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1.
No Shinkei Geka ; 48(10): 927-933, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33071229

RESUMO

Intracranial teratoma is a rare disease that frequently occurs in children and young adults. It comprises of approximately 0.1% of the brain tumors. We report a case of a large mature teratoma in the third ventricle with Holmes tremor. A 5-year-old boy presented with tremors 2 years ago. CT showed a 56×48 mm tumor in the third ventricle and hydrocephalus. The tumor was well demarcated from the surrounding brain tissue and contained calcification. MRI indicated a partially high-intensity signal on T1-weighted and T2-weighted images. The preoperative diagnosis was teratoma. Initially, the tumor was biopsied using neuroendoscopy and the Ommaya reservoir was set. The pathological results showed fat-like tissues and fibroblasts. Subsequently, the tumor was completely removed using the interhemispheric transcallosal transchoroidal approach. The tumor included fat and hair tissues. It also included calcification similar to that observed in a tooth. It was strongly adhered near the pineal gland. Pathologically, the diagnosis was a mature teratoma. Postoperatively, the tremor disappeared and the patient was discharged from the hospital without neurological deficits. We believe that compression of the Guillain-Mollaret triangle was relieved by removal of the tumor. Hence, the tremor disappeared after the operation.


Assuntos
Cisto Dermoide , Teratoma , Terceiro Ventrículo , Criança , Pré-Escolar , Humanos , Imagem por Ressonância Magnética , Masculino , Teratoma/diagnóstico , Teratoma/diagnóstico por imagem , Terceiro Ventrículo/diagnóstico por imagem , Terceiro Ventrículo/cirurgia , Tremor/diagnóstico por imagem , Tremor/etiologia , Tremor/cirurgia , Adulto Jovem
2.
Fortschr Neurol Psychiatr ; 88(9): 582-585, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32957143

RESUMO

Treatment of tremor is a challenge in everyday clinical practice; tremor in movement disorders such as essential or orthostatic tremor (ET, OT) or Parkinson's disease (PD) can rarely be treated sufficiently with oral medication. An alternative to deep brain stimulation is the targeted local lesion of specific structures of the thalamus and basal ganglia by means of transcranial magnetic resonance imaging guided focused ultrasound (MRgFUS). MRgFUS allows to thermally ablate small areas of the brain safely and precisely. MRgFUS treatments are performed without opening of the skull under MRI control ('incisionless surgery'). This minimal invasive procedure can improve the often severely impaired quality of life of the mostly elderly patients on a day to day basis without the need for long in-patient procedures. A sustained effect of the lesion treatment has so far been investigated and documented over 4 years.


Assuntos
Imagem por Ressonância Magnética , Tremor/diagnóstico por imagem , Ultrassonografia , Idoso , Tremor Essencial/diagnóstico por imagem , Humanos , Qualidade de Vida
3.
Neurology ; 95(11): e1461-e1470, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32651292

RESUMO

OBJECTIVE: We tested the hypothesis that there are 2 distinct phenotypes of Parkinson tremor, based on interindividual differences in the response of resting tremor to dopaminergic medication. We also investigated whether this pattern is specific to tremor by comparing interindividual differences in the dopamine response of tremor to that of bradykinesia. METHODS: In this exploratory study, we performed a levodopa challenge in 76 tremulous patients with Parkinson tremor. Clinical scores (Movement Disorders Society-sponsored version of the Unified Parkinson's Disease Rating Scale part III) were collected "off" and "on" a standardized dopaminergic challenge (200/50 mg dispersible levodopa-benserazide). In both sessions, resting tremor intensity was quantified using accelerometry, both during rest and during cognitive coactivation. Bradykinesia was quantified using a speeded keyboard test. We calculated the distribution of dopamine-responsiveness for resting tremor and bradykinesia. In 41 patients, a double-blinded, placebo-controlled dopaminergic challenge was repeated after approximately 6 months. RESULTS: The dopamine response of resting tremor, but not bradykinesia, significantly departed from a normal distribution. A cluster analysis on 3 clinical and electrophysiologic markers of tremor dopamine-responsiveness revealed 3 clusters: dopamine-responsive, intermediate, and dopamine-resistant tremor. A repeated levodopa challenge after 6 months confirmed this classification. Patients with dopamine-responsive tremor had greater disease severity and tended to have a higher prevalence of dyskinesia. CONCLUSION: Parkinson resting tremor can be divided into 3 partially overlapping phenotypes, based on the dopamine response. These tremor phenotypes may be associated with different underlying pathophysiologic mechanisms, requiring a different therapeutic approach.


