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Jacques Favre - One of the best experts on this subject based on the ideXlab platform.

  • Thalamic deep brain stimulation for the treatment of head, voice, and bilateral Limb Tremor.
    Journal of neurosurgery, 1999
    Co-Authors: Jamal M. Taha, Michele A. Janszen, Jacques Favre
    Abstract:

    Object. In published series of patients who undergo deep brain stimulation (DBS) of the thalamus the effects of unilateral stimulation on contralateral Limb Tremor have been reported. The authors detail their experience with bilateral thalamic DBS in the treatment of head, voice, and bilateral Limb Tremor and compare it with earlier studies of unilateral stimulation. Methods. Twenty-three patients (six with Parkinson's disease, 15 with essential Tremor, and two with multiple sclerosis) underwent 19 bilateral DBS procedures (nine staged, 10 simultaneous) and four procedures contralateral to thalamotomy to control Tremor of the head in 10, voice in seven, and Limbs in 20 patients. Limb Tremor improvement was graded as follows: 4, no Tremor; 3, stress-induced Tremor; 2, functional improvement; 1, no functional improvement; and 0, persistent Tremor. Improvement of head or voice Tremor was graded as follows: 4, greater than 75%; 3, between 50% and 75%; 2, between 25% and 50%; 1, less than 25%; and 0, no improv...

Christopher R. Honey - One of the best experts on this subject based on the ideXlab platform.

  • Bilateral thalamic deep brain stimulation for the treatment of head Tremor. Report of two cases.
    Journal of neurosurgery, 2002
    Co-Authors: Caglar Berk, Christopher R. Honey
    Abstract:

    Isolated head Tremor is rare, but can be disabling. The authors' experience with the treatment of Limb Tremor due to essential Tremor led them to consider using bilateral thalamic deep brain stimulation (DBS) in two patients presenting only with disabling head Tremor. One patient exhibited no peripheral Tremor and the other displayed only a slight upper-Limb Tremor. Both patients underwent placement of units that apply simultaneous bilateral thalamic DBS. Surgical targets were verified by using intraoperative macrostimulation, and the stimulators were implanted during the same surgery. Patients were videotaped preoperatively and at 2, 4, 6, and 9 months postoperatively during periods in which the stimulators were turned on and off. Videotapes were randomized and rated for resting, postural, and action Tremors according to the Fahn clinical rating scale for Tremor. Because this scale is not designed for head Tremor, the patients were also evaluated on the basis of a functional scale that reflected their quality of life and the amount of disability caused by head Tremor. Both patients experienced no Tremor after their stimulators were turned on and properly adjusted at the 6th postoperative week. The patients were followed for a total of 9 months and results remained stable throughout this period. No complications were encountered. Bilateral thalamic DBS appears to be an effective and safe treatment for isolated head Tremor in patients with essential Tremor. The authors present a scale for the functional assessment of head Tremor.

William J. Weiner - One of the best experts on this subject based on the ideXlab platform.

  • evidence based guideline update treatment of essential Tremor report of the quality standards subcommittee of the american academy of neurology
    Neurology, 2011
    Co-Authors: Theresa A Zesiewicz, Rodger J. Elble, Elan D Louis, Gary S Gronseth, William G Ondo, Richard B Dewey, Michael S Okun, Kelly L Sullivan, William J. Weiner
    Abstract:

    Background: This evidence-based guideline is an update of the 2005 American Academy of Neurology practice parameter on the treatment of essential Tremor (ET). Methods: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 2004 and April 2010. Results and Recommendations: Conclusions and recommendations for the use of propranolol, primidone (Level A, established as effective); alprazolam, atenolol, gabapentin (monotherapy), sotalol, topiramate (Level B, probably effective); nadolol, nimodipine, clonazepam, botulinum toxin A, deep brain stimulation, thalamotomy (Level C, possibly effective); and gamma knife thalamotomy (Level U, insufficient evidence) are unchanged from the previous guideline. Changes to conclusions and recommendations from the previous guideline include the following: 1) levetiracetam and 3,4-diaminopyridine probably do not reduce Limb Tremor in ET and should not be considered (Level B); 2) flunarizine possibly has no effect in treating Limb Tremor in ET and may not be considered (Level C); and 3) there is insufficient evidence to support or refute the use of pregabalin, zonisamide, or clozapine as treatment for ET (Level U). Neurology ® 2011;77:1752–1755

