Hz Tremor Research Articles

Deep Brain Stimulation for Holmes Tremors and Literature Review.

Deep Brain Stimulation for Holmes Tremors and Literature Review.

Limb myorhythmia treated with chemodenervation: a case report

We describe a case of limb myorhythmia successfully palliated with botulinum toxin injections. The patient is a 30-year-old male evaluated for abnormal movements of the left lower foot that began after an ankle injury for which the patient underwent Achilles tendon scar tissue debridement without improvement. On examination, he had near-constant involuntary, slow, rhythmic flexion/extension tremor of toes 2-4 that was diminished during active movement. Needle electromyography (EMG) revealed a rhythmic, 2-3 Hz tremor isolated to the flexor digitorum brevis. After failure of medical management with muscle relaxants, gabapentin, and levodopa trials, the patient underwent two EMG-guided chemodenervation procedures with incobotulinum toxin A injections of the left flexor digitorum brevis. At 3-month follow-up, he had achieved a sustained 50% reduction in the intensity of the movements and improved quality of life. Myorhythmia is a rare condition characterized by a repetitive, rhythmic, slow frequency (1-4 Hz) movement affecting the cranial and limb muscles. The most common causes include stroke, demyelinating disorders, drug or toxin intake, trauma, and infections. The management of this condition is very limited with pharmacologic agents such as anticholinergics, antispasmodics, anticonvulsants, or dopaminergic agents showing limited efficacy. The use of botulinum toxin chemodenervation aided by EMG muscle targeting can be a useful therapeutic intervention in cases of medication-refractory regionally distributed myorhythmia involving accessible muscles.

Mild hyperphenylalaninemia (hpa) presenting as orthostatic tremor: a case report

BackgroundOrthostatic tremor (OT) is a type of postural tremor of the lower extremities that has not been described in either phenylketonuria (PKU) or hyperphenylalaninemia (HPA). Because little is known about the clinical features and therapeutic responses of OT in mild HPA, we describe a mild HPA patient who presented with OT as an initial symptom.Case presentationA 22-year-old male was admitted for bilateral leg tremor while standing, with symptom onset eight months prior. One month before admission, the tremor disappeared in the left leg but persisted in the right leg. Electromyography recorded from the right gastrocnemius revealed a 6–8 Hz tremor, which appeared when the patient was standing and disappeared when he was resting or walking. Blood screening showed a phenylalanine/tyrosine ratio of 2.06 and a phenylalanine level of 140 μmol/L. Urine metabolic screening was negative. Whole-exome sequencing confirmed the presence of a compound heterozygous mutation, c.158G > A and c.728G > A, in phenylalanine hydroxylase (PAH) gene. After three months of levodopa/benserazide tablets (250 mg, tid) and a low-phenylalanine diet treatment, the tremor disappeared.ConclusionsYoung-onset mild HPA is a relatively rare autosomal recessive metabolic disease, and slow OT is a rare clinical feature. Metabolic screening and genetic testing are the keys to early diagnosis and treatment. For adolescents and young adults, appropriate medication and long-term dietary therapy remain important treatments. This case expanded the disease spectrum of slow OT.

Plume height, duration and volume of sustained explosive eruptions inferred from eruption tremor amplitudes

SUMMARY Seismic source amplitudes determined by using the amplitudes of high-frequency (5−10 Hz) tremor signals generated by sustained explosive eruptions have been shown to be related to eruption plume height by power-law and exponential relations and to eruption volume flux by a proportional relation. We further examined these relations and extended this source quantification approach to investigate eruption duration by using the envelope width, defined by the ratio of the cumulative source amplitude to the source amplitude. We first confirmed that the relationship between source amplitude and plume height proposed by a previous study holds for small eruptions at Nevado del Ruiz (Colombia), although slight modifications were required. We then showed that the relations of envelope width with source amplitude and with cumulative source amplitude of eruption tremor associated with sub-Plinian eruptions at Kirishima (Japan) and Tungurahua (Ecuador) could be described by a power law. The source amplitude functions of these tremors were characterized by three periods and could be approximated by a trapezoidal shape. A power-law function fitted to the relation between eruption volume and eruption duration obtained from these relations was similar to that estimated by fitting a power-law function to previously reported eruption volume and duration data of well-documented silicic and andesitic eruptions. Our results suggest that eruption duration may systematically vary with eruption volume when the conduit is stably open during the second period of the trapezoidal source amplitude function. This study demonstrated that source amplitudes can be used for real-time predictions of both plume height and eruption duration, which in turn may be used to estimate ashfall distributions and tephra transport for local residents and aviation operations.

