Unilateral Tongue and Hand Tremor Secondary to a Brainstem Lesion.
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ABSTRACT:
SUBMITTER: AbdelRazek MA
PROVIDER: S-EPMC6336156 | biostudies-literature | 2018 May-Jun
REPOSITORIES: biostudies-literature
Publications
Unilateral Tongue and Hand Tremor Secondary to a Brainstem Lesion.
AbdelRazek Mahmoud A MA Venna Nagagopal N
Movement disorders clinical practice 20180401 3
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Project description:In the context of injury to the corticospinal tract (CST), brainstem-origin circuits may provide an alternative system of descending motor influence. However, subcortical circuits are largely under subconscious control. To improve volitional control over spared fibers after CST injury, we hypothesized that a combination of physical exercises simultaneously stimulating cortical and brainstem pathways above the injury would strengthen corticobulbar connections through Hebbian-like mechanisms. We sought to test this hypothesis in mice with unilateral CST lesions. Ten days after pyramidotomy, mice were randomized to four training groups: (1) postural exercises designed to stimulate brainstem pathways (BS); (2) distal limb-grip exercises preferentially stimulating CST pathways (CST); (3) simultaneous multimodal exercises (BS+CST); or (4) no training (NT). Behavioral and anatomical outcomes were assessed after 20 training sessions over 4 weeks. Mice in the BS+CST training group showed a trend toward greater improvements in skilled limb performance than mice in the other groups. There were no consistent differences between training groups in gait kinematics. Anatomically, multimodal BS+CST training neither increased corticobulbar fiber density of the lesioned CST rostral to the lesion nor collateral sprouting of the unlesioned CST caudal to the lesion. Further studies should incorporate electrophysiological assessment to gauge changes in synaptic strength of direct and indirect pathways between the cortex and spinal cord in response to multimodal exercises.
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Project description:Background and purposeHand tremor is one of the most frequent symptoms in movement disorders, and differential diagnoses for hand tremor include Parkinson's disease (PD) and essential tremor (ET). However, accurately differentiating between PD and ET in clinical practice remains challenging in patients presenting with hand tremor. We investigated whether a questionnaire-based survey could be useful as a screening tool in patients with hand tremor.MethodsA questionnaire related to hand tremor consisting of 12 items was prospectively applied to patients with PD or ET in three movement-disorder clinics. Each question was analyzed, and a query-based scoring system was evaluated for differentiating hand tremors between PD and ET.ResultsThis study enrolled 24 patients with PD and 25 patients with ET. Nine of the 12 questions differed significantly between PD and ET: 1 about resting tremor, 4 questions about action tremor, and 4 about asymmetry. A receiver operating characteristics curve analysis revealed that the 9-item questionnaire showed a good discrimination ability, with a sensitivity of 88% and a specificity of 84%.ConclusionsThe developed Hand Tremor Questionnaire might be a good screening tool for hand tremors in patients with PD and ET.
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Project description:BackgroundTremor in essential tremor and in tremor-dominant Parkinson's disease is assessed by subjective observations in patients undergoing focused ultrasound thalamotomy, a minimally invasive procedure intended to alleviate tremor in these patients.ObjectiveTo develop an objective tool for tremor analysis to be used before and after focused ultrasound thalamotomy treatment in the treated hand (contralateral to ablation) and non-treated (ipsilateral to ablation).MethodsUsing image processing and signal processing that utilized images of a Archimedes spiral drawing, we created a tool to analyze tremor. First, we showed that the proposed tool reproduces known clinical dynamics on the treated hand, and then we used it to evaluate the clinical dynamics on the non-treated hand.ResultsUsing the tool we developed, we were able to demonstrate a significant reduction in tremor following focused ultrasound thalamotomy among 132 essential tremor and 26 tremor-dominant Parkinson's disease patients in the treated hand using drawings of Archimedes spirals up to 1 year following the procedure. Thus, we reproduced known clinical data and therefore validated the proposed tool. In addition, we were able to demonstrate a significant improvement in the non-treated hand as well as a significant deterioration in the efficacy of focused ultrasound thalamotomy over time.ConclusionOur objective method, which incorporated image processing and signal processing, provided a quantitative measure of tremor reduction following focused ultrasound thalamotomy. It demonstrated significant improvement in tremors in the treated and non-treated hands following focused ultrasound thalamotomy as well as deterioration in the efficacy of treatment over time. If replicated in other studies, this method may complement current subjective assessments.
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Project description:Tremor is a debilitating symptom that can lead to functional impairment. Pharmacotherapy is often successful, but up to 50% of patients are resistant to medications or cannot tolerate side effects. Thalamotomy to the ventral intermediate nucleus of the thalamus is a surgical intervention for refractory tremor. Thalamotomy surgeries include radiofrequency and incisionless procedures, such as Gamma Knife radiosurgery and magnetic resonance-guided focused ultrasound. Cognitive changes following thalamotomy have been inconsistently reported across studies. We performed a meta-analysis to summarize the impact of unilateral thalamotomy to the ventral intermediate nucleus of the thalamus across multiple cognitive domains. We searched MEDLINE, Embase Classic, Embase and EBM Reviews for relevant studies. Neuropsychological tests were categorized into seven cognitive domains: global cognition, verbal memory, non-verbal memory, executive function, phonemic fluency, semantic fluency and visuospatial processing. We calculated standardized mean differences as Hedges' g and 95% confidence intervals of the change between pre- and postoperative cognitive scores. Pooling of standardized mean differences across studies was performed using random-effects models. Risk of bias across studies and quality of evidence for each cognitive domain were assessed with the National Institute of Health quality assessment tool and the GRADEpro Guideline Development Tool, respectively. Of the 1251 records reviewed, eight studies met inclusion criteria. We included 193 patients with essential tremor, Parkinson's disease, or multiple sclerosis in the meta-analysis. There was a small significant decline in phonemic fluency [standardized mean difference = -0.29, 95% confidence interval: (-0.52, -0.05), P = 0.017] and a trend towards a decline in semantic fluency [standardized mean difference = -0.19, 95% confidence interval: (-0.40, 0.01), P = 0.056]. No postoperative changes were observed in the other cognitive domains (P values >0.14). In secondary analyses, we restricted the analyses to studies using magnetic resonance-guided focused ultrasound given its growing popularity and more precise targeting. In those analyses, there was no evidence of cognitive decline across any domain (P values >0.37). In terms of risk of bias, five studies were rated as 'good' and three studies were rated as 'fair'. According to GRADEpro guidelines, the certainty of the effect for all cognitive domains was low. This study provides evidence that unilateral thalamotomy to the ventral intermediate nucleus of the thalamus is relatively safe from a cognitive standpoint, however, there may be a small decline in verbal fluency. Magnetic resonance-guided focused ultrasound might have a more favourable postoperative cognitive profile compared with other thalamotomy techniques.
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