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Objective: To explore the value of tremor analysis using accelerator combined with electromyography (EMG) in differential diagnosis of essential tremor (ET) and Parkinson's disease (PD). Methods: We made a retrospective analysis and comparison of 61 ET patients in the outpatient department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, and 49 PD patients. Tremor analysis was performed in the two groups, and differences in tremor characteristics between the two groups were compared. Results: ① General information: 61 ET patients, including 27 males (44.3%), aged 21-84 years (mean 58.8±15.8 years), with an average duration of 8.8 years (8.2 years). There were 49 PD patients including 23 males (46.9%), aged 44-84 years (mean 64.3±9 years). ② Tremor waveform: ET group had single wave crest. 72.1% patients had double peaks after loading. 95.9% patients in PD group were mainly harmonic, and no double peaks appeared. ③ The muscle contractile modes in the two groups were mutually antagonistic in tremor. ET group had mainly synchronous contraction, while PD group had synchronous contraction and alternating contraction mode (P<0.05) simultaneously. The characteristics of tremor wave: the frequency of ET group was higher than that of PD group (6.62±1.70 vs. 4.77±0.67, P<0.05), and the half width of wave peak was larger (0.95±0.30 vs. 0.82±0.21, P<0.05), but there was no significant difference in the half width power between the two group (χ2=49.22, P<0.05).The multiple factor analysis showed that significant differences between the two groups in the double wave peak, harmonic phenomenon, tremor position and tremor after the weight negative. The surrounding waves were positively correlated with ET. The appearance of the surrounding waves was more inclined to diagnose ET (P=0.003, OR value=90.496). The harmonic phenomenon was positively related to ET, and the harmonic phenomenon was more inclined to appear in PD (P=0.014, OR value=0.042). The area under the ROC curve of the peak frequency of the tremor after 1000g was 0.845. The best diagnostic boundary value of ET was 5.445 0 Hz, the sensitivity was 77%, the specificity was 85.7%, the positive predictive value was 87%, and the negative predictive value was 75%. Conclusion: ET and PD differ significantly in tremor frequency, muscle contraction mode, half-width value, frequency after loading and waveform changes. Tremor analysis is of high value in differentiating ET from PD tremor.
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@#Objective To compare the characteristics of tremor and non-motor symptoms in patients with essential tremor (ET) and patients with Parkinson's disease developed from essential tremor (ET-PD). Methods From March, 2016 to August, 2017, 30 ET patients and 17 ET-PD patients were investigated with the general questionnaire, Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), and were measured with transcranial sonography and the frequency, amplitude and contraction patterns of resting and postural tremors. Results Compared with the ET patients, there were more patients reported olfactory dysfunction and rapid eye movement behavior disorder (RBD) in ET-PD patients (χ2>4.656, P<0.05). Meanwhile, the area of hyperechogenicity in substantia nigra was greater (t=2.164, P<0.05), the incidence of lower limb tremor and mandibular tremor was more (χ2>8.745, P<0.01), the frequency of rest and postural tremor in the head and upper limbs was less (t>2.082, P<0.05). The rest and postural tremors in the upper limbs were mainly synchronous in ET patients, whereas it was alternating in ET-PD patients (χ2>3.943, P<0.05). Conclusion Some differences of non-motor symptoms and tremor are found in patients with ET-PD and ET. When ET patients suffer from hyposmia, RBD, or the site, frequency and contraction patterns of tremor changes, they may develop to PD.