  • Upper Limb Tremor induced by peripheral nerve injury
    Neurology, 2007
    Co-Authors: William J. Weiner, Stephen G. Reich
    Abstract:

    We report a patient with proximal right upper Limb Tremor, secondary to direct peripheral nerve lesion caused by prior thoracic surgery. Electromyography demonstrated neurogenic abnormalities and Tremor in muscles innervated by the thoracodorsal and long thoracic nerves. Somatosensory evoked potentials, transcranial magnetic stimulation, and MRI of the cervical and thoracic spine were normal. Tremor persisted in REM and non-REM sleep. These findings suggest a peripheral generator.

  • practice parameter therapies for essential Tremor report of the quality standards subcommittee of the american academy of neurology
    Neurology, 2005
    Co-Authors: Rodger J. Elble, Theresa A Zesiewicz, Elan D Louis, Gary S Gronseth, William G Ondo, Richard B Dewey, Kelly L Sullivan, Robert A Hauser, William J. Weiner
    Abstract:

    Background: Essential Tremor (ET) is one of the most common Tremor disorders in adults and is characterized by kinetic and postural Tremor. To develop this practice parameter, the authors reviewed available evidence regarding initiation of pharmacologic and surgical therapies, duration of their effect, their relative benefits and risks, and the strength of evidence supporting their use. Methods: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 1966 and August 2004. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence. Results and Conclusions: Propranolol and primidone reduce Limb Tremor (Level A). Alprazolam, atenolol, gabapentin (monotherapy), sotalol, and topiramate are probably effective in reducing Limb Tremor (Level B). Limited studies suggest that propranolol reduces head Tremor (Level B). Clonazepam, clozapine, nadolol, and nimodipine possibly reduce Limb Tremor (Level C). Botulinum toxin A may reduce hand Tremor but is associated with dose-dependent hand weakness (Level C). Botulinum toxin A may reduce head Tremor (Level C) and voice Tremor (Level C), but breathiness, hoarseness, and swallowing difficulties may occur in the treatment of voice Tremor. Chronic deep brain stimulation (DBS) (Level C) and thalamotomy (Level C) are highly efficacious in reducing Tremor. Each procedure carries a small risk of major complications. Some adverse events from DBS may resolve with time or with adjustment of stimulator settings. There is insufficient evidence regarding the surgical treatment of head and voice Tremor and the use of gamma knife thalamotomy (Level U). Additional prospective, double-blind, placebo-controlled trials are needed to better determine the efficacy and side effects of pharmacologic and surgical treatments of ET. NEUROLOGY 2005;64:2008-2020 Background and justification. Essential Tremor (ET) is a common adult Tremor disorder, with preva- lence estimates from population studies ranging from 0.4% to 5%. 1,2 The incidence and prevalence of ET increase with advancing age. 2 ET is characterized by the presence of postural and kinetic Tremor. 3 In classic ET, upper Limbs (95% of patients) and less commonly the head (34%), lower Limbs (30%), voice (12%), tongue (7%), face (5%), and trunk (5%) exhibit a postural or kinetic Tremor. 4 ET has been referred to as a benign

Victor S C Fung - One of the best experts on this subject based on the ideXlab platform.

  • 038 Tremor a clinical and neurophysiological study
    Journal of Neurology Neurosurgery and Psychiatry, 2019
    Co-Authors: Alessandro F Fois, Neil Mahant, Steve Vucic, Victor S C Fung
    Abstract:

