA plus other antiepileptics). Patients underwent a neurological examination, video recordings and kinematic assessments of postural, kinetic, and resting upper limb tremor using a motion analysis system. Movement execution was tested by kinematic assessment of finger tapping. Data of patients with VIT were compared with those of 13 patients with epilepsy taking VPA but without tremor, 13 patients with epilepsy who were not on VPA treatment, 20 patients with Parkinson's disease (PD), and 20 healthy controls (HCs). Results Clinical and kinematic evaluations showed that tremor in patients taking VPA alone was less severe than tremor in patients taking VPA plus other antiepileptics. All patients taking VPA, regardless of the presence of tremor, performed slower finger tapping compared with HCs, similar to what was observed in PD, although with no sequence effect. Patients with epilepsy without VPA showed a normal motor performance. Conclusions Tremor and movement slowness are motor signs induced by VPA. VIT severity is exacerbated when VPA is taken in combination with other antiepileptics. VPA‐induced slowness occurs regardless of tremor, may precede tremor development, and is not attributed to epilepsy.

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Tremor Distribution and the Variable Clinical Presentation of Essential Tremor

Cited by 33 publications

References 38 publications

Non‐motor symptoms are associated with midline tremor in essential tremor

Non‐motor symptoms are associated with midline tremor in essential tremor

Distinct non‐motor features of essential tremor with head tremor patients

Tremor and Movement Slowness Are Two Unrelated Adverse Effects Induced by Valproate Intake

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