Assuntos
Antiparkinsonianos/uso terapêutico , Dopaminérgicos/uso terapêutico , Resistência a Medicamentos/efeitos dos fármacos , Levodopa/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Tremor/tratamento farmacológico , Acelerometria , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Resistência a Medicamentos/fisiologia , Feminino , Seguimentos , Humanos , Hipocinesia/diagnóstico por imagem , Hipocinesia/tratamento farmacológico , Hipocinesia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/fisiopatologia , Resultado do Tratamento , Tremor/diagnóstico por imagem , Tremor/fisiopatologia
4.
Yonsei Med J ; 61(7): 644-646, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32608210

RESUMO

A weight-holding tremor is a rare type of hand tremor that occurs only when someone holds some weight. Here we report three cases of isolated weight-holding tremors, of which one patient was diagnosed with Parkinson's disease (PD) and the others as a variant of essential tremor (ET). A 68-year-old woman presented with a left-hand tremor that appeared only when she held objects with some weight. Her tremor was reminiscent of the re-emergent tremor of PD, and dopamine transporter imaging revealed reduced uptake at the right posterior putamen. A 21-year-old man and a 71-year-old woman also presented with similar weight-holding tremors. However, these tremors were not re-emergent, and no signs of parkinsonism were observed during follow-up. Although the underlying etiologies of these tremors differed, all three tremors worsened as the held weight increased. These tremors could be isolated isometric tremors, but further research is needed to clarify the nature of this rare tremor.


Assuntos
Tremor Essencial/diagnóstico , Doença de Parkinson/complicações , Tomografia por Emissão de Pósitrons/métodos , Tremor/diagnóstico por imagem , Tremor/etiologia , Adulto , Idoso , Peso Corporal , Dopamina/metabolismo , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Tremor Essencial/fisiopatologia , Feminino , Humanos , Masculino , Tremor/classificação , Tremor/fisiopatologia
5.
World Neurosurg ; 137: 286-290, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32084623

RESUMO

BACKGROUND: Hypertrophic olivary degeneration (HOD) is very rare type of degeneration that causes hypertrophy rather than atrophy. The classical presentation of HOD is palatal myoclonus. However, HOD may rarely present with Holmes tremor (HT). HT is unusual symptomatic tremor characterized by combination of rest and intention tremor. It has been reported in small case series, so far. CASE DESCRIPTION: In this study, a man aged 62 years with HOD and HT spreading to the upper and lower extremities after pontine-midbrain hemorrhage due to cavernoma was presented. CONCLUSIONS: Although pontine-midbrain hemorrhage may cause HT in the late period, HOD can be revealed on magnetic resonance imaging. Tract anatomy, especially the Guillain-Mollaret triangle, should be considered to explain the relationship between HT and HOD.


Assuntos
Neoplasias do Tronco Encefálico/complicações , Hemangioma Cavernoso do Sistema Nervoso Central/complicações , Hemorragias Intracranianas/etiologia , Núcleo Olivar/diagnóstico por imagem , Degeneração Retrógrada/etiologia , Tremor/etiologia , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Humanos , Hipertrofia , Hemorragias Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Núcleo Olivar/patologia , Ponte/diagnóstico por imagem , Núcleo Rubro/diagnóstico por imagem , Degeneração Retrógrada/diagnóstico por imagem , Degeneração Retrógrada/patologia , Tomografia Computadorizada por Raios X , Tremor/diagnóstico por imagem
6.
World Neurosurg ; 136: 301-304, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31954915

RESUMO

BACKGROUND: Dandy-Walker Syndrome (DWS) is a rare congenital brain malformation characterized by underdevelopment of cerebellar vermis and cystic enlargement of the fourth ventricle and enlargement of the posterior fossa. The cooccurrence of DWS and syringomyelia in adults is very rare. CASE DESCRIPTION: We report a man aged 19 years who presented with a 2-year history of tremor. Magnetic resonance imaging showed cystic dilation of the fourth ventricle, hypoplasia of the cerebellar vermis, and syringomyelia. Posterior fossa decompression and spinal cord ostomy were performed. Tremor was markedly improved and the fourth ventricular and the syringomyelia were reduced in size postoperatively. CONCLUSIONS: Tremor can be a clinical manifestation in patients of DWS concomitant with syringomyelia in adults. Spinal cord ostomy combined with posterior fossa decompression may be an effective approach for alleviation of symptoms and syringomyelia.