Evolving Concepts in Our Understanding and Treatment of Holmes Tremor, Over 100 Years in the Making.

Holmes Tremor (HT) is an irregular, slow-frequency (<4.5 Hz) tremor characterized by a combination of resting, postural, and action tremors mostly of the upper extremities. Symptoms of HT typically emerge 4 weeks to 2 years after a brain injury caused by a spectrum of etiologies. HT pathophysiology is thought to result from aberrant collateral axonal sprouting and synaptic dysfunction following neuronal damage. To date, the dopaminergic nigrostriatal system, cerebello-thalamo-cortical pathway, and dentate-rubro-olivary pathway have all been implicated in the clinical manifestations of HT. The diversity of HT etiologies usually requires a personalized treatment plan. Current treatment options include carbidopa-levodopa, levetiracetam, and trihexyphenidyl, and surgical management such as deep brain stimulation in selected medication-refractory patients. In this review we discuss the pathophysiology, etiology, neuroimaging, and the latest clinical guidelines for care and management of HT.

Physiology of Tremor Reduction by Putting the Hands Together in Essential Tremor.

Essential tremor is a common movement disorder, characterized by 4-12 Hz tremor of the hands and arms that can affect many activities of daily living. It has been reported by patients that when performing tasks bimanually their tremor is reduced, but why this happens is unknown. We measured patients' tremors in different conditions when performed with 1 hand and 2 hands to observe if bimanual task performance changes the characteristics of the tremor. A total of 10 patients with essential tremor participated in the study. Electromyographic electrodes were attached bilaterally to the wrist flexor and extensor muscles, and accelerometers were attached to the dorsum of the hands. For each condition, holding a cup, wingbeat, and extending both arms up, data were collected with a single hand and bimanually with the hands touching. When the hands were touching, there was a significant decrease in both accelerometric and electromyographic power at the tremor frequency. In addition, there was a decrease in coherence between accelerometer and electromyography on the same side. There was no change in the tremor frequency. Tremor amplitude does decrease when the hands are together. Together, the characteristics underlying the decrease in tremor amplitude may indicate a decrease in power of the central oscillator driving the tremor, which we speculate is attributed to the differences in unimanual and bimanual motor control. However, given the small sample size, we note that future hypothesis-driven studies with an a priori power analysis will be required to further explore this phenomenon.

Distributed Acoustic Sensing in Volcano‐Glacial Environments—Mount Meager, British Columbia

AbstractWe demonstrate the logistic feasibility and scientific potential of distributed acoustic sensing (DAS) in alpine volcano‐glacial environments that are subject to a broad range of natural hazards. Our work considers the Mount Meager massif, an active volcanic complex in British Columbia, estimated to have the largest geothermal potential in Canada, and home of Canada's largest recorded landslide in 2010. From September to October 2019, we acquired continuous strain data, using a 3‐km long fiber‐optic cable, deployed on a ridge of Mount Meager and on the uppermost part of a glacier above 2,000 m altitude. The data analysis detected a broad range of unexpectedly intense, low‐magnitude, local seismicity. The most prominent events include long‐lasting, intermediate‐frequency (0.01–1 Hz) tremor, and high‐frequency (5–45 Hz) earthquakes that form distinct spatial clusters and often repeat with nearly identical waveforms. We conservatively estimate that the number of detectable high‐frequency events varied between several tens and nearly 400 per day. We also develop a beamforming algorithm that uses the signal‐to‐noise ratio (SNR) of individual channels, and implicitly takes the direction‐dependent sensitivity of DAS into account. Both the tremor and the high‐frequency earthquakes are most likely related to fluid movement within Mount Meager's geothermal reservoir. Our work illustrates that DAS carries the potential to reveal previously undiscovered seismicity in challenging environments, where comparably dense arrays of conventional seismometers are difficult to install. We hope that the logistics and deployment details provided here may serve as a starting point for future DAS experiments.

