ABSTRACT
Over the past few decades, it has been recognized that traumatic brain injury (TBI) may result in various movement disorders. However, moderate or mild TBI only rarely causes persistent post-traumatic movement disorders. In the present report, we describe a case of secondary tremor due to amild head injury with a transitory loss of consciousness. A 26- year-old man developed an isolated rest tremor of the hands and legs without other neurologic signs. The interval between the head trauma and the onset of the symptomswas 4 months. Neuroimaging studies reveled gliosis in the lentiform nucleus. Haloperidol administration resulted in tremor reduction. A rest tremor, similar to essential tremor, can be a rare complication of head trauma. Haloperidolmay be an effective and safe treatment modality for post-traumatic tremor. Further studies are needed to clarify the optimal drug for the treatment of post-traumatic tremor.
Subject(s)
Humans , Male , Adult , Tremor/classification , Tremor/diagnosis , Tremor/drug therapy , Brain Injuries, Traumatic/complications , Haloperidol/administration & dosage , Movement Disorders/therapyABSTRACT
OBJECTIVES: Vocal tremors, which cause social difficulties for patients, may be classified as resting or action tremors. Of the vocal action tremors, essential and dystonic tremors are the most common. Botulinum toxin and oral medications have been used to treat vocal tremors, but no comparative clinical trials have been performed. The aim of this study was to compare the effects of botulinum toxin injection and the oral administration of propranolol in the treatment of essential and dystonic vocal tremors. METHODS: This clinical trial recruited 15 patients, divided into essential and dystonic vocal tremor groups. Patients in both groups received successive treatment with botulinum toxin and propranolol. The treatments were administered at different times; the order of treatment was randomly selected. Patients were assessed with flexible nasofibrolaryngoscopy and with perceptual and acoustic voice evaluations. A statistical significance level of 0.05 (5%) was used. RESULTS: Botulinum toxin produced statistically significant improvements in perceptual measures of vocal instability in patients with dystonic vocal tremors compared with baseline values and treatment with propranolol. The acoustic measure of variability in the fundamental frequency was significantly lower in patients with dystonic vocal tremors after treatment with botulinum toxin. CONCLUSION: Essential and dystonic vocal tremors responded differently to treatment. Dystonic vocal tremors responded significantly to treatment with botulinum toxin but not oral propranolol. Essential vocal tremors did not respond significantly to either treatment, perhaps due to the small number of patients, which is a limitation of this research.
Subject(s)
Humans , Propranolol/administration & dosage , Voice Disorders/drug therapy , Adrenergic beta-Agonists/administration & dosage , Botulinum Toxins, Type A/therapeutic use , Dystonic Disorders/drug therapy , Laryngeal Muscles/drug effects , Neuromuscular Agents/administration & dosage , Propranolol/therapeutic use , Tremor/drug therapy , Reproducibility of Results , Treatment Outcome , Statistics, Nonparametric , Electromyography , Injections, IntramuscularABSTRACT
OBJECTIVE: To study tremor in patients with X-linked recessive spinobulbar muscular atrophy or Kennedy's disease. METHODS: Ten patients (from 7 families) with a genetic diagnosis of Kennedy's disease were screened for the presence of tremor using a standardized clinical protocol and followed up at a neurology outpatient clinic. All index patients were genotyped and showed an expanded allele in the androgen receptor gene. RESULTS: Mean patient age was 37.6 years and mean number of CAG repeats 47 (44-53). Tremor was present in 8 (80 percent) patients and was predominantly postural hand tremor. Alcohol responsiveness was detected in 7 (88 percent) patients with tremor, who all responded well to treatment with a β-blocker (propranolol). CONCLUSION: Tremor is a common feature in patients with Kennedy's disease and has characteristics similar to those of essential tremor.
