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1.
Medicine (Baltimore) ; 99(11): e19518, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176101

RESUMO

INTRODUCTION: The incidence of Hashimoto's thyroiditis among patients who have Turner syndrome (TS) has increased, but Graves' disease (GD) in patients with TS is rarely reported. Here we report a rare case of TS with GD accompanied by hypogonadotropic hypogonadism. PATIENT CONCERNS: We report the case of a 16-year-old girl who complained nervousness, fatigue, marasmus, heat intolerance, sweating, palpitation, and tremor lasting for more than a month. She had no medical history. DIAGNOSIS: TS was diagnosed of the results of karyotyping demonstrated a gene karyotype of 46, X, i (X)(q10). GD was also diagnosed in this patient following the detection of thyroid function analysis. INTERVENTIONS: Methimazole was administered after identification of GD. Due to the absence of secondary sex characteristics, the patient was given a conjugated estrogen preparation for 1 year, followed by the addition of estradiol cyproterone tablets for the onset of menstruation. OUTCOMES: The hyperthyroidism symptoms of the patient had improved both clinically and laboratory tests after methimazole therapy. She was treated with estrogen and estradiol cyproterone, and the uterus and secondary sexual characteristics of the patient developed during 1 year follow-up. CONCLUSION: TS generally presents as hypergonadotropic hypogonadism. However, hypogonadotropic hypogonadism cannot completely exclude TS. The diagnosis of this disease depends on chromosomal examination. The disease should be detected and treated as early as possible to improve life quality of the patient.


Assuntos
Doença de Graves/diagnóstico , Síndrome de Turner/diagnóstico , Adolescente , Antitireóideos/uso terapêutico , Diagnóstico Diferencial , Fadiga/etiologia , Feminino , Doença de Graves/complicações , Humanos , Cariotipagem , Metimazol/uso terapêutico , Tremor/etiologia , Síndrome de Turner/complicações , Síndrome de Turner/genética
2.
Zhonghua Yi Xue Za Zhi ; 100(3): 207-212, 2020 Jan 21.
Artigo em Chinês | MEDLINE | ID: mdl-32008288

RESUMO

Objective: To find more objective evidence and support for clinical classification of Parkinson's disease by means of tremor analysis in patients with early confirmed Parkinson's disease. Methods: A cross-sectional study was conducted to collect 65 patients with early Parkinson's disease treated in the Third Hospital of Peking University from January 2015 to December 2016. Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn-Yahr scale (H-Y scale), Mini-mental state examination (MMSE), Hamilton depression scale (HAMD) were recorded in all patients. According to the ratio of UPDRS rigidity score to tremor score, the patients were divided into tremor dominant (TD), postural instability/gait difficulty (PIGD) and mixed types. All patients were examined by tremor analysis and the results were analyzed and compared. Results: Among the 65 patients, the mean age of onset was (63±10) years, the course of disease was (14±8) months. Twenty-one patients were classified to TD group, 28 patients were classified to PIGD type, and 16 patients with mixed type. There was no significant difference in frequency and amplitude of tremor between the three groups (P>0.05), but the proportion of alternating contraction and harmonic resonance of active and antagonistic muscles in TD group was significantly higher (P<0.05). Twenty patients (71.4%) in TD group showed typical Parkinson's disease manifestations in tremor analysis. Only four patients (14.3%) in PIGD group showed the typical manifestations. More patients in PIGD group showed no clear main peak of tremor at rest. Some patients showed 6-8 Hz/sec peak frequency in posture position and simultaneous contraction of the active and antagonist muscles. These two manifestations occured simultaneously in mixed type patients, including 10 cases (62.5%) with typical Parkinson's disease manifestations. Conclusion: As an objective electrophysiological method to evaluate tremor type, tremor analysis can be used as an important assistant method for clinical classification of Parkinson's disease. It can provide information of the pathway of pathological loss in different types and give important hints in prognosis and treatment.