Electroencephalography in Orthostatic Tremor: A Prospective Study of 30 Patients.

Background:Orthostatic tremor (OT) is characterized by a sensation of instability while standing, associated with high frequency (1318 Hz) tremor in the legs. Small retrospective series have reported electroencephalography (EEG) findings in OT with discordant results.Methods:We prospectively enrolled 30 OT subjects. Mean age = 68.3 (range 5487) with mean disease duration 16.3 years (range 444). A modified 1020 system EEG recording with additional midline electrodes was obtained. EMG electrodes were placed on quadricep muscles. EEG recording was performed at rest, during sleep and while standing unassisted.Results:In all subjects, EEG showed normal background, normal drowsiness and/or stage 2 sleep, and normal responses to hyperventilation and photic stimulation. These normal results persisted during stance. EEG abnormalities were found in 3 subjects (anterior-mid temporal slow activity), but were not position-dependent and were judged unlikely to be related to OT. Tremor artifact while standing was noted in all subjects, however it was measurable in 26 with frequency in the OT range in 25. When compared with EMG, the average difference in frequency was small at 1.2 Hz (range 0.52.5, p 0.46). Visual EEG analysis in OT patients did not reveal electrographic abnormalities even upon standing unassisted.Discussion:EEG was normal on this prospective, relatively large OT series. Clinicians interpreting video-EEGs should be aware of the OT artifact that can be seen in EEG and EKG leads mostly while standing.

Trans-Spinal Direct Current Stimulation for Managing Primary Orthostatic Tremor.

Primary orthostatic tremor (POT) is a rare disorder, characterized by 13 to 18 Hz tremor in the legs when standing and is often refractory to medical treatment. Epidural spinal cord stimulation has been proposed as an alternative treatment. However, this approach is invasive, which limits its application. Trans-spinal direct current stimulation (tsDCS) is a non-invasive method to modulate spinal cord circuits. The aim of this proof-of-concept study was to investigate the potential beneficial effect of tsDCS in POT. We conducted a double-blind, sham-controlled study in 16 patients with POT. In two separate visits, patients received sham tsDCS first followed by active (either cathodal or anodal) tsDCS. The primary outcome was the change in time in standing position. Secondary outcomes comprised quantitative assessment of tremor, measurement of corticospinal excitability including short-latency afferent inhibition, and clinical global impression-improvement (CGI-I). Measurements were made at baseline, after sham tsDCS, 0-30 min, and 30-60 min after active conditions. Cathodal-tsDCS reduced tremor amplitude and frequency and lowered corticospinal excitability whereas anodal-tsDCS reduced tremor frequency only. CGI-I scores positively correlated with the time in standing position after both active tsDCS conditions. A single session of tsDCS can improve instability in POT. This opens a new vista for experimental treatment options using multiple sessions of spinal DC stimulation. © 2021 International Parkinson and Movement Disorder Society.

3 Hz postural tremor: A specific and sensitive sign of cerebellar dysfunction in patients with cerebellar ataxia

Objective3 Hz postural tremor was described in patients with anterior cerebellar lobe atrophy, however sensitivity and specificity of this sign in degenerative cerebellar diseases has not yet been evaluated. Our aim was to assess the 3 Hz tremor in patients with cerebellar ataxia, compare its sensitivity and specificity with other posturography parameters and to find out a correlation of intensity of 3 Hz tremor with ataxia severity. Methods30 patients with degenerative cerebellar ataxia, a control group of 30 patients with compensated peripheral vestibulopathy and 40 healthy volunteers were examined by posturography. 3 Hz tremor was assessed both qualitatively and quantitatively, its sensitivity and specificity were compared with other standard posturography parameters. Results3 Hz postural tremor was detected in 90% of patients with cerebellar ataxia, with 100% specificity and 90% sensitivity. The sensitivity and specificity of quantitative analysis of 3 Hz tremor was largely superior to standard posturography parameters when differentiating patients with cerebellar ataxia from vestibular impairment and healthy controls. Conclusion3 Hz postural tremor is highly sensitive and specific sign of cerebellar impairment in patients with cerebellar ataxia. SignificanceEvaluation of 3 Hz postural tremor should be a standard part of posturography examination when considering a cerebellar impairment.