Assuntos
Síndrome de Dandy-Walker/complicações , Siringomielia/complicações , Tremor/etiologia , Vermis Cerebelar/diagnóstico por imagem , Vermis Cerebelar/patologia , Fossa Craniana Posterior/cirurgia , Síndrome de Dandy-Walker/diagnóstico por imagem , Descompressão Cirúrgica , Quarto Ventrículo/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Procedimentos Neurocirúrgicos , Estomia , Medula Espinal/cirurgia , Siringomielia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tremor/diagnóstico por imagem , Adulto Jovem
7.
Acta Neurochir (Wien) ; 162(5): 1053-1066, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31997069

RESUMO

INTRODUCTION: Deep brain stimulation alleviates tremor of various origins. The dentato-rubro-thalamic tract (DRT) has been suspected as a common tremor-reducing structure. Statistical evidence has not been obtained. We here report the results of an uncontrolled case series of patients with refractory tremor who underwent deep brain stimulation under tractographic assistance. METHODS: A total of 36 patients were enrolled (essential tremor (17), Parkinson's tremor (8), multiple sclerosis (7), dystonic head tremor (3), tardive dystonia (1)) and received 62 DBS electrodes (26 bilateral; 10 unilateral). Preoperatively, diffusion tensor magnetic resonance imaging sequences were acquired together with high-resolution anatomical T1W and T2W sequences. The DRT was individually tracked and used as a direct thalamic or subthalamic target. Intraoperative tremor reduction was graded on a 4-point scale (0 = no tremor reduction to 3 = full tremor control) and recorded together with the current amplitude, respectively. Stimulation point coordinates were recorded and compared to DRT. The relation of the current amplitude needed to reduce tremor was expressed as TiCR (tremor improvement per current ratio). RESULTS: Stimulation points of 241 were available for analysis. A total of 68 trajectories were tested (62 dB leads, 1.1 trajectories tested per implanted lead). Tremor improvement was significantly decreasing (p < 0.01) if the distance to both the border and the center of the DRT was increasing. On the initial trajectory, 56 leads (90.3%) were finally placed. Long-term outcomes were not part of this analysis. DISCUSSION: Tremor of various origins was acutely alleviated at different points along the DRT fiber tract (above and below the MCP plane) despite different tremor diseases. DRT is potentially a common tremor-reducing structure. Individual targeting helps to reduce brain penetrating tracts. TiCR characterizes stimulation efficacy and might help to identify an optimal stimulation point.


Assuntos
Estimulação Encefálica Profunda/métodos , Imagem de Tensor de Difusão/métodos , Tremor Essencial/terapia , Esclerose Múltipla/terapia , Tálamo/cirurgia , Tremor/terapia , Idoso , Tremor Essencial/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico por imagem , Tálamo/diagnóstico por imagem , Tremor/diagnóstico por imagem
8.
Clin Nucl Med ; 45(1): e46-e47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31306206

RESUMO

A 24-year-old woman with an unresectable right mesencephalic pilocytic astrocytoma was treated with stereotaxic radiation therapy. Three months after a radiation therapy-induced bleeding, she presented a severe disabling low frequency rest and kinetic tremor involving the left upper limb, associated with dystonia, and a Holmes tremor was suspected. Thereby, we performed a I-FP-CIT SPECT (DATSCAN) that revealed a normal distribution of radiotracer over the left striatum, whereas no binding was seen in the right caudate and putamen. This pattern was consistent with a right severe nigrostriatal dopaminergic denervation due to an ipsilateral red nucleus injury.