Assuntos
Transtornos Neurológicos da Marcha/fisiopatologia , Doença de Parkinson/classificação , Doença de Parkinson/fisiopatologia , Tremor/fisiopatologia , Idade de Início , Idoso , Estudos Transversais , Feminino , Marcha , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Tremor/etiologia
3.
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
4.
Medicine (Baltimore) ; 98(51): e17897, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860947

RESUMO

Parkinson disease (PD) is the second most common neurodegenerative disease which affects population older than 65 years. Tremor represents one of the main symptomatic triads in PD, particularly in rest state.We enrolled 41 idiopathic PD patients, to validate the assessment of tremor symptoms.To be enrolled in the study, patients had to fulfill the movement disorder society clinical diagnostic criteria for PD.We used an innovative home-made, low-cost device, able to quantify the frequency and amplitude of rest tremor and stress conditionOur results confirmed the presence of tremor during muscular effort in a significant number of patients and the influence of emotional stress.We suppose that this new device should be validated in clinical practice as a support of differential diagnosis and therapeutic management of PD patients.


Assuntos
Técnicas Biossensoriais/instrumentação , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Tremor/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Técnicas Biossensoriais/métodos , Estudos de Coortes , Intervalos de Confiança , Desenho de Equipamento , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/tratamento farmacológico , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Tremor/etiologia
6.
BMC Neurol ; 19(1): 194, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412802

RESUMO

BACKGROUND: Coffee consumption represents a negative risk factor for Parkinson's disease (PD) and seems to affect PD motor symptoms. We aimed to investigate the association between coffee consumption and motor symptoms in de novo PD patients. METHODS: In total, 284 patients with de novo PD were included in the current study. Motor and non-motor symptoms were evaluated using various scales. History of coffee consumption was obtained via a semi-structured interview. RESULTS: In total, 204 patients were categorized as coffee drinkers and 80 as non-coffee drinkers. Coffee drinkers were predominantly male and had early symptom onset; in addition, they were younger, reported more years in formal education, and had better motor and non-motor scores than did non-coffee drinkers. After adjustments, coffee drinkers had lower tremor scores than did non-coffee drinkers, and coffee consumption was related to tremors in a dose-dependent manner. These relationships were statistically significant in case of rest tremor but not in case of action tremor. The dose-dependent relationship between coffee consumption and tremor severity was significant only in men. Non-motor symptom scores were not significantly different between coffee drinkers and non-coffee drinkers. CONCLUSIONS: Coffee consumption and tremor severity are inversely related in male patients with de novo PD.


Assuntos
Café , Doença de Parkinson , Tremor , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Tremor/etiologia
7.
BMC Med Inform Decis Mak ; 19(1): 162, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31419976

RESUMO

BACKGROUND: There is growing interest in sensor-based assessment of upper limb tremor in multiple sclerosis and other movement disorders. However, previously such assessments have not been found to offer any improvement over conventional clinical observation in identifying clinically relevant changes in an individual's tremor symptoms, due to poor test-retest repeatability. METHOD: We hypothesised that this barrier could be overcome by constructing a tremor change metric that is customised to each individual's tremor characteristics, such that random variability can be distinguished from clinically relevant changes in symptoms. In a cohort of 24 people with tremor due to multiple sclerosis, the newly proposed metrics were compared against conventional clinical and sensor-based metrics. Each metric was evaluated based on Spearman rank correlation with two reference metrics extracted from the Fahn-Tolosa-Marin Tremor Rating Scale: a task-based measure of functional disability (FTMTRS B) and the subject's self-assessment of the impact of tremor on their activities of daily living (FTMTRS C). RESULTS: Unlike the conventional sensor-based and clinical metrics, the newly proposed 'change in scale' metrics presented statistically significant correlations with changes in self-assessed impact of tremor (max R2>0.5,p<0.05 after correction for false discovery rate control). They also outperformed all other metrics in terms of correlations with changes in task-based functional performance (R2=0.25 vs. R2=0.15 for conventional clinical observation, both p<0.05). CONCLUSIONS: The proposed metrics achieve an elusive goal of sensor-based tremor assessment: improving on conventional visual observation in terms of sensitivity to change. Further refinement and evaluation of the proposed techniques is required, but our core findings imply that the main barrier to translational impact for this application can be overcome. Sensor-based tremor assessments may improve personalised treatment selection and the efficiency of clinical trials for new treatments by enabling greater standardisation and sensitivity to clinically relevant changes in symptoms.