Two cases with postural axial tremor: Consider a genetic origin

We present two cases with postural axial tremor predominantly involving the head, trunk, and shoulders. In the first patient, the postural tremor occurred in multiple attacks a day lasting approximately 10 min. The second patient developed a progressive tremor of his head and arms, worsened during sitting and standing. Electrophysiological supported the postural axial tremor in both patients with a varying 3–10 Hz tremor frequency between different muscles and within the same muscles at different times.Postural axial tremor is a rare and complex movement disorder. The majority of cases are caused by acquired cerebellar pathology. However, isolated cases with underlying genetic disorders are described in literature.Here, we illustrate how to differentiate paroxysmal axial tremor from other axial hyperkinetic movement disorders and extend the genetic heterogeneity of this intriguing movement disorder phenotype.

Greater Postural Sway and Tremor during Balance Tasks in Patients with Plantar Fasciitis Compared to Age-Matched Controls.

Plantar fasciitis (PF) is a common condition found in men and women and can reoccur throughout life. PF is commonly diagnosed by prolonged foot pain lasting more than 3 months and a plantar fascia over 0.4 mm thick, as measured using ultrasound imaging. This study examined the ability to balance and the occurrence of muscle tremor during different balance tasks in patients with PF compared to their control counterparts. Fifty subjects (25 patients with PF and 25 control subjects) participated in this study. Subjective pain (measured with a visual analog scale (VAS)), pressure pain threshold (PPT), and postural sway and tremor during eight different balance tasks were measured. Postural sway was measured by a balance platform, while tremor was measured as the mechanical movement of the platform in the 8 Hz frequency range. Thickness of plantar fascia, subjective pain, and PPT were significantly greater in the PF group compared to the controls (p < 0.001). Postural sway and 8 Hz tremor were significantly greater in the PF group compared to the control group for all eight balance tasks (p < 0.01). These results indicate that the lack of plantar fascia elasticity is probably the cause of the reduced balance and increased muscle tremor.

Detecting and Quantifying Ataxia-Related Motor Impairments in Rodents Using Markerless Motion Tracking With Deep Neural Networks.

In this study we evaluate the application of video-based markerless motion tracking based on deep neural networks for the analysis of ataxia-specific movement abnormalities in rodent models of cerebellar ataxia. Based on a small amount (<100) of manually labeled video frames, markerless motion tracking enabled the extraction of movement trajectories and parameters characterizing ataxia-specific movement abnormalities. In the first experiment, we analyzed videos of 6 shaker and 4 wildtype rats and were able to reproduce thê5 Hz tremor frequency in the shaker rat without the usage of a force plate. In the second experiment, we investigated a spinocerebellar ataxia type 3 (SCA3) mouse model (6 mice aged 3 months and 3 mice aged 9 months) in a beam-balancing task. By establishing a parameter for the assessment of rhythmicity of gait (RoG), we not only found a significantly higher RoG in wildtype mice compared to affected SCA3 mice aged 9 months, but were also able to reveal a significantly lower than typical RoG in SCA3 mice aged 3 months which exhibit no abnormalities in visual inspection. These prototypical results suggest the capability of the presented methods for the application in upcoming therapeutic intervention trials to identify subtle changes in movement behavior.