Assuntos
Astrocitoma/complicações , Mesencéfalo/diagnóstico por imagem , Mesencéfalo/patologia , Tomografia Computadorizada de Emissão de Fóton Único , Tremor/diagnóstico por imagem , Tremor/etiologia , Tropanos , Feminino , Humanos , Tremor/patologia , Adulto Jovem
10.
Clin Neurophysiol ; 131(1): 274-284, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31744673

RESUMO

OBJECTIVE: Accurate and reliable detection of tremor onset in Parkinson's disease (PD) is critical to the success of adaptive deep brain stimulation (aDBS) therapy. Here, we investigated the potential use of feature engineering and machine learning methods for more accurate detection of rest tremor in PD. METHODS: We analyzed the local field potential (LFP) recordings from the subthalamic nucleus region in 12 patients with PD (16 recordings). To explore the optimal biomarkers and the best performing classifier, the performance of state-of-the-art machine learning (ML) algorithms and various features of the subthalamic LFPs were compared. We further used a Kalman filtering technique in feature domain to reduce the false positive rate. RESULTS: The Hjorth complexity showed a higher correlation with tremor, compared to other features in our study. In addition, by optimal selection of a maximum of five features with a sequential feature selection method and using the gradient boosted decision trees as the classifier, the system could achieve an average F1 score of up to 88.7% and a detection lead of 0.52 s. The use of Kalman filtering in feature space significantly improved the specificity by 17.0% (p = 0.002), thereby potentially reducing the unnecessary power dissipation of the conventional DBS system. CONCLUSION: The use of relevant features combined with Kalman filtering and machine learning improves the accuracy of tremor detection during rest. SIGNIFICANCE: The proposed method offers a potential solution for efficient on-demand stimulation for PD tremor.


Assuntos
Algoritmos , Estimulação Encefálica Profunda/métodos , Aprendizado de Máquina , Doença de Parkinson/complicações , Tremor/diagnóstico por imagem , Tremor/terapia , Idoso , Análise de Variância , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Reação , Descanso , Núcleo Subtalâmico , Tremor/etiologia , Análise de Ondaletas
11.
Stereotact Funct Neurosurg ; 97(4): 241-243, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31743916

RESUMO

The beneficial effect of thalamic deep brain stimulation (DBS) on action tremor has been reported in a few cases of spinocerebellar ataxia (SCA); however, several factors should be taken into account regarding the indication for DBS in advanced cases. We performed DBS of the ventral intermediate nucleus (Vim) of the thalamus for treatment of coarse action tremor in a patient with SCA2 (spinocerebellar ataxia type 2) in the wheelchair-bound stage. Although improvement of the tremor of the proximal part was incomplete, the patient regained substantial parts of daily functioning. The effect lasted for more than 6 years, and the suppression of tremor significantly contributed to maintaining the level of the patient's expression into the bedridden stage. Vim DBS can be a treatment option for tremor in SCA patients, even in the advanced stage, as long as the tremor is depriving the patient of behavioral expression. As residual proximal tremor may hamper functional recovery, DBS of other targets or multi-targets should be further explored to attain a better outcome.


Assuntos
Estimulação Encefálica Profunda/métodos , Ataxias Espinocerebelares/diagnóstico por imagem , Ataxias Espinocerebelares/terapia , Tremor/diagnóstico por imagem , Tremor/terapia , Núcleos Ventrais do Tálamo/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Ataxias Espinocerebelares/fisiopatologia , Fatores de Tempo , Tremor/fisiopatologia , Núcleos Ventrais do Tálamo/fisiopatologia
12.
Sensors (Basel) ; 19(19)2019 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-31569335

RESUMO

Tremor is one of the main symptoms of Parkinson's Disease (PD) that reduces the quality of life. Tremor is measured as part of the Unified Parkinson Disease Rating Scale (UPDRS) part III. However, the assessment is based on onsite physical examinations and does not fully represent the patients' tremor experience in their day-to-day life. Our objective in this paper was to develop algorithms that, combined with wearable sensors, can estimate total Parkinsonian tremor as the patients performed a variety of free body movements. We developed two methods: an ensemble model based on gradient tree boosting and a deep learning model based on long short-term memory (LSTM) networks. The developed methods were assessed on gyroscope sensor data from 24 PD subjects. Our analysis demonstrated that the method based on gradient tree boosting provided a high correlation (r = 0.96 using held-out testing and r = 0.93 using subject-based, leave-one-out cross-validation) between the estimated and clinically assessed tremor subscores in comparison to the LSTM-based method with a moderate correlation (r = 0.84 using held-out testing and r = 0.77 using subject-based, leave-one-out cross-validation). These results indicate that our approach holds great promise in providing a full spectrum of the patients' tremor from continuous monitoring of the subjects' movement in their natural environment.