Assuntos
Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico , Tremor/diagnóstico , Tremor/etiologia , Atividades Cotidianas , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Avaliação de Sintomas , Extremidade Superior
9.
J Neurol ; 266(10): 2505-2511, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31256281

RESUMO

BACKGROUND: Prospective memory (PM) is defined as memory for future intentions and it is typically divided into time-based and event-based PM. Deficit of PM has been reported in patients with Parkinson's disease (PD) but no study has yet explored the association between motor subtypes (tremor dominant and rigidity/bradykinesia dominant) and performance on PM tasks. The aim of the study was to explore the role of motor subtypes in the defect of PM. METHODS: Consecutive outpatients with tremor dominant (TD-PD) or rigidity/bradykinesia dominant (PIGD-PD) PD and healthy subjects (HCs) were enrolled and underwent a neuropsychological battery assessing PM, verbal memory and executive functions and questionnaires assessing apathy, functional autonomy, and perceived memory disturbances. RESULTS: We enrolled 28 patients with TD-PD, 28 patients with PIGD-PD and 50 HCs. The three groups did not differ on demographic and cognitive variables. Patients with TD-PD performed worse on time-based PM tasks than patients with PIGD-PD and HCs; no significant difference was found among the three groups on event-based PM tasks. Executive dysfunctions contributed to reduced time-based PM scores in TD-PD. Moreover, severe deficit of time-based and more frequency of perceived failures of PM contributed to reduced functional autonomy in TD-PD. CONCLUSION: The finding of a poorer performance of patients with TD-PD than ones with PIGD-PD and HCs suggests a selective deficit of time-based PM abilities in TD-PD group; therefore, deficit of time-based PM might be considered as a distinctive non-motor symptom of TD-PD and it might affect the functional autonomy in this subtype of PD.


Assuntos
Disfunção Cognitiva/fisiopatologia , Hipocinesia/fisiopatologia , Memória Episódica , Rigidez Muscular/fisiopatologia , Doença de Parkinson/fisiopatologia , Tremor/fisiopatologia , Idoso , Disfunção Cognitiva/etiologia , Função Executiva/fisiologia , Feminino , Humanos , Hipocinesia/etiologia , Masculino , Pessoa de Meia-Idade , Rigidez Muscular/etiologia , Doença de Parkinson/classificação , Doença de Parkinson/complicações , Tremor/etiologia
11.
BMC Neurol ; 19(1): 120, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185934

RESUMO

BACKGROUND: Clinical diagnosis of Parkinson's disease (PD) has always lagged behind clinical symptoms. The diagnostic latency might be influenced by many factors. The diagnostic latency of Chinese people with PD has been unknown. Here we designed this cross-sectional study with the purpose to identify the diagnostic latency and its determinants in Chinese people with PD. METHODS: One hundred and thirty-one newly diagnosed people with PD were recruited into this study. Demographic and clinical characteristics as well as a detailed clinical history were collected. Motor and non-motor symptoms (NMSs) severity were assessed with appropriate assessment scales. Medical professional types in the first medical consultations were also recorded. According to the initially presenting motor phenotypes, patients would be divided into the groups of rest tremor, limb rigidity, movement slowness and walking problems. The investigated variables would be compared among the four groups. RESULTS: The PD diagnostic latency in China was around 15 months. It closely correlated to the severity of motor symptoms, anxiety and depression as well as the number of NMSs. The diagnostic latency significantly varied among the groups of different motor phenotypes of onset. Finally, initially presenting with limb rigidity, having more NMSs, motor symptoms at a more serious degree and the initial medical consultations with physicians or specialists of non-neurology were considered as determinants of a longer diagnostic latency of PD. CONCLUSIONS: Patients presenting with minor motor symptoms and disturbing NMSs as well as physicians' unfamiliarity with PD symptomology were determinants of the diagnostic delay of PD. Health education in community and improvement of the referral system might be proper strategies to shorten the diagnostic latency of PD.