    Introduction Tremor is a common clinical problem seen in a number of diseases. Robust classification and diagnosis of Tremor remains controversial due to overlap in clinical features and lack of established biomarkers. This hampers effective research including therapeutic trials. We present our research protocol for a cross-sectional study which aims to find more robust methods of Tremor classification and diagnosis. Methods Adults with upper Limb Tremor of varying aetiologies, diagnosed using current clinical criteria (including essential Tremor, Parkinsonian Tremor, and dystonic Tremor), and age-matched controls are eligible for recruitment. Participants undergo a clinical and neurophysiological assessment, including accelerometry, surface electromyography, long-latency stretch reflexes, temporal discrimination, and tonic vibration reflexes. Data will be analysed using a cluster analysis to identify robust Tremor syndromes and biomarkers associated with them. We aim to recruit 100 participants prior to analysis. Results At time of writing, 13 participants with upper Limb Tremor have been studied (6 with essential Tremor, 5 with dystonic Tremor, and 2 with indeterminate Tremor; mean age 66 years, range 18–85). Participants tolerated the clinical and neurophysiological studies well with 100% completion rate after recruitment. With current rates of recruitment we anticipate completion of recruitment and commencement of data analysis in October 2019. Conclusions Our protocol aims to identify robust Tremor phenotypes and biomarkers for them. This will allow patients with Tremor to be classified into more biologically homogeneous diagnostic categories, aiding future research into the mechanism of Tremor and more rational clinical trial design.

  • Treatment of proximal upper Limb Tremor with botulinum toxin therapy.
    Movement disorders : official journal of the Movement Disorder Society, 2013
    Co-Authors: Samuel D. Kim, Neil Mahant, Steve Vucic, Con Yiannikas, Victor S C Fung
    Abstract:

    Background Proximal-dominant upper Limb Tremor is highly disabling, and there is no effective medical therapy. In this study, we evaluated the efficacy of botulinum toxin (BTX) injections for the treatment of proximal Tremor. Methods We conducted a retrospective analysis of open-label treatment with BTX in 19 patients with proximal Tremor. The response to therapy was graded into four categories according to self-reported improvements in Tremor and function. Results In total, 63% of patients reported moderate or marked benefit, defined as functional improvements sufficient enough to allow feeding or drinking from a cup; whereas 21% of patients reported mild benefit; and 15% of patients reported no benefit. One patient developed severe weakness of shoulder abduction and withdrew from the treatment; otherwise, the therapy was free of side effects. Conclusions The current findings support the efficacy of BTX therapy in the treatment of proximal upper Limb Tremor with minimal side effects. © International Parkinson and Movement Disorder Society © 2013 International Parkinson and Movement Disorder Society

Rodger J. Elble - One of the best experts on this subject based on the ideXlab platform.

  • Temporal discrimination is altered in patients with isolated asymmetric and jerky upper Limb Tremor
    Movement disorders : official journal of the Movement Disorder Society, 2019
    Co-Authors: Felix Gövert, John C Rothwell, Jos Steffen Becktepe, Bettina Balint, Lorenzo Rocchi, Florian Brugger, Alicia Garrido, Tim Walter, Ricci Hannah, Rodger J. Elble
    Abstract:

    BACKGROUND Unilateral or very asymmetric upper Limb Tremors with a jerky appearance are poorly investigated. Their clinical classification is an unsolved problem because their classification as essential Tremor versus dystonic Tremor is uncertain. To avoid misclassification as essential Tremor or premature classification as dystonic Tremor, the term indeterminate Tremor was suggested. OBJECTIVES The aim of this study was to characterize this Tremor subgroup electrophysiologically and evaluate whether diagnostically meaningful electrophysiological differences exist compared to patients with essential Tremor and dystonic Tremor. METHODS We enrolled 29 healthy subjects and 64 patients with Tremor: 26 with dystonic Tremor, 23 with essential Tremor, and 15 patients with upper Limb Tremor resembling essential Tremor but was unusually asymmetric and jerky (indeterminate Tremor). We investigated the somatosensory temporal discrimination threshold, the short-interval intracortical inhibition, and the cortical plasticity by paired associative stimulation. RESULTS Somatosensory temporal discrimination threshold was significantly increased in patients with dystonic Tremor and indeterminate Tremor, but it was normal in the essential Tremor patients and healthy controls. Significant differences in short-interval intracortical inhibition and paired associative stimulation were not found among the three patient groups and controls. CONCLUSION These results indicate that indeterminate Tremor, as defined in this study, shares electrophysiological similarities with dystonic Tremor rather than essential Tremor. Therefore, we propose that indeterminate Tremor should be considered as a separate clinical entity from essential Tremor and that it might be dystonic in nature. Somatosensory temporal discrimination appears to be a useful tool in Tremor classification. © 2019 International Parkinson and Movement Disorder Society.