Progressive myoclonus epilepsy caused by a gain-of-function KCNA2 mutation

Progressive myoclonus epilepsy caused by a gain-of-function KCNA2 mutation

VESTIBULAR OCULAR THERAPY TO OPTIMIZE THE BRAIN OF A YOUNG MAN WITH ASPERGER’S

Event Abstract Back to Event VESTIBULAR OCULAR THERAPY TO OPTIMIZE THE BRAIN OF A YOUNG MAN WITH ASPERGER’S Benjamin R. Behrendt1, 2* 1 NeuroWorks Healthcare LLC, United States 2 Carrick Institute, United States BACKGROUND: A 29-year-old male presented with Asperger’s, increased anxiety, difficulty with coordination, tremors and uncontrolled movements, following directions, comprehension, finishing tasks, mental fatigue and fogginess, sound and touch sensitivity. When in a visually busy environment he experiences blurring while “zoning out”. METHODS: An extensive neurological examination and treatment protocol was performed. Significant findings included: camptocormic posture; an accentuated 10-14 Hz tremor that was evident with hand writing and with rest; tachycardia and acceleration of HR from supine to standing. Also occurring was a loss in the ability to pursuit at frequencies approaching .2 and .4 Hz; absent optokinetic (OPK) reflexive eye movements, along with significant decrease in cognitive following OPK eye movements horizontally and vertically while staring into space and significant ptosis; decrease in gain during head impulse bilaterally going from lateral to medial, however not when going medial to lateral. Using the Unified Parkinson’s Disease Rating Scale (UPDRS) he had a grade 1 with facial expression, Luria hand sequencing and foot tap, and a grade 0 finger tap, and there was a positive glabellar sign. Noted was bilateral, dysmetric cerebellar findings with finger-to-nose; alternating hand movements; and heel/shin slide seated and supine; and past pointing. Positive extinction at the shoulder/cheek, loss of graphesthesia with recognizing letters and numbers in the hands and feet was discovered. Patellar reflexes (MSR) were 3+. He had increased instability with Romberg’s, tandem and perturbed stance; an increase in toe off/springing of gait; decreased right arm swing; increased hesitations with stiffening of gait during dual tasking. Therapy targeted the right posterior canal and left anterior canal input centrally utilizing a procedure which combined times-zero viewing into posterior canal plane, pursuing leftward into times-one viewing into the left anterior canal plane; and left anterior canal repositioning to integrate central vestibular with cervical ocular structures. A prescribed set of exercises for home included somatosensory mapping; gait training with large accentuated arm movements; cross crawl multiplanar joint movements; right unilateral multiplanar joint patterning; and orthogonal ocular movements. A return visit consisted of anterior canal reintegration, VOR head movements with head thrust to the right, cerebellar patterning, orthogonal eye movements, as well as, home therapies. RESULTS: Following the initial treatment he had reduced tremor; WNL Glabellar reflex; reduced muscle tone globally; reduced tremor in the hands; reduced light sensitivity; improved OPKs horizontally and vertically; and maintained loss of graphesthesia. Home program improved hand-writing, and reduced tremor. After second treatment he regained graphesthesia and somatosensory localization; no longer felt internal sense of jitters; and was less anxious and more relaxed. CONCLUSION: Connected functional neurological exam and treatment utilizing the vestibular system and somatosensory integration can significantly change the timing of cerebellum and brain output. Further investigation is warranted for the integration of vestibular ocular therapy for brain synchronization. Keywords: Aspergers, cognitive ehnancement, Vestibular Rehabilitation, Neurorehabilitation, Vestibular ocular rehabilitation, Cognition Conference: International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019. Presentation Type: Poster Presentation Topic: Clinical Neuroscience Citation: Behrendt BR (2019). VESTIBULAR OCULAR THERAPY TO OPTIMIZE THE BRAIN OF A YOUNG MAN WITH ASPERGER’S. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience. doi: 10.3389/conf.fneur.2019.62.00053 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Apr 2019; Published Online: 27 Sep 2019. * Correspondence: Dr. Benjamin R Behrendt, NeuroWorks Healthcare LLC, Marietta, United States, drben@neuroworkshealthcare.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Benjamin R Behrendt Google Benjamin R Behrendt Google Scholar Benjamin R Behrendt PubMed Benjamin R Behrendt Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. 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P31. Gait disturbance in patients with orthostatic tremor