Assuntos
Algoritmos , Doença de Parkinson/fisiopatologia , Tremor/diagnóstico por imagem , Dispositivos Eletrônicos Vestíveis , Atividades Cotidianas , Idoso , Aprendizado Profundo , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Caminhada
13.
Ann Neurol ; 86(6): 812-820, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31614012

RESUMO

OBJECTIVE: Holmes tremor is a debilitating movement disorder with limited treatment options. Lesions causing Holmes tremor can occur in multiple different brain locations, leaving the neuroanatomical substrate unclear. Here, we test whether lesion locations that cause Holmes tremor map to a connected brain circuit and whether this circuit might serve as a useful therapeutic target. METHODS: Case reports of Holmes tremor caused by focal brain lesions were identified through a systematic literature search. Connectivity between each lesion location and the rest of the brain was computed using resting state functional connectivity magnetic resonance imaging data from 1,000 healthy volunteers. Commonalities across lesion locations were identified. This Holmes tremor circuit was then compared to neurosurgical treatment targets and clinical efficacy. RESULTS: We identified 36 lesions causing Holmes tremor, which were scattered across multiple different brain regions. However, all lesion locations were connected to a common brain circuit with nodes in the red nucleus, thalamus, globus pallidus, and cerebellum. In cases with effective neurosurgical treatment, the treatment target was connected with the lesion location, indicating that a second hit to the same circuit might be beneficial. Commonly used deep brain stimulation targets such as the ventral intermediate nucleus and subthalamic nucleus fell outside our Holmes tremor circuit, whereas the globus pallidus target was close, consistent with published clinical response rates for these targets. INTERPRETATION: Lesions causing Holmes tremor are part of a single connected brain circuit that may serve as an improved therapeutic target. ANN NEUROL 2019;86:812-820.


Assuntos
Mapeamento Encefálico/métodos , Encéfalo/diagnóstico por imagem , Conectoma/métodos , Rede Nervosa/diagnóstico por imagem , Tremor/diagnóstico por imagem , Encéfalo/fisiopatologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Rede Nervosa/fisiopatologia , Tremor/fisiopatologia
14.
Parkinsonism Relat Disord ; 67: 14-20, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31621599

RESUMO

INTRODUCTION: Apomorphine is a dopamine agonist used in Parkinson's disease (PD), which matches levodopa in terms of the magnitude of effect on the cardinal motor features, such as tremor and bradykinesia. The beneficial effect of this treatment on PD patients with tremor-dominant has widely been demonstrated, although the underlying neural correlates are unknown. We sought to examine the effects of apomorphine on topological characteristics of resting-state functional connectivity networks in tremor-dominant PD (tdPD) patients. METHODS: Sixteen tdPD patients were examined using a combined electromyography-functional magnetic resonance imaging approach. Patients were scanned twice following either placebo (subcutaneous injection of 1 mL saline solution) or 1 mg of apomorphine injection. Graph analysis methods were employed to investigate the modular organization of functional connectivity networks before and after drug treatment. RESULTS: After injection of apomorphine, evident reduction of tremor symptoms was mirrored by a significant increase in overall connectivity strength and reorganization of the modular structure of the basal ganglia and of the fronto-striatal module. Moreover, we found an increase in the centrality of motor and premotor regions. No differences were found between pre- and post-placebo sessions. CONCLUSION: These results provide new evidence about the effects of apomorphine at a large-scale neural network level showing that drug treatment modifies the brain functional organization of tdPD, increasing the overall resting-state functional connectivity strength, the segregation of striato-frontal regions and the integrative role of motor areas.


