Differential Diagnosis Of Tremor Research Articles

Epidemiology and differential diagnosis of tremor

Tremor are involuntary, rhythmic, oscillatory movements of a body part. The diagnosis of tremor is based on clinical information obtained from the history and physical examination. The most common types are enhanced physiological tremor, essential tremor, and parkinsonian tremor. The first step in evaluating a patient with a tremor is to classify the tremor based on its activation state, topographic distribution, and frequency. We analyzed the medical records of 99 patients who applied with complaints of tremor to the Regional Clinical Hospital, which showed that the most common diagnoses in patients with tremor were Parkinson's disease (44.4 %) and essential tremor (15.1 %).

Tremors

Tremor is the most common movement disorder and denotes a rhythmic and involuntary movement of one or several regions of the body. This review covers disease definition, essential tremor, enhanced physiologic tremor, parkinsonian tremor, dystonic tremor, orthostatic tremor, cerebellar tremor, Holmes tremor, neuropathic tremor, palatal tremor, drug-induced and toxic tremors, functional tremor, rare tremor syndromes, tremorlike conditions, and treatment of tremor. Figures show action tremor assessment, the central nervous system circuits of tremor, magnetic resonance imaging findings in specific tremor conditions, general management of tremor patients, an algorithm for the treatment of parkinsonian tremor, and an algorithm for the treatment of dystonic tremor and primary writing tremor. Tables list types of tremor according to the condition of activation, tremor conditions in newborns and during childhood, clinical features of the most common tremor syndromes, motor signs other than tremor and nonmotor features of essential tremor patients, Movement Disorder Society consensus criteria for the diagnosis of essential tremor, genetic and environmental causes of essential tremor, causes of enhanced physiologic tremor, drugs and toxins known to cause tremor, paroxysmal tremors, pseudorhythmic myoclonus in the differential diagnosis of tremor, and pharmacologic management of essential tremor. Key words: essential tremor, movement disorder, pathologic tremor, physiologic tremor, tremor This review contains 6 highly rendered figures, 7 videos, 11 tables, and 163 references.

Diagnoses behind patients with hard-to-classify tremor and normal DaT-SPECT: a clinical follow up study.

The [123I]ioflupane—a dopamine transporter radioligand—SPECT (DaT-SPECT) has proven to be useful in the differential diagnosis of tremor. Here, we investigate the diagnoses behind patients with hard-to-classify tremor and normal DaT-SPECT. Therefore, 30 patients with tremor and normal DaT-SPECT were followed up for 2 years. In 18 cases we were able to make a diagnosis. The residual 12 patients underwent a second DaT-SPECT, were then followed for additional 12 months and thereafter the diagnosis was reconsidered again. The final diagnoses included cases of essential tremor, dystonic tremor, multisystem atrophy, vascular parkinsonism, progressive supranuclear palsy, corticobasal degeneration, fragile X–associated tremor ataxia syndrome, psychogenic parkinsonism, iatrogenic parkinsonism and Parkinson's disease. However, for 6 patients the diagnosis remained uncertain. Larger series are needed to better establish the relative frequency of the different conditions behind these cases.

P134 Olfactory testing in differential diagnosis of tremor

P134 Olfactory testing in differential diagnosis of tremor

Long-term EMG recordings differentiate between parkinsonian and essential tremor

The differential diagnosis of tremor is mainly based on clinical criteria.Nevertheless, these criteria are in some cases not sufficient to differentiate between different tremor forms. Long-term EMG has proven to be a valid and reliable method for the quantification of pathological tremors. The aim of the study was to develop a long-term EMG-based automated analysis procedure that separates parkinsonian tremor from essential tremor. Using longterm EMG tremor was recorded in 45 consecutive patients, 26 with Parkinson's disease (PD) and 19 with essential tremor (ET). Eight tremor parameters were generated automatically. By stepwise backward regression a subset of these criteria was extracted to achieve an automated classification of the tremor by a mathematical model. The obtained model was then tested on a new group of 13 patients in early stages of the disease. Significant differences between groups were found for tremor occurrence, tremor asymmetry, mean tremor frequency and standard deviation of phase of antagonistic muscles. Due to data overlap a classification of the two tremor forms was not possible based on a single tremor parameter. Using logistic regression, a linear formula based on the three parameters tremor occurrence, mean tremor frequency and standard deviation of phase was established and predicted the correct diagnosis in 93% of patients. The validation of the model on the new group of patients in early stages of the tremor disease yielded a correct diagnosis in 100% of cases. We conclude that long-term EMG recording allows a rater-independent classification of parkinsonian versus essential tremor.