Introduction Orthostatic tremor (OT) is a rare disorder of unclear etiology characterized by a 13–18 Hz tremor of the legs while standing with resolving symptoms during sitting or walking. OT is associated with other movement disorders such as parkinsonism, essential tremor or cerebellar disorders. Although gait disturbances are frequently described in these diseases, there is no systemic analysis of the gait disorder linked to OT. Therefore, the aim of this study is to investigate the gait performance of patients with OT assessed by a standardized sensorimotor and cognitive walking paradigm. Methods Patients with a diagnosis of primary OT were screened and included in this study after informed consent. Gait performance was investigated during 8 different walking conditions using a pressure-sensitive sensor carpet (GAITRite®). Patients walked at preferred, slow and maximum walking speeds (PS, SS, MS), during head reclination and eyes closed conditions (HR, EC) as well as calculatory, semantic and motoric dual task conditions (DTC, DTS, DTM). The gait performance of patients was compared to age-matched healthy subjects. Gait parameters were assessed by a multivariate analysis of variance. Results Eighteen patients with a diagnosis of primary OT with a mean age of 70.4 ± 5.9 years were included in the study. In all walking conditions gait velocity (p Discussion Although OT symptoms diminish during walking, we identified constant impairments of locomotion control. The gait disturbance was characterized by an increased level of a cautious gait (slow, small-stepped, increased double support phases and BOS). Moreover, we identified disturbance of gait stability (increased CV) and interlimb coordination (left-right asymmetry). The specific alterations were found in conditions with increased sensory feedback control as well as attentional cognitive gait control. This implies an impaired integration of sensory feedback, possibly due to a dysfunction of midline cerebellar structures, as cerebellar dysfunction in OT was frequently described.

Pathological ponto-cerebello-thalamo-cortical activations in primary orthostatic tremor during lying and stance.

Primary orthostatic tremor is a rare neurological disease characterized mainly by a high frequency tremor of the legs while standing. The aim of this study was to identify the common core structures of the oscillatory circuit in orthostatic tremor and how it is modulated by changes of body position. Ten patients with orthostatic tremor and 10 healthy age-matched control subjects underwent a standardized neurological and neuro-ophthalmological examination including electromyographic and posturographic recordings. Task-dependent changes of cerebral glucose metabolism during lying and standing were measured in all subjects by sequential 18F-fluorodeoxyglucose-positron emission tomography on separate days. Results were compared between groups and conditions. All the orthostatic tremor patients, but no control subject, showed the characteristic 13-18 Hz tremor in coherent muscles during standing, which ceased in the supine position. While lying, patients had a significantly increased regional cerebral glucose metabolism in the pontine tegmentum, the posterior cerebellum (including the dentate nuclei), the ventral intermediate and ventral posterolateral nucleus of the thalamus, and the primary motor cortex bilaterally compared to controls. Similar glucose metabolism changes occurred with clinical manifestation of the tremor during standing. The glucose metabolism was relatively decreased in mesiofrontal cortical areas (i.e. the medial prefrontal cortex, supplementary motor area and anterior cingulate cortex) and the bilateral anterior insula in orthostatic tremor patients while lying and standing. The mesiofrontal hypometabolism correlated with increased body sway in posturography. This study confirms and further elucidates ponto-cerebello-thalamo-primary motor cortical activations underlying primary orthostatic tremor, which presented consistently in a group of patients. Compared to other tremor disorders one characteristic feature in orthostatic tremor seems to be the involvement of the pontine tegmentum in the pathophysiology of tremor generation. High frequency oscillatory properties of pontine tegmental neurons have been reported in pathological oscillatory eye movements. It is remarkable that the characteristic activation and deactivation pattern in orthostatic tremor is already present in the supine position without tremor presentation. Multilevel changes of neuronal excitability during upright stance may trigger activation of the orthostatic tremor network. Based on the functional imaging data described in this study, it is hypothesized that a mesiofrontal deactivation is another characteristic feature of orthostatic tremor and plays a pivotal role in development of postural unsteadiness during prolonged standing.

Orthostatic tremor: current challenges and future prospects.

This review provides an outlook of orthostatic tremor (OT), a rare adult-onset tremor characterized by subjective unsteadiness during standing that is relieved by sitting or walking. Recent case series with a long-time follow-up have shown that the disease is slowly progressive, spatially spreads to the upper limbs, and other neurological disorders may develop in about one-third of the patients. The diagnosis of OT hinges on the typical history of unsteadiness during standing, which is confirmed by electromyographic findings of a 13–18 Hz tremor that is typically absent during tonic activation while the patient is sitting and lying. Although the tremor is generated by a central oscillator, cerebellar and/or basal ganglia dysfunction are needed for its manifestation (double lesion hypothesis). However, functional neuroimaging findings have not consistently implicated the dopaminergic system in its pathogenesis. Drug treatments have been largely disappointing with no sustained benefits, although thalamic deep brain stimulation has helped some patients. Large-scale follow-up studies, more drug trials, and novel therapies are urgently needed.