Assuntos
Apomorfina/farmacologia , Agonistas de Dopamina/farmacologia , Lobo Frontal/efeitos dos fármacos , Neostriado/efeitos dos fármacos , Doença de Parkinson/tratamento farmacológico , Tremor/tratamento farmacológico , Idoso , Apomorfina/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Eletromiografia , Feminino , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/fisiopatologia , Neuroimagem Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neostriado/diagnóstico por imagem , Neostriado/fisiopatologia , Vias Neurais/diagnóstico por imagem , Vias Neurais/efeitos dos fármacos , Vias Neurais/fisiopatologia , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/fisiopatologia , Método Simples-Cego , Tremor/diagnóstico por imagem , Tremor/fisiopatologia
15.
Ann Clin Transl Neurol ; 6(11): 2212-2222, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31588694

RESUMO

OBJECTIVE: The pathogenesis of orthostatic tremor (OT) is unknown. We investigated OT-related white matter changes and their correlations with scores from a neuropsychological testing battery. METHODS: Diffusion tensor imaging measures were compared between 14 OT patients and 14 age- and education-matched healthy controls, using whole-brain tract-based spatial statistics analysis. Correlations between altered diffusion metrics and cognitive performance in OT group were assessed. RESULTS: In all cognitive domains (attention, executive function, visuospatial ability, verbal memory, visual memory, and language), OT patients' cognitive performance was significantly worse than that of healthy controls. OT patients demonstrated altered diffusivity metrics not only in the posterior lobe of the cerebellum (left cerebellar lobule VI) and in its efferent cerebellar fibers (left superior cerebellar peduncle), but also in medial lemniscus bilaterally (pontine tegmentum), anterior limb of the internal capsule bilaterally, right posterior limb of the internal capsule, left anterior corona radiata, right insula, and the splenium of corpus callosum. No relationship was found between diffusion measures and disease duration in OT patients. Diffusion white matter changes, mainly those located in right anterior limb of the internal capsule, were correlated with poor performance on tests of executive function, visuospatial ability, verbal memory, and visual memory in OT patients. INTERPRETATION: White matter changes were preferentially located in the cerebellum, its efferent pathways, as well as in the pontine tegmentum and key components of the frontal-thalamic-cerebellar circuit. Further work needs to be done to understand the evolution of these white matter changes and their functional consequences.


Assuntos
Encéfalo/patologia , Tontura/patologia , Tremor/patologia , Substância Branca/patologia , Idoso , Encéfalo/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Tontura/diagnóstico por imagem , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Tremor/diagnóstico por imagem , Substância Branca/diagnóstico por imagem
16.
Neurology ; 93(19): e1787-e1798, 2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586023

RESUMO

OBJECTIVES: To evaluate changes in tremor severity and motor/emotion-processing circuits in response to cognitive behavioral therapy (CBT) delivered as treatment for functional tremor (FT), the most common functional movement disorder in adults. METHODS: Fifteen patients with FT underwent fMRI with motor, basic-emotion, and intense-emotion tasks before and after 12 weeks of CBT. Baseline fMRI was compared to those of 25 healthy controls (HCs). The main clinical endpoint was the tremor score (sum of severity, duration, and incapacitation subscores) adapted from the Rating Scale for Psychogenic Movement Disorders (PMDRS) assessed by a blinded clinician. CBT responders were defined as those with PMDRS score reduction >75%. Anatomic and functional brain images were obtained with a 4T MRI system. Generalized linear model and region-of-interest analyses were used to evaluate before-versus-after treatment-related changes in brain activation. RESULTS: CBT markedly reduced tremor severity (p < 0.01) with remission/near remission achieved in 73.3% of the cohort. Compared to HCs, in those with FT, a functionally defined fMRI region of interest in the anterior cingulate/paracingulate cortex showed increased activation at baseline and decreased activation after CBT during basic-emotion processing (p = 0.012 for CBT responders). Among CBT responders, the change in anterior cingulate/paracingulate was more significant in those with more severe baseline depression (r = 0.75, p < 0.01). CONCLUSIONS: Tremor severity improved significantly after CBT. The improvement was associated with changes in the anterior cingulate/paracingulate activity, which may represent a marker of emotional dysregulation in FT and a predictor of treatment response. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that CBT significantly improves tremor severity in patients with functional tremor.


