[Tremor: update and controversy]. / El temblor: actualidad y controversias.

INTRODUCTION: Tremor is the most common movement disorder. The differential diagnosis on its origin is sometimes difficult and the number of conditions that include this symptom as part of their clinical spectrum continues to increase. AIMS: To provide an update on aspects that may help in the process of diagnosis, to review the main lines of therapy and to reflect on tremor within the context of Parkinson's disease. DEVELOPMENT: Complementary techniques in the study of Parkinson's disease, such as DaT-SCAN or the study of the cardiac sympathetic pathway by means of cardiac scintigraphy with meta-iodobenzylguanidine (MIBG), have helped in the aetiological diagnosis of this symptom; nevertheless, the patient's clinical history continues to be the main source of information for an accurate diagnosis. Pharmacologically, the therapeutic approach has varied very little and the outcomes of surgical procedures are still described as an alternative in medication-resistant cases. In Parkinson's disease, tremor at rest is a characteristic clinical sign that comprises a series of peculiarities, and the interrelation between essential tremor and this disease is always a controversial issue. The appearance of cases that have been diagnosed as Parkinson's disease, but in which the nigrostriatal pathway remains intact, opens up the spectrum even wider. CONCLUSIONS: In this paper we review the data available today that help in the differential diagnosis of tremor; the particularities concerning Parkinson's disease from the diagnostic, therapeutic and genotypic point of view are also discussed.

El temblor: actualidad y controversias / Tremor update and controversy

esumen. Introducción. El temblor es el más común de los trastornos del movimiento. El diagnóstico diferencial sobre su origen resulta en ocasiones difícil, y cada vez son más las entidades que describen este síntoma dentro de su espectro clínico. Objetivos. Actualizar los aspectos que pueden ayudar en el proceso diagnóstico, revisar las principales vías de tratamiento y reflexionar sobre el temblor en el contexto de la enfermedad de Parkinson. Desarrollo. Las técnicas complementarias en el estudio de la enfermedad de Parkinson como el DaT-SCAN, o el estudio de la vía simpática cardíaca mediante la gammagrafía cardíaca con metayodobencilguanidina (MIBG), han ayudado en el diagnóstico etiológico de este síntoma; no obstante, la anamnesis sigue siendo la principal fuente de información para un diagnóstico preciso. En el abordaje terapéutico no han existido apenas variaciones a nivel farmacológico, y se siguen describiendo los resultados de procedimientos quirúrgicos como alternativa en los casos resistentes a la medicación. En la enfermedad de Parkinson, el temblor de reposo como signo clínico característico encierra en sí una serie de peculiaridades, y la interrelación del temblor esencial con esta enfermedad es siempre un motivo de controversia. La entrada en escena de los casos diagnosticados de enfermedad de Parkinson, pero con integridad en la vía nigroestriada, abre aún más el espectro. Conclusiones. En este artículo revisamos los datos actuales que ayudan en el diagnóstico diferencial del temblor, haciendo mención a particularidades relacionadas con la enfermedad de Parkinson desde el punto de vista del diagnóstico, del tratamiento y del genotipo (AU)

Summary. Introduction. Tremor is the most common movement disorder. The differential diagnosis on its origin is sometimes difficult and the number of conditions that include this symptom as part of their clinical spectrum continues to increase. Aims. To provide an update on aspects that may help in the process of diagnosis, to review the main lines of therapy and to reflect on tremor within the context of Parkinson’s disease. Development. Complementary techniques in the study of Parkinson’s disease, such as DaT-SCAN or the study of the cardiac sympathetic pathway by means of cardiac scintigraphy with meta-iodobenzylguanidine (MIBG), have helped in the aetiological diagnosis of this symptom; nevertheless, the patient’s clinical history continues to be the main source of information for an accurate diagnosis. Pharmacologically, the therapeutic approach has varied very little and the outcomes of surgical procedures are still described as an alternative in medication-resistant cases. In Parkinson’s disease, tremor at rest is a characteristic clinical sign that comprises a series of peculiarities, and the interrelation between essential tremor and this disease is always a controversial issue. The appearance of cases that have been diagnosed as Parkinson’s disease, but in which the nigrostriatal pathway remains intact, opens up the spectrum even wider. Conclusions. In this paper we review the data available today that help in the differential diagnosis of tremor; the particularities concerning Parkinson’s disease from the diagnostic, therapeutic and genotypic point of view are also discussed (AU)