ID 192 – Orthostatic tremor: A spectrum of fast and slow frequencies or distinct entities?

Objective Orthostatic tremor (OT) is defined by the presence of a high frequency (13–18 Hz) tremor of the legs on standing but some patients have discharge frequencies of. Methods A retrospective review was performed on all subjects with a diagnosis of OT that were referred for confirmation by neurophysiology at the Mayo Clinic Arizona between 1999 and 2013. Results Fourteen of 28 subjects (50%) had slow OT, of whom 8 had intermediate frequencies of. Conclusions Slow tremor frequencies may characterize may characterize a substantial proportion of patients with OT. These subjects may have greater gait involvement and higher likelihood of falls.

Multimodal neurorehabilitation of a patient with tinnitus and memory difficulties

Event Abstract Back to Event Multimodal neurorehabilitation of a patient with tinnitus and memory difficulties Matthew M. Antonucci1, 2, Jeremy Husk3 and Susan E. Esposito3* 1 Plasticity Brain Centers, United States 2 Carrick Institute for Graduate Studies, United States 3 Life University, United States Background: We describe a 61-year-old male who presented to a functional neurology clinic with tinnitus, memory changes, sleeping issues, and fatigue as his chief complaints. Additional complaints were anxiety, back pain, depression, and abnormal psychological changes. The patient had previously received treatment at the same facility three months prior and reported that his symptoms of “chatter” in his head had decreased, he felt calmer, his mood was much better, and he no longer experienced his “post traumatic stress disorder (PTSD) symptoms.” He also noted that he tried to stop taking his Wellbutrin, an antidepressant medication, but it “did not go well.” The patient’s symptoms are consistent with a bipolar disorder diagnosis, but the severity since his last treatment had greatly diminished. Methods: A physical exam revealed several significant abnormal findings. The examiner noted a decreased left arm swing and lateropulsion during a dual tasking gait test. The patient exhibited bilateral dysmetria on finger-nose-finger testing with the greatest deficit occurring in the lower left quadrant; left extensor muscle weakness; and an 8-10 hz tremor of the chin and hands. Also, square wave jerks were present in all eye positions and with without fixation, nystagmus was manifest in an up and rightward beating direction. Rightward saccadic intrusions were noted during right and leftward pursuits. Lastly, there was an increased gain of the optokinetic response going leftward, rightward, and downward. Following the examination, the patient participated in a 5-day multimodal neurorehabilitation program that included several specific rehabilitation efforts. Therapy included vestibular rehabilitation, gaze stability exercises with head movements, and ocular fixation exercises. Additionally, repetitive peripheral somatic stimulation (RPSS) of the mandibular nerve, passive complex non-linear limb movements, and off vertical axis rotations; as well as basic balance training and hand eye coordination activities were utilized. Results: After 5 days of treatment, the patient reported decreased tinnitus, decreased memory difficulties and experienced an increase in both the quality and duration of sleep. Examination revealed a decrease in bilateral dysmetria during the finger-nose-finger testing, resolution of muscle weakness, smooth pursuits in all directions, and fewer square wave jerks. The patient retained a decrease in left arm swing during dual task gait testing, but his lateropulsion was completely resolved. Conclusion: This case showed significant neurological improvements after administration of the multimodal neurorehabilitation regimen described. The authors have suggested further investigation into vestibular rehabilitation mechanisms and brain-based approaches for patient treatments of various cognitive and neurological complaints. Keywords: Tinnitus, Memory Disorders, PTSD Symptoms, chiropractic neurology, Neurorehabilitation Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016. Presentation Type: Poster Presentation Topic: Abstracts ISCN 2016 Citation: Antonucci MM, Husk J and Esposito SE (2016). Multimodal neurorehabilitation of a patient with tinnitus and memory difficulties. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00031 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 31 Aug 2016; Published Online: 07 Sep 2016. * Correspondence: Dr. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Matthew M Antonucci Jeremy Husk Susan E Esposito Google Matthew M Antonucci Jeremy Husk Susan E Esposito Google Scholar Matthew M Antonucci Jeremy Husk Susan E Esposito PubMed Matthew M Antonucci Jeremy Husk Susan E Esposito Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.