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Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Essential tremor is a common movement disorder. Deep brain stimulation of the VIM nucleus of the thalamus has been reported to be efficacious for reducing essential hand tremor. The effect of deep brain stimulation of the thalamus on essential head tremor has not been well studied. Therefore, we evaluated the effect of DBS of the thalamus in 38 patients with essential head tremor. Head tremor scores prior to surgery were compared with scores at 3, 6, and 12 months postimplant with stimulation "on" and "off." The 3-month evaluations were blinded for 24 patients and all others were open-label. There was a significant improvement in head tremor at all postimplant evaluations compared with baseline. Essential head tremor can be reduced with deep brain stimulation of the VIM nucleus of the thalamus and, pending the results of other controlled trials, should be considered as a treatment option for patients with disabling essential head tremor unresponsive to medication.
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PMID:Efficacy of unilateral deep brain stimulation of the VIM nucleus of the thalamus for essential head tremor. 1049 50

Movement disorders in children encompass disorders of motor control--both hyperkinetic (excessive movement) and hypokinetic (decreased movement). This article focuses on the hyperkinetic movement disorders, particularly tremor, Wilson's disease, dystonia, tics and Tourette syndrome, chorea, myoclonus, neuroleptic-induced movement disorders, and psychogenic movement disorders. Phenomenology of the disorders as well as clinical presentation, basic pathophysiology, genetics, and treatment are discussed.
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PMID:Pediatric movement disorders. 1055 1

Movement disorders have rarely been the result of psychiatric disturbances. Psychogenic dystonia is caracterized by inconsistent findings, a known precipitant factor, onset in legs, pain, multiple somatizations and incongruent association with other movement disorders. We report two patients with clinically established psychogenic dystonia. Patient 1: a female that presented sudden loss of strength in her four limbs; she developed feet dystonia, alternant laterocollis, generalized and irregular tremor, and limb hypertonia that disappeared with distraction; psychological examination showed severe depression, hypochondria and obsessive disorder. Patient 2: a female that presented with irregular limb tremors that disappeared with distraction and left foot dystonia nine years ago; she gradually lost her walk capacity; she complained pain in lumbar area and in her left limb, psychological examination showed infantile behaviour, low frustration tolerance, impulsivity and self-aggression. Their complementary exams showed no alterations and they had no response to specific pharmacological treatment. Dystonia is rarely psychogenic, but this etiology is suggested when clinical characteristics are inconsistent and incongrous with a classical disorder. It should be part of differential diagnosis when appears in association with other somatization or psychiatric disorders.
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PMID:[Psychogenic dystonia: report of 2 cases]. 1092 Apr 17

Essential tremor (ET) is a common movement disorder that often becomes refractory to conventional pharmacologic management. Open-label studies suggest that gabapentin is efficacious for ET, but the results of controlled trials have been mixed. To determine the efficacy and tolerability of gabapentin in ET, we conducted a double-blind, placebo-controlled, cross-over trial evaluating two doses (1800 mg per day and 3600 mg per day; N = 25). Patients on other ET medications were maintained on their concurrent medications for 3 months prior to study initiation and throughout the study. Twenty patients (mean age, 69.9 +/- 6.1 yrs) completed the study. Overall, patient global assessments (p <0.05), observed tremor scores (p <0.005), water pouring scores (p <0.05), and activities of daily living scores (p <0.005) significantly improved. Accelerometry scores, spirographs, and investigator global impression scores did not improve. The results were similar for high and low doses. Statistical regression models did not demonstrate any significant predictors for response. Gabapentin may be effective in some cases of ET.
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PMID:Gabapentin for essential tremor: a multiple-dose, double-blind, placebo-controlled trial. 1092 78

Parkinsonism secondary to neoplasm is uncommon. We report two patients with bilaterally symmetric parkinsonism as the initial presentation of their brain tumors. The first patient was a 71-year-old woman who presented with a gradual onset of bilateral resting tremor, bradykinesia and rigidity. Computerized tomography (CT) of the brain revealed a large parasagittal tumor in the left frontal lobe. The patient completely recovered from the parkinsonian symptoms after removal of the brain tumor. The second patient, a 74-year-old man with a history of renal cell carcinoma of the right kidney suffered from an insidious onset of bilateral bradykinesia, rigidity and gait difficulty. Cerebral metastasis was noted on the brain CT scan. Early recognition of intracranial tumor as the cause of parkinsonism is important for the management of this type of movement disorder. Moreover, brain CT scanning plays an important role in the differential diagnosis of patients with parkinsonian symptoms.
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PMID:Parkinsonism as an initial manifestation of brain tumor. 1096 54

Tremor is the most common involuntary movement disorder. It is differentiated from other involuntary movement disorders, such as chorea, athetosis, ballismus, tics, and myoclonus, by its repetitive, stereotyped, movements of a regular amplitude and frequency. Tremor can be defined as an involuntary, rhythmic, periodic, mechanical oscillation of a body part. Since small-amplitude tremors may not be visible to the naked eye and may only be detectable by sensitive recording devices, amplitude of the tremor is therefore not critical to the definition. Accurate diagnosis of tremor is important because appropriate treatment depends on the accuracy of the clinical diagnosis. This article reviews the classification and management of tremor.
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PMID:Diagnosis and management of tremor. 1097 54