Subject(s)
Adult , Humans , Male , Middle Aged , Young Adult , Bulbo-Spinal Atrophy, X-Linked/physiopathology , Tremor/physiopathology , Age of Onset , Adrenergic beta-Antagonists/administration & dosage , Muscle Weakness/physiopathology , Propranolol/administration & dosage , Tremor/drug therapyABSTRACT
FXTAS (Fragile X-associated tremor and ataxia syndrome) is a late- onset neurodegenerative disorder affecting mainly men, over 50 years of age, who are carriers of the FMR1 gene premutation. The full mutation of this gene causes the fragile X syndrome (FXS), the most common cause of inherited mental retardation. Individuals affected by FXTAS generally present intention tremor and gait ataxia that might be associated to specific radiological and/or neuropathological signs. Other features commonly observed are parkinsonism, cognitive decline, peripheral neuropathy and autonomic dysfunction. Nearly a decade after its clinical characterization, FXTAS is poorly recognized in Brazil. Here we present a review of the current knowledge on the clinical, genetic and diagnostic aspects of the disease.
A FXTAS (síndrome de tremor e ataxia associada ao X frágil) é uma doença neurodegenerativa de início tardio que afeta principalmente homens acima dos 50 anos de idade, portadores de pré-mutação do gene FMR1. A mutação completa desse gene é responsável pela síndrome do cromossomo X frágil (SXF), a causa mais comum de deficiência mental herdada. Indivíduos afetados pela FXTAS geralmente apresentam tremor de intenção e ataxia de marcha que podem estar associados a sinais radiológicos ou neuropatológicos específicos. Outras características comumente observadas são parkinsonismo, declínio cognitivo, neuropatia periférica e disfunções autonômicas. Quase uma década após sua caracterização clínica, a FXTAS é mal conhecida por médicos no Brasil. Esta revisão apresenta o conhecimento atual sobre os aspectos clínicos, genéticos e diagnósticos da síndrome.
Subject(s)
Animals , Humans , Male , Middle Aged , Ataxia , Fragile X Syndrome , Fragile X Mental Retardation Protein/genetics , Tremor , Ataxia/diagnosis , Ataxia/drug therapy , Ataxia/genetics , Fragile X Syndrome/diagnosis , Fragile X Syndrome/drug therapy , Fragile X Syndrome/genetics , Magnetic Resonance Imaging , Tremor/diagnosis , Tremor/drug therapy , Tremor/geneticsABSTRACT
OBJECTIVE: The association of cervical dystonia (CD) with other movement disorders have been already described, but data on clinical outcome regarding these patients are scant. The aim of this paper was to investigate whether patients with CD and head tremor (HT) would have a different outcome regarding to botulinum toxin type-A (BTX-A) treatment response and clinical and demographic parameters. METHOD: We retrospectively evaluated 118 medical charts of patients with CD and divided them into two groups: with (HT+) and without (HT-) head tremor. We compared the following clinical and demographic parameters: age at onset, disease duration, progression of symptoms, etiology, familial history, presence of hand tremor. We also analyzed the response to BTX-A according to Tsui score in both groups. RESULTS: The occurrence of head tremor in our sample was of 38.2 percent. The occurrence of postural hand tremor in the patients from the HT+ group was higher than in the HT- one (p=0.015) and if we compare BTX-A response in each group, we observe that patients with HT present a better outcome in a setting of longer follow-up. In HT+ group, Tsui score pre treatment was 10 (6-12.5) and after follow-up was 8 (5.5-10.5); p<0.001. In HT- group there was no significant difference 9 (7-12) in pre treatment and after follow-up; p=0.07. CONCLUSION: According to our data it seems that head tremor may influence the clinical outcome or treatment response with BTX-A in patients with CD.
OBJETIVO: A associação de distonia cervical (DC) com outros transtornos do movimento já foi descrita, mas há poucos dados quanto à evolução clínica destes pacientes. Avaliamos se os pacientes com DC e tremor cefálico (TC) apresentam características clínicas e demográficas, assim como a resposta ao tratamento com toxina botulínica tipo A, diferentes. MÉTODOS: Analisamos retrospectivamente 118 prontuários de pacientes com DC e os dividimos em dois grupos: com (TC+) e sem (TC-) tremor cefálico. Comparamos os seguintes parâmetros clínicos e demográficos entre os grupos: idade de início, duração da doença, progressão de sintomas, etiologia, história familiar, presença de tremor em mãos. Também analisamos a resposta ao tratamento com toxina botulínica de acordo com escore Tsui em ambos os grupos. RESULTADOS: A ocorrência de tremor cefálico em nosso grupo de pacientes foi 38,2 por cento. A ocorrência de tremor postural nas mãos em pacientes TC+ foi maior (p=0,015) e se compararmos a resposta ao tratamento com toxina botulínica em cada grupo, observamos que os pacientes com TC têm melhor evolução em uma situação de seguimento mais prolongado. No grupo TC+, o escore Tsui pré-tratamento foi 10 (6-12,5) e após o período de "follow-up" foi 8 (5,5-10,5); p<0,001. No grupo TC-, não houve diferença significante: 9 (7-12) no pré-tratamento e após período de "follow-up"; p=0,07. CONCLUSÃO: Nossos dados apontam que o tremor cefálico pode influenciar a evolução clínica ou resposta ao tratamento com toxina botulínica em pacientes com DC.
Subject(s)
Aged , Female , Humans , Male , Botulinum Toxins, Type A/therapeutic use , Head Movements , Neuromuscular Agents/therapeutic use , Torticollis/drug therapy , Tremor/drug therapy , Tremor/etiology , Hand , Retrospective Studies , Treatment Outcome , Torticollis/complicationsABSTRACT
Botulinum toxins are, as a group, among the most potent neuromuscular toxins known, yet they are clinically useful in the management of conditions associated with muscular and glandular over-activity. Botulinum toxins act by preventing release of acetylcholine into the neuromuscular junction. While botulinum toxin type A is commonly available, different manufacturers produce specific products, which are not directly interchangeable and should not be considered as generically equivalent formulations. Type B is also available in the market. Each formulation of botulinum toxin is unique with distinct dosing, efficacy and safety profiles for each use to which it is applied. Botulinum toxin type A is the treatment of choice based on its depth of evidence in dystonias and most other conditions. Botulinum toxin type A is established as useful in the management of spasticity, tremors, headache prophylaxis and several other neurological conditions. Active research is underway to determine the parameters for which the type B toxin can be used in these conditions, as covered in this review. Botulinum toxin use has spread to several fields of medicine.
Subject(s)
Anti-Dyskinesia Agents/therapeutic use , Botulinum Toxins/therapeutic use , Dystonia/drug therapy , Humans , India , Tremor/drug therapyABSTRACT
Relatamos quatro casos de tremor ortostático primário. O motivo do relato está na raridade da doença e no seu diagnóstico diferencial com outros tremores, muitas vezes confuso. Nossos casos foram estudados eletrofisiologicamente e a frequência dos tremores variou entre 15 e 20 Hz. Existem diferenças clínicas, eletrofisiológicas e terapêuticas entre o tremor ortostático primário e outros tremores de membros inferiores, de acordo com a literatura e com as características de nossos quatro casos.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Leg/physiopathology , Tremor/diagnosis , Anti-Anxiety Agents/administration & dosage , Anti-Anxiety Agents/therapeutic use , Anticonvulsants/administration & dosage , Anticonvulsants/therapeutic use , Arm/physiopathology , Clonazepam/administration & dosage , Clonazepam/therapeutic use , Depression/physiopathology , Diagnosis, Differential , Electromyography , Posture , Primidone/administration & dosage , Primidone/therapeutic use , Propranolol/administration & dosage , Propranolol/therapeutic use , Tremor/drug therapyABSTRACT
Introducción. La broncodisplasia pulmonar es una complicación frecuente del recién nacido prematuro que desarrolla enfermedad de membrana hialina; su repercusión sobre el neurodesarrollo incluye: alteraciones motoras, retardo en la adquisición de habilidades lingüísticas y microcefalia; recientemente se ha relacionado con el desarrollo de movimientos involuntarios de tipo coreico y temblor de origen extrapiramidal durante el primer año de vida. Caso clínico. Se reporta un caso típico de discinesia con movimientos coreicos, temblor, postura distónica y dificultades en la succión y deglución asociadas a disquinesia oro-buco-lingual que se desarrolló en los primeros 3 meses de vida en un paciente con broncodisplasia pulmonar y dependencia de suplementos de oxígeno inhalado. Conclusión. Se hace hincapié en el diagnóstico diferencial de los trastornos de la succión y deglución, los hallazgos video-electroencefalográficos y la necesidad de reconocer correctamente el síndrome, así como su tratamiento farmacológico
Subject(s)
Humans , Male , Infant , Basal Ganglia Diseases/diagnosis , Basal Ganglia Diseases/drug therapy , Basal Ganglia Diseases/physiopathology , Bronchopulmonary Dysplasia , Deglutition Disorders , Electromyography , Hyaline Membrane Disease/complications , Suction , Tremor/drug therapy , Tremor/etiologyABSTRACT
A toxina botulínica (TOXBA) produz paralisia muscularpela inibiçäo pré-sináptica da liberaçäo da acetilcolina. A eliminaçäo de sua toxicidade natural através de sofisticadas técnicas laboratoriais tornou possível clínica no tratamento de uma diversidade de desordens de movimentos até entäo de difícil controle. A filosofia de seu uso repousa na identificaçäo dos principais músculos envolvidos no movimento anormal e na paralisaçäo dos mesmos pela injeçäo tópica de TOXBA, de modo a bloquear o movimento anormal em questäo. O procedimento, em mäos experimentadas, é até simples e tem a vantagem de ser um método poco invasivo e de poder ser realizado ambulatorialmente. Além de seguro, tem elevada eficácia. A experiência pessoal do autor e a literatura mostram que melhora significativa é obtidaem estrabismo, 85 por cento; blefaroespasmo, 70-90 por cento; distonia oromadibular, 70 por cento; distonia cervical (torcicolo espasmódico), 50-90 por cento; distonia laríngea, 80-100 por cento; distonia de mäo, 40-80 por cento; e espasmo hemifacial, 90 por cento...
Subject(s)
Humans , Blepharospasm/drug therapy , Dystonia/drug therapy , Muscle Spasticity/drug therapy , Ocular Motility Disorders/drug therapy , Meige Syndrome/drug therapy , Strabismus/drug therapy , Botulinum Toxins, Type A/therapeutic use , Tremor/drug therapyABSTRACT
Orthostatic tremor is characterized by a fine tremor of lower limb muscles that produces instability while standing still and alleviates on walking or sitting. We report 2 patients, aged 54 and 72 years old, in whom the tremor caused falls. The clinical features, a negative neurological examination, the alleviation on walking or sitting and the good response to clonazepam allowed the diagnosis. This disease should be considered in the differential diagnosis of standing still instability
Subject(s)
Humans , Male , Female , Middle Aged , Tremor/diagnosis , Sensation Disorders/etiology , Propranolol/administration & dosage , Tremor/drug therapy , Clonazepam/administration & dosage , 1-Propanol , Postural Balance/physiologyABSTRACT
Ethanol extract (ETE) and cold aqueous infusion (CAI) of Vitex leucoxylon leaf were evaluated in a battery of tests to define the activity profile of the plant. CAI depressed SMA, antagonised d-amphetamine stereotypy and oxotremorine tremors, shortened the duration of mice immobility in behavioural 'despair' test and lowered serum total cholesterol level. ETE showed significant inhibition of carrageenin paw oedema and granulation tissue formation in rats. Suppression of acetic acid writhing was observed with both ETE and CAI. LD50 value of ETE was > 3000 mg kg-1 (ip) and that of CAI 1050 (800-1200) mgkg-1.
Subject(s)
Analgesics/pharmacology , Animals , Behavior, Animal/drug effects , Cholesterol/blood , Female , Inflammation/drug therapy , Male , Mice , Motor Activity/drug effects , Plant Extracts/pharmacology , Plants, Medicinal , Rats , Rats, Wistar , Sleep/drug effects , Tremor/drug therapyABSTRACT
O tremor da escrita é distúrbio precipitado por atividade motora específica, geralmente a escrita. Analisamos este caso sob o ponto de vista clínico e terapêutico. O paciente apresentava tremor ao escrever tornando sua letra ilegível; sem qualquer outra alteraçäo neurológica. Näo havia antecedentes familiares, metabólicos, endócrinos, iatrogênicos, tóxicos ou traumáticos. No manuseio terapêutico näo ocorreu resposta satisfatória ao propranolol, sendo discreta à primidona. A introduçäo de anticolinérgicos (tri-hexifenidil) evidenciou certa melhora na sintomatologia, com reduçäo do tremor no momento da escrita
Subject(s)
Humans , Male , Aged , Handwriting , Parasympatholytics/administration & dosage , Tremor/physiopathology , Parasympatholytics/therapeutic use , Tremor/drug therapyABSTRACT
Diversas drogas han sido señaladas como capaces de inducir o exacerbar los síntomas de parkinsonianos, presentamos un paciente con enfermedad de parkinson que incrementó su déficit motor luego de la administración de fluoxetina. La supresión del fármaco produjo reversión de los síntomas
Subject(s)
Humans , Male , Middle Aged , Depression/drug therapy , Fluoxetine/pharmacology , Parkinson Disease/psychology , Antidepressive Agents, Tricyclic/pharmacology , Psychomotor Performance , Fluoxetine/adverse effects , Selective Serotonin Reuptake Inhibitors/pharmacology , Tremor/drug therapyABSTRACT
Os músicos podem ser acometidos por afecçöes neurológicas de natureza ocupacional. O temor de palco é um distúrbio decorrente da descarga adrenérgica excessiva relacionada a apresentaçöes difícies e/ou importantes. O uso excessivo dos músculos ao tocar por períodos prolongados pode resultar em uma lesäo ultra-estrutural de resoluçäo demorada. A compressäo de nervos periféricos pode resultar do contato direto com os instrumentos musicais ou da posiçäo necessária para tocá-los. Mais raramente, os músicos säo acometidos por uma discinesia ocupacional, de origem obscura e tratamento difícil
Subject(s)
Occupational Diseases/etiology , Fear , Music , Tremor/etiology , Adrenergic beta-Antagonists/therapeutic use , Anxiety Disorders/drug therapy , Anxiety Disorders/etiology , Sympathetic Nervous System/physiology , Tremor/drug therapyABSTRACT
Consideramos esta publicación como la primera sobre Temblor Esencial en América Latina. Todos nuestros pacientes eran inmigrantes o hijos de inmigrantes de los orígenes más comunes en nuestro país (España, Italia, Francia y Polonia). No se incluyeron pacientes indoamericanos. El reducido número de indoamericanos puros en Buenos Aires y sus alrededores debe tenerse en cuenta. El temblor hereditario esencial es entidad monosintomática, conocida durante más de cien años. Sus elementos más importantes se describen progresivamente aquí y también, las dificultades terapéuticas que presenta. Durante un período de quince años, los autores pudieron seleccionar un total de 16 familias, con 39 casos de temblor esencial, estudiados básicamente desde el punto de vista clínico. Esto nos permitió confirmar el carácter del temblor, de tipo rítmico (4 a 10 c/seg), preponderante en maños, especialmente en los dedos pulgar e índice, extensión del temblor a la boca, cabeza y eventualmente, a todo el cuerpo. La característica dominante y autosómica de la herencia también se demostró en nuestros pacientes. La edad de comienzo de esta entidad oscila entre los 20 y los 40 años, con una exacerbación en la quinta década de la vida. No hubo predominancia de ninguno de los sexos, ni de longevidad ni multiparidad. Esta enfermedad no produce la muerte y la incapacidad que acarrea no es muy importante. No parece existir una asociacicón entre esta entidad y otras enfermedades, excepto aquellas patologías desencadeantes como la tensión emocional y eventualmente, el alcoholismo como tratamiento aparente propuesto por el propio paciente para aliviar su sintomatología. La ubicación nosológica de esta enfermedad debe estar junto con los trastornos extrapiramidales, a pesar de los 5 casos existentes en la bibliografía mundial sobre anatomía patológica, los que no presentaron alteraciones tales que justificaran el temblor en el sistema nervioso central...
Subject(s)
Humans , Male , Female , Tremor/genetics , Argentina , Diagnosis, Differential , Gene Pool , Pedigree , Primidone/therapeutic use , Propranolol/therapeutic use , Tremor/diagnosis , Tremor/drug therapyABSTRACT
Tremor ortostático (TO) é um novo tipo de tremor, irregular e de alta freqüência, recentemente descrito, que afeta grupamentos musculares antagonistas nos membros inferiores, desde que seja mentida a postura ereta. Descrevemos dois novos casos deste tipo peculiar de tremor, que pode näo ser täo incomum quanto até entäo suposto. Enfatizamos suas principais características diagnósticas e semiológicas. O TO pode compartilhar algum mecanismo fisiopatológico básico com os tremores da variedade heredofamilial essencial clássica