Assuntos
Encéfalo/diagnóstico por imagem , Terapia Cognitivo-Comportamental/métodos , Transtorno Conversivo/terapia , Tremor/terapia , Adulto , Ansiedade/psicologia , Estudos de Casos e Controles , Transtorno Conversivo/diagnóstico por imagem , Transtorno Conversivo/psicologia , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Feminino , Neuroimagem Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/psicologia , Resultado do Tratamento , Tremor/diagnóstico por imagem , Tremor/psicologia
17.
J Neurol Sci ; 404: 124-127, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31374410

RESUMO

BACKGROUND: Non-motor symptoms (NMSs) are clearly more prevalent in Parkinson's disease (PD) patients compared to healthy individuals. However, NMSs are also common in the elderly and other neurological conditions, and thus, it is not known whether NMSs could be used to differentiate PD from parkinsonism/tremor without dopamine deficiency. METHODS: We prospectively evaluated NMSs immediately before brain dopamine transporter (DAT) [123I]FP-CIT SPECT scanning in 193 patients with unclear parkinsonism/tremor. According to the clinical follow-up and imaging results, 84 patients had PD. NMSs and their correlations with striatal DAT binding were investigated in PD patients and in parkinsonism/tremor patients with normal dopamine function. RESULTS: Total NMS burden, anxiety or depression did not differ between PD patients and patients with normal DAT binding. DAT-normal patients reported more perception-related (p = 0.045) and attention/memory-related NMSs than PD patients (p < 0.001). Total NMS score did not correlate with striatal DAT binding in either group. CONCLUSIONS: In clinically uncertain cases, the total NMS burden cannot be used as a tool in distinguishing PD patients from patients with non-dopaminergic parkinsonism/tremor. Clinical screening of NMSs appears equally important in all patients with parkinsonism.


Assuntos
Corpo Estriado/diagnóstico por imagem , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Transtornos Parkinsonianos/diagnóstico por imagem , Tremor/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Corpo Estriado/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Parkinsonianos/metabolismo , Índice de Gravidade de Doença , Avaliação de Sintomas , Tomografia Computadorizada de Emissão de Fóton Único , Tremor/metabolismo , Adulto Jovem
18.
Ann Clin Transl Neurol ; 6(7): 1142-1150, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31353863

RESUMO

BACKGROUND: The selection of optimal deep brain stimulation (DBS) parameters is time-consuming, experience-dependent, and best suited when acute effects of stimulation can be observed (e.g., tremor reduction). OBJECTIVES: To test the hypothesis that optimal stimulation location can be estimated based on the cortical connections of DBS contacts. METHODS: We analyzed a cohort of 38 patients with Parkinson's disease (24 training, and 14 test cohort). Using whole-brain probabilistic tractography, we first mapped the cortical regions associated with stimulation-induced efficacy (rigidity, bradykinesia, and tremor improvement) and side effects (paresthesia, motor contractions, and visual disturbances). We then trained a support vector machine classifier to categorize DBS contacts into efficacious, defined by a therapeutic window ≥2 V (threshold for side effect minus threshold for efficacy), based on their connections with cortical regions associated with efficacy versus side effects. The connectivity-based classifications were then compared with actual stimulation contacts using receiver-operating characteristics (ROC) curves. RESULTS: Unique cortical clusters were associated with stimulation-induced efficacy and side effects. In the training dataset, 42 of the 47 stimulation contacts were accurately classified as efficacious, with a therapeutic window of ≥3 V in 31 (66%) and between 2 and 2.9 V in 11 (24%) electrodes. This connectivity-based estimation was successfully replicated in the test cohort with similar accuracy (area under ROC = 0.83). CONCLUSIONS: Cortical connections can predict the efficacy of DBS contacts and potentially facilitate DBS programming. The clinical utility of this paradigm in optimizing DBS outcomes should be prospectively tested, especially for directional electrodes.


Assuntos
Estimulação Encefálica Profunda/métodos , Doença de Parkinson/terapia , Idoso , Encéfalo/diagnóstico por imagem , Estimulação Encefálica Profunda/efeitos adversos , Estudos de Viabilidade , Humanos , Hipocinesia/diagnóstico por imagem , Hipocinesia/terapia , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico por imagem , Tremor/diagnóstico por imagem , Tremor/terapia
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