Assuntos
Diagnóstico Tardio , Doença de Parkinson/diagnóstico , Idoso , Ansiedade/etiologia , Grupo com Ancestrais do Continente Asiático , China , Estudos Transversais , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Tremor/etiologia
13.
J Neuroeng Rehabil ; 16(1): 61, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138267

RESUMO

BACKGROUND: Tremor is one of the hallmarks and most bothersome symptoms in Parkinson's disease (PD). The classical PD tremor is present at rest, but postural tremor also occurs. PD tremor can be continuous or intermittently present and can have a re-emergent nature. The tremor intensity is affected by attention and stress level. Observations of PD tremor have indicated increased tremor intensity with time during 30-s tremor assessments. This phenomenon has not previously been studied systematically. Thus, in order to contribute to our understanding of the mechanisms associated with PD tremor, our aim was to investigate the influence of time during a posture holding and a resting task on hand tremor characteristics in persons with PD compared to healthy peers. METHOD: Fifty persons with PD and at least one tremoring hand (tremor intensity exceeding mean + 2SD of a healthy reference group (REF), N = 40) were included from a clinical trial population. Hand accelerations in a rest and postural condition were measured in 30-s assessments while the participants performed a self-paced simple subtraction task with eyes closed to standardize attention without inducing stress. Tremor intensity, maximal power, frequency of maximal power and tremor onset time was calculated for three consecutive 10-s time intervals. RESULTS: Tremor intensity and maximal power increased significantly during the 30-s recording in the PD-group in both conditions (1st-3rd time-interval, tremor intensity: rest + 65% p < 0.0001, postural + 55% p < 0.0001; maximal power: rest + 93% p < 0.0001, postural + 82% p < 0.001). No effect of time was found on frequency of maximal power in the PD-group or on any effect measure in the REF-group. CONCLUSION: Tremor intensity and maximal power increased with time in the PD-group during 30-s tasks, while no change with time was found in the REF-group. In contrast, frequency of maximal power remained unchanged, which may suggest that the same neural circuits were responsible for the tremor generation throughout the tasks. The increase in tremor intensity and maximal power could not solely be explained by re-emergence of tremor. This suggests an increasing or gradually more synchronized cortico-spinal drive throughout the tasks. However, this requires further studies to determine.


Assuntos
Atenção/fisiologia , Doença de Parkinson/fisiopatologia , Postura/fisiologia , Tremor/fisiopatologia , Idoso , Feminino , Mãos , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Fatores de Tempo , Tremor/etiologia
14.
Cerebellum ; 18(4): 705-720, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30963396

RESUMO

It is a clinical experience that acute lesions of the cerebellum induce pathological tremor, which tends to improve. However, quantitative characteristics, imaging correlates, and recovery of cerebellar tremor have not been systematically investigated. We studied the prevalence, quantitative parameters measured with biaxial accelerometry, and recovery of pathological tremor in 68 patients with lesions affecting the cerebellum. We also investigated the correlation between the occurrence and characteristics of tremor and lesion localization using 3D T1-weighted MRI images which were normalized and segmented according to a spatially unbiased atlas template for the cerebellum. Visual assessment detected pathological tremor in 19% while accelerometry in 47% of the patients. Tremor was present both in postural and intentional positions, but never at rest. Two types of pathological tremor were distinguished: (1) low-frequency tremor in 36.76% of patients (center frequency 2.66 ± 1.17 Hz) and (2) normal frequency-high-intensity tremor in 10.29% (center frequency 8.79 ± 1.43 Hz). The size of the lesion did not correlate with the presence or severity of tremor. Involvement of the anterior lobe and lobule VI was related to high tremor intensity. In all followed up patients with acute cerebellar ischemia, the tremor completely recovered within 8 weeks. Our results indicate that cerebellar lesions might induce pathological postural and intentional tremor of 2-3 Hz frequency. Due to its low