Assistive Methodologies for Parkinson's Disease Tremor Management-A Health Opinion.
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ABSTRACT:
SUBMITTER: Dineshkumar V
PROVIDER: S-EPMC9087179 | biostudies-literature | 2022
REPOSITORIES: biostudies-literature
Publications
Assistive Methodologies for Parkinson's Disease Tremor Management-A Health Opinion.
Dineshkumar V V Dolly D Raveena Judie DRJ Jagannath D J DJ Peter J Dinesh JD
Frontiers in public health 20220426
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Project description: Not available
| S-EPMC6353404 | biostudies-literature
Project description:BackgroundDistinguishing between essential tremor (ET) and tremor-dominant Parkinson's disease (PD-TD) can be challenging due to overlapping motor symptoms. This study aims to investigate the differences in nonmotor symptoms (NMS) between ET and PD-TD patients to provide additional evidence for differentiating these two conditions.MethodsThis retrospective study included 1656 participants, comprising 558 PD-TD patients, 584 ET patients, and 514 controls. ET patients were assessed using the Tremor Research Group Essential Tremor Rating Assessment Scale (TETRAS), while PD-TD patients were evaluated based on the Unified Parkinson's Disease Rating Scale (UPDRS). All participants were assessed for NMS using the Nonmotor Symptoms Scale (NMSS).ResultsThe composite NMSS score for the PD-TD group was significantly higher than that for the ET group and the control group (23.44 ± 20.20 vs. 12.60 ± 14.89 vs. 9.37 ± 12.44, p < 0.001). Compared to ET patients, PD-TD patients had an increased risk of all NMS, especially in hyposmia (OR = 7.70, 95% CI: 5.11-11.62). The NMSS score, urinary symptoms, and hyposmia may play a role in differentiating ET from PD-TD. The area under the curve (AUC) is 0.766 (95% CI: 0.739-0.793), with a sensitivity of 80.8% and specificity of 58.6%. When family history is included in the analysis, the AUC increases to 0.819 (95% CI: 0.795-0.843), with sensitivity improving to 82.4% and specificity to 68.2%.ConclusionsThe study reveals significant differences in NMS between ET and PD-TD. Compared to patients with ET, those with PD-TD exhibit more frequent and severe NMS. NMS and family history are helpful in differentiating between ET and PD-TD.
| S-EPMC11808177 | biostudies-literature
Project description:Background:This is a case of re-emergent kinetic tremor in Parkinson's Disease (PD). Phenomenology shown:The video shows re-emergent kinetic tremor while drawing a spiral and with repeated attempts to drink water from a cup. Educational value:The kinetic tremor described by patients with PD can be a re-emergent tremor which occurs after a few repetitive movements.
| S-EPMC6691624 | biostudies-literature
Project description:Surprisingly little has been written about the combined clinical entity, essential tremor-Parkinson's disease (ET-PD), which is the result of a double disease hit. We carefully quantified tremor burden using a wide range of measures (tremor severity, tremor-related disability, tremor-related quality of life) and furthermore, studied additional motor and non-motor features in ET-PD.In this prospective, clinical-epidemiological study, we performed a standardized, structured clinical evaluation of 27 ET-PD patients, comparing them to age-matched samples of 35 PD and 109 ET patients.The number of hours/day shaking was lowest in PD (median=3.0), intermediate in ET (median=10.0) and highest in ET-PD (median=14.0) (p<0.001). All measures of mobility and balance (Berg Balance test, Activities-specific Balance Confidence Scale, Timed Up and Go test) worsened across groups in a stepwise manner from ET to PD to ET-PD (p<0.05). Mini-mental state test scores worsened (p=0.002) and daytime sleepiness increased (p=0.002) across groups from ET to PD to ET-PD.The ET-PD patient seems to be more than just a PD patient with a little more kinetic tremor. Aside from a significantly greater tremor burden, ET-PD patients exhibited more cognitive and sleep problems and more mobility and balance problems than patients with isolated PD.
| S-EPMC5300045 | biostudies-literature
Project description:BackgroundDespite the significance of tremor in Parkinson's disease (PD) diagnosis, classification, and patient's quality of life, there is a relative lack of data on prevalence and relationship of different tremor types in PD.MethodsThe presence of rest tremor (RT) and action tremor (AT; defined as combination of both postural and kinetic tremor) was determined and RT severity was defined using the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) at baseline in the Progression Marker Initiative (PPMI, n = 423), the Fox Investigation for New Discovery of Biomarkers (BioFIND, n = 118) and the Parkinson's Disease Biomarkers Program (PDBP, n = 873) cohorts.ResultsAcross baseline data of all three cohorts, RT prevalence (58.2%) was higher than AT prevalence (39.0%). Patients with RT had significantly higher (Chi-square test, p < 0.05) prevalence of AT compared to patients without RT in the PPMI (40.0% versus 30.1%), BioFIND (48.0% versus 40.0%) and PDBP (49.9% versus 21.0%) cohorts. Furthermore, patients with AT had significantly (Student t-test, p < 0.05) higher RT severity that those without AT in PPMI (5.7 ± 5.4 versus 3.9 ± 3.3), BioFIND, 6.4 ± 6.3 versus 3.8 ± 4.4) and PDBP (6.4 ± 6.6 versus 3.7 ± 4.4) cohorts. In the BioFIND cohort, the prevalence of all types of tremor and their combinations significantly decreased from the off-state to on-state.DiscussionThe RT is the most frequent tremor type and present in more than half of the PD patients. However, AT is also present in nearly one-third of the PD patients. Our results also indicate that RT and AT may have cross-interactions in PD, and that dopaminergic treatment influences both RT and AT.