High-frequency thalamic stimulation alleviates tremor in Parkinson's disease (PD) and essential tremor (ET). The origin of thalamic myoclonus is unexplained and the effects of low-frequency thalamic stimulation on movement control are still unknown. We studied the effects of stimulation at a low frequency of 15 Hz in five drug-free patients (3 PD, 2 ET) 6 months after thalamic implantation of quadripolar electrodes (unilateral in four patients, bilateral in one patient). Clinical, electrophysiological, and videotaped assessment, using a monopolar 15 Hz frequency (3 V, 90 micros) stimulation current applied simultaneously through two adjacent contacts of the electrode, was performed. We observed myoclonus and irregular jerky tremor in the upper limb contralateral to the site of stimulation. The jerks lasted less than 200 ms, were irregular and not synchronous with stimulation, were superimposed on rest or postural tremor, and increased in response to tactile, proprioceptive, or vibratory stimuli. The fact that this complex movement disorder can be induced by low-frequency stimulation in the ventral intermediate nucleus (Vim) of the thalamus suggests that it results, at least partly, from dysfunction of the Vim and possibly adjacent nuclei of the thalamus.
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PMID:Irregular jerky tremor, myoclonus, and thalamus: a study using low-frequency stimulation. 1100

Motor fluctuations represent important late complications of Parkinson's disease treated with levodopa. Although treatment of these problems has improved with the emergence of numerous pharmacologic and surgical therapies, the various options can make it confusing. Pharmacologic treatment is the first step. Polytherapy is often the rule in this case with a variety of agents available as adjunctive therapy with levodopa. These adjuncts include dopamine agonists (bromocriptine, pergolide, pramipexole, ropinirole), catechol-O-methyltransferase (COMT) inhibitors (tolcapone), controlled-release formulations of levodopa, monoamine oxidase (MAO) B inhibitors (selegiline), and amantadine. The treatment can consist of any of a number of combinations of these agents. No single algorithm can be used in all patients; therapy should be individualized. Physicians treating these patients need to be well versed in late complication patterns as well as the medications chosen. In addition, optimal doses vary, and often patients are considered treatment failures and taken off medications before reaching that level. In the more complicated cases, patients should be evaluated by specialists in movement disorders. With this in mind, some guidelines are offered for the pharmacologic approach to patients with fluctuating responses to medications. For simple wearing off, controlled-release levodopa (Sinemet CR, Dupont Pharmaceuticals, Wilmington, DE), COMT inhibitors, MAO inhibitors, and dopamine agonists are reasonable options. For more complicated fluctuations, dopamine agonists with limits on levodopa are the first choice, especially when dyskinesia is present; when dyskinesia is not a factor, COMT inhibitors may be used. For dyskinesia specifically, dopamine agonists or addition of amantadine can be helpful. Surgery should be a treatment of last resort for patients in whom medical therapy fails. Patients who are candidates for medial pallidotomy should be fluctuators with severe dyskinesia and "off" periods that have not improved with pharmacologic therapy. Thalamic deep brain stimulation (DBS) should be used only in patients with tremor-predominant disease and severe intractable tremor that is unresponsive to medication and occurs not only at rest but with posture and action as well. Surgical therapy should be performed only in centers with surgeons experienced in stereotactic techniques and movement disorder specialists to ensure that the appropriate patients come to surgery and that complications are kept to a minimum. Dietary adjustment has a limited role in treating advanced Parkinson's disease.
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PMID:Parkinson's Disease: Motor Fluctuations. 1109 92

In mammalian cells, regulation of the expression of proteins involved in iron metabolism is achieved through interactions of iron-sensing proteins known as iron regulatory proteins (IRPs), with transcripts that contain RNA stem-loop structures referred to as iron responsive elements (IREs). Two distinct but highly homologous proteins, IRP1 and IRP2, bind IREs with high affinity when cells are depleted of iron, inhibiting translation of some transcripts, such as ferritin, or turnover of others, such as the transferrin receptor (TFRC). IRPs sense cytosolic iron levels and modify expression of proteins involved in iron uptake, export and sequestration according to the needs of individual cells. Here we generate mice with a targeted disruption of the gene encoding Irp2 (Ireb2). These mutant mice misregulate iron metabolism in the intestinal mucosa and the central nervous system. In adulthood, Ireb2(-/-) mice develop a movement disorder characterized by ataxia, bradykinesia and tremor. Significant accumulations of iron in white matter tracts and nuclei throughout the brain precede the onset of neurodegeneration and movement disorder symptoms by many months. Ferric iron accumulates in the cytosol of neurons and oligodendrocytes in distinctive regions of the brain. Abnormal accumulations of ferritin colocalize with iron accumulations in populations of neurons that degenerate, and iron-laden oligodendrocytes accumulate ubiquitin-positive inclusions. Thus, misregulation of iron metabolism leads to neurodegenerative disease in Ireb2(-/-) mice and may contribute to the pathogenesis of comparable human neurodegenerative diseases.
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PMID:Targeted deletion of the gene encoding iron regulatory protein-2 causes misregulation of iron metabolism and neurodegenerative disease in mice. 1117 92

We report an unusual case of probable progressive multifocal leukoencephalopathy (PML), who initially presented with a right-sided movement disorder, including upper limb dystonia, tremor, and dyspraxia, reminiscent of corticobasal degeneration. In the further course, the patient developed disorientation, confusion, and bradyphrenia. The appearance of white matter MRI lesions as well as a positive PCR test result for JC-virus in the cerebrospinal fluid finally led to the correct diagnosis.
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PMID:A "cortico-basal degeneration"-like syndrome as first sign of progressive multifocal leukoencephalopathy. 1123 80


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