  • evidence based guideline update treatment of essential Tremor report of the quality standards subcommittee of the american academy of neurology
    Neurology, 2011
    Co-Authors: Theresa A Zesiewicz, Rodger J. Elble, Elan D Louis, Gary S Gronseth, William G Ondo, Richard B Dewey, Michael S Okun, Kelly L Sullivan, William J. Weiner
    Abstract:

    Background: This evidence-based guideline is an update of the 2005 American Academy of Neurology practice parameter on the treatment of essential Tremor (ET). Methods: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 2004 and April 2010. Results and Recommendations: Conclusions and recommendations for the use of propranolol, primidone (Level A, established as effective); alprazolam, atenolol, gabapentin (monotherapy), sotalol, topiramate (Level B, probably effective); nadolol, nimodipine, clonazepam, botulinum toxin A, deep brain stimulation, thalamotomy (Level C, possibly effective); and gamma knife thalamotomy (Level U, insufficient evidence) are unchanged from the previous guideline. Changes to conclusions and recommendations from the previous guideline include the following: 1) levetiracetam and 3,4-diaminopyridine probably do not reduce Limb Tremor in ET and should not be considered (Level B); 2) flunarizine possibly has no effect in treating Limb Tremor in ET and may not be considered (Level C); and 3) there is insufficient evidence to support or refute the use of pregabalin, zonisamide, or clozapine as treatment for ET (Level U). Neurology ® 2011;77:1752–1755

  • practice parameter therapies for essential Tremor report of the quality standards subcommittee of the american academy of neurology
    Neurology, 2005
    Co-Authors: Rodger J. Elble, Theresa A Zesiewicz, Elan D Louis, Gary S Gronseth, William G Ondo, Richard B Dewey, Kelly L Sullivan, Robert A Hauser, William J. Weiner
    Abstract:

    Background: Essential Tremor (ET) is one of the most common Tremor disorders in adults and is characterized by kinetic and postural Tremor. To develop this practice parameter, the authors reviewed available evidence regarding initiation of pharmacologic and surgical therapies, duration of their effect, their relative benefits and risks, and the strength of evidence supporting their use. Methods: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 1966 and August 2004. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence. Results and Conclusions: Propranolol and primidone reduce Limb Tremor (Level A). Alprazolam, atenolol, gabapentin (monotherapy), sotalol, and topiramate are probably effective in reducing Limb Tremor (Level B). Limited studies suggest that propranolol reduces head Tremor (Level B). Clonazepam, clozapine, nadolol, and nimodipine possibly reduce Limb Tremor (Level C). Botulinum toxin A may reduce hand Tremor but is associated with dose-dependent hand weakness (Level C). Botulinum toxin A may reduce head Tremor (Level C) and voice Tremor (Level C), but breathiness, hoarseness, and swallowing difficulties may occur in the treatment of voice Tremor. Chronic deep brain stimulation (DBS) (Level C) and thalamotomy (Level C) are highly efficacious in reducing Tremor. Each procedure carries a small risk of major complications. Some adverse events from DBS may resolve with time or with adjustment of stimulator settings. There is insufficient evidence regarding the surgical treatment of head and voice Tremor and the use of gamma knife thalamotomy (Level U). Additional prospective, double-blind, placebo-controlled trials are needed to better determine the efficacy and side effects of pharmacologic and surgical treatments of ET. NEUROLOGY 2005;64:2008-2020 Background and justification. Essential Tremor (ET) is a common adult Tremor disorder, with preva- lence estimates from population studies ranging from 0.4% to 5%. 1,2 The incidence and prevalence of ET increase with advancing age. 2 ET is characterized by the presence of postural and kinetic Tremor. 3 In classic ET, upper Limbs (95% of patients) and less commonly the head (34%), lower Limbs (30%), voice (12%), tongue (7%), face (5%), and trunk (5%) exhibit a postural or kinetic Tremor. 4 ET has been referred to as a benign