| S-EPMC7757606 | biostudies-literature
Project description:BackgroundFragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative disease affecting carriers of a 55-200 CGG repeat in the fragile X mental retardation 1 gene, may receive an initial diagnosis of Parkinson's disease (PD) or essential tremor (ET) due to overlapping motor symptoms. Therefore, tremor and bradykinesia were compared in these disorders using quantitative tremorography.MethodsThe inertial sensor based Kinesia ™ system was used to quantify upper extremity tremor and bradykinesia in participants with FXTAS (n = 25), PD (n = 23), ET (n = 18) and controls (n = 20) and regression analysis was performed to determine whether tremorography measures distinguished between the groups. The FXTAS Rating scale (FXTAS-RS) was administered to determine whether sub-score items on the clinician rated scale correlated with tremorography variables.ResultsFXTAS participants had reduced finger tap speed compared to those with ET, and ET had increased kinetic tremor compared to PD. Higher kinetic tremor distinguished FXTAS from PD (p = .02), and lower finger tap speed distinguished FXTAS from ET (p = .004). FXTAS-RS tremor and bradykinesia items correlated with tremorography measures (p = .005 to <0.0001).ConclusionsThis is the first quantitative study to compare tremor and bradykinesia in FXTAS, PD and ET. Kinetic tremor and bradykinesia measures using a quantitative inertial sensor system distinguished FXTAS from PD and ET, respectively. Such technologies may be useful for detecting precise tremor and bradykinesia abnormalities and distinguishing the tremor and bradykinesia profiles in each of these disorders.
| S-EPMC8298795 | biostudies-literature
Project description:The pathophysiology of Parkinson's disease (PD) tremor remains incompletely understood and there is a lack of clinical trials specifically addressing its pharmacological treatment. Levodopa is the most efficacious drug for most patients and should be used as primary approach to control troublesome tremor. While the efficacy of oral dopamine agonists on PD tremor has been demonstrated in controlled trials, there is no evidence of greater antitremor efficacy compared to levodopa. The magnitude of the antitremor effect of anticholinergics is generally lower than that of levodopa. Due to their adverse effects, anticholinergics have a limited role in selected young and cognitively intact patients. Propranolol may improve resting and action tremor and may be considered as an adjunct in patients with insufficient tremor response to levodopa and this also applies to clozapine, despite its unfavorable adverse effect profile. Treating motor fluctuations with MAO-B and COMT inhibitors, dopamine agonists, amantadine, or on-demand treatments such as subcutaneous or sublingual apomorphine and inhaled levodopa as well as with continuous infusions of levodopa or apomorphine will improve off period tremor episodes. For patients with drug-refractory PD tremor despite levodopa optimization deep brain stimulation and focused ultrasound are first-line considerations. Surgery can also be highly effective for the treatment medication-refractory tremor in selected patients without motor fluctuations. The present review highlights the clinical essentials of parkinsonian tremor, critically examines available trial data on the effects of medication and surgical approaches and provides guidance for the choice of treatments to control PD tremor in clinical practice.
| S-EPMC10041452 | biostudies-literature
Project description:BackgroundTremor is one of the most troublesome manifestations of Parkinson's Disease (PD) and its response to dopaminergic medication is variable; an evidence-based framework of PD tremor is lacking yet needed to inform future investigations.ObjectiveTo perform a comprehensive longitudinal analysis on the clinical characteristics, course and response to dopaminergic medication of tremor in de-novo PD.MethodsThree hundred ninety-seven participants were recruited in the Parkinson Progressive Markers Initiative, a prospective observational cohort study in early de-novo PD. Rest, postural and kinetic tremor scores were extracted from the Movement Disorders Society-Unified Parkinson's Disease Rating Scale. Progression from baseline to 7-year follow-up of rest, postural and kinetic tremor scores, and their response to in-clinic dopaminergic medication were analyzed through linear mixed-effects models adjusted for age, sex and disease duration at enrollment. A sensitivity analysis was conducted through subgroup and imputation analyses.Results382 (96.2%) participants showed tremor and 346 (87.2%) showed rest tremor in at least one assessment over 7 years. Off-state rest, postural and kinetic tremor scores increased significantly over time, coupled with a significant effect of dopaminergic medication in reducing tremor scores. However, at each assessment, tremor was unresponsive to in-clinic dopaminergic medication in at least 20% of participants for rest, 30% for postural and 38% for kinetic tremor.ConclusionsPD tremor is a troublesome manifestation, with increasing severity and variable response to medications. This analysis details the current clinical natural history of tremor in early-to-mid stage PD, outlining an evidence-based framework for future pathophysiological and interventional studies.
| S-EPMC10585977 | biostudies-literature
Project description: Not available
| S-EPMC6178599 | biostudies-literature
Project description:We present clinical features and tremor characterization in a patient with Parkinson's disease (PD) as well as in two cases of essential tremor (ET) with some parkinsonian features but no evidence of dopaminergic terminal loss on (123)I-FP-CIT Single Photon Emission Computed Tomography (SPECT). Relatively slow frequency rest tremor and bilateral upper extremity bradykinesia without decrementing amplitude were observed in the ET cases, with unilaterally decreased arm swing in case 3. Alternating rest tremor and re-emergent tremor with 13 second latency was confirmed in the PD case. Re-emergent tremor had alternating characteristics, which to our knowledge has not been previously reported. The ET cases had synchronous postural tremor. Alternating re-emergent tremor in PD provides further evidence for re-emergent tremor as an analogue of rest tremor in PD. Two cases of ET with synchronous postural tremor and one to two year history of parkinsonian features had no evidence of dopaminergic terminal loss up to 40 years after the initial onset of ET. Tremor synchronicity characterization can assist in differential diagnosis between the two disorders.
| S-EPMC3656631 | biostudies-literature