Heterozygous Niemann-Pick disease type C presenting with tremor

Tremor is defined as rhythmic oscillation of a body part. The differential diagnosis of tremor is extensive; however, when there is a family history of tremor, the diagnosis most likely will be essential tremor. We describe a woman who sought treatment for tremor, had a family history of tremor, and was found to have a unique diagnosis. A 75-year-old woman was referred to the neurology department with a 10-year history of tremor, initially a side-to-side head tremor. Five years after onset, her tremor had progressed, involving her right hand and 1 year later, the left. The tremor in her upper extremities predominantly occurred at rest; however, she also stated that occasionally she would experience a tremor in her hands while holding a cup of coffee or a deck of cards. She carried a diagnosis of Parkinson disease, but her tremor did not improve with 1,000 mg of l-dopa/carbidopa therapy, which …

Differential diagnosis of tremor.

The differential diagnosis of tremor is based on the clinical distinction of rest, postural and intention tremor and the presence of additional clinical signs and data from the medical history. The most common pathological tremors are essential tremor and the tremors of Parkinson's disease. Among the patients with essential tremor those with intention tremor are often misdiagnosed as cerebellar tremors. Patients with monosymptomatic resting tremors represent a special subgroup of Parkinson's disease. Primary orthostatic tremor and dystonic tremor are rare clinical syndromes which have recently been well defined. Holmes' tremors are defined by their low frequency and the occurrence of resting and intention tremor. Palatal tremor can be separated into two subgroups. Psychogenic tremor can be diagnosed on the basis of clinical criteria. The gold standard of tremor differential diagnosis is still based on clinical criteria.

Curious Neurologic Sequelae in Galactosemia

Two siblings with classic transferase deficiency galactosemia that was detected at birth have been treated with lactose restriction since the neonatal period. Both patients developed a unique and progressive neurologic syndrome of mental retardation, tremor, and ataxia. Careful review of the family history and medical records, the absence of metabolic disturbances other than those related to galactosemia, and the aggregate physical findings and neurodiagnostic studies ruled out other neurologic disorders in these siblings. It is therefore proposed that these patients represent a subgroup of transferase-deficient galactosemic patients, who develop characteristic neurologic sequelae with conventional dietary management. The existence of this subgroup should be considered in evaluations of therapeutic responses in cohorts of patients with galactosemia. Further, galactosemia should be included in the differential diagnosis of tremor and ataxia in the setting of mental retardation.

Data compression, and a dynamic display system for the differential diagnosis of hand tremor in the clinical neurological examination

A display system using multivariate analysis and signal compression methods is described; it serves for the analysis of complex dynamic phenomena via curves in a 2-dimensional coordinate system. Differential diagnosis is then possible, simply by comparing visually the relative variations and differences of shape for these curves. Two major applications are given: (a) 2-dimensional display of hand tremor, for reference testing in relation to the positive diagnosis of ataxia and the differential diagnosis of extrapyramidal syndrome, including the Parkinson syndrome. (b) Visual feedback to the patient when performing tracking tasks in relation to the differential diagnosis of tremor or in training for the use of limbs.

Physiological and pharmacological aids in the differential diagnosis of tremor.

Physiological and pharmacological studies of more than 150 patients with movement disorders are reported. Particular attention is paid to the differentiation of various types of tremor on the basis of rate, rhythm, and pattern of EMG activity in antagonistic muscles. The typical 'tremor-at-rest' of Parkinson's disease--3-7 Hz activity which alternates between antagonistic muscles--is suppressed, at least briefly, during voluntary activity, at which time typical 8--12 Hz 'physiological tremor' may be seen. Essential tremor and its familial or senile variants also have a characteristic EMG pattern during voluntary activity--5-8 Hz bursts of activity which are synchronous in antagonistic muscles. This type of tremor may also be present in patients with Parkinson's disease and in certain kinships with a Charcot-Marie-Tooth polyneuropathy. Other tremors in association with polyneuropathy ('neuropathic tremor') have different physiological characteristics. Myoclonus is of essentially two types ('positive' with EMG bursts and 'negative' with brief pauses in ongoing activity, as with asterixis) and may, at times, mimic tremor. Certain specific tremors respond predictably to specific pharmacological therapy.