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@#Objective To compare the characteristics of the tremor of multiple system atrophy Parkinsonism type (MSA-P) with Parkinson's disease (PD), and improvement after acute levodopa challenge test. Methods From Match to September 2017, 70 patients with PD and 23 patients with probable MSA-P were included. All the patients were required of rest or postural tremor in at least one extremity or head, and accepted acute levodopa challenge test and analysis for dominant tremor frequency, amplitude and rhythm under resting state, posturing and holding 1000 g state, respectively.Results The score of Unified Parkinson Diease Rating Scale Part III was higher in MSA-P patients than in PD patients (t=-2.098, P<0.05), with less improvement after acute levodopa challenge test (Z=-9.446, P<0.01), while the tremor score and improvement were not significantly different between two groups (P>0.05). There were more frequence with non-alternating or synchronic tremor rhythm (χ2=8.756, P<0.01) and small irregular tremor in rest tremor (χ2=4.788, P<0.05) in MSA-P patients than in PD patients, as well as the high frequency tremor (>6 Hz) in postural tremor (χ2=11.312, P<0.01). The frequency of rest tremor was higher in MSA-P patients than in PD patients (t=-2.119, P<0.05), as well as the frequency of postural tremor with 1000 g (t=-2.274, P<0.05). Both PD and MSA-P patients showed, the lower frequency the postural tremor was, the higher the tremor scores were. There were 25% PD patients with head tremor, while none in MSA-P patients. Tremor score improved more than 30% after acute levodopa challenge test in 22.7% MSA-P patients, but none improved in UPDRS score. The frequence of tremor score improvement was more in female MSA-P patients than in males (P<0.05).Conclusion The features of the tremor are similar in PD and MSA-P, with some differences that MSA-P tend to higher frequency in rest or postural tremor, more non-alternating or synchronic tremor rhythm in rest tremor, and fewer has tremor besides limbs. Some MSA-P patients improve after acute levodopa challenge test, and women may improve more than men.
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Objective To summarize the characteristics of tremor peak frequency,power and harmonics occurrence rate between Parkinson's disease (PD) and multiple system atrophy-parkinsonism (MSA-P).Methods From January to December in 2016,48 PD patients and 22 MSA-P patients were enrolled in Beijing Tiantan Hospital.Upper limb tremor patients got tremor analysis test in rest,posture and holding 1 000 g states,while lower limb tremor patients in rest and posture states.Peak frequency,power and harmonics occurrence rate of tremor were compared between PD and MSA-P patients in different states.Results Peak frequency of PD and MSA-P patients in upper rest ((4.76± 0.82) Hz vs (6.03 ± 0.25)Hz,t=-2.161,P=0.037),posture ((5.25 ±0.88) Hz vs (7.66 ±1.90) Hz,t=-4.266,P=0.001),holding 1 000 g ((5.80 ± 1.28) Hz vs (8.32 ± 1.51) Hz,t =-6.436,P =0.000) and lower posture ((4.85 ±0.78) Hz vs (6.42 ± 1.13) Hz,t =-3.001,P =0.012) showed statistically significant difference.Half-width power of PD and MSA-P patients in upper rest (extensor:15.70 (5.82,32.96)mg2/μV2 vs 3.14 (1.69,4.60) mg2/μV2,Z =-2.008,P =0.037),in posture (extensor:33.14(20.46,64.27) mg2/μV2 vs 10.02 (7.11,14.60) mg2/μV2,Z =-3.627,P =0.000;flexor:27.49(9.48,41.74) mg2/μV2 vs 5.97 (4.41,15.59) mg2/μV2,Z =-2.336,P =0.019),in holding 1 000g (flexor:17.80 (9.40,36.60) mg2/μV2vs8.15 (5.32,17.65) mg2/μV2,Z=-2.494,P=0.013),and in lower posture (flexor:26.63(7.09,85.84) mg2/μV2 vs 3.78 (2.51,7.12) mg2/μμV2,Z=-2.049,P =0.045) showed statistically significant difference.Harmonics occurrence rate of PD and MSAP patients in rest (82.5％ vs 5.9％,χ2 =29.096,P =0.000),posture (80.0％ vs 5.9％,χ2 =26.884,P=0.000) and holding 1 000 g (65.0％ vs 0,χ2 =20.318,P=0.000) had statistically significant difference.Conclusions Tremor peak frequency in PD patients was lower than that in MSA-P patients,while power and harmonics occurrence rate in PD patients were higher than in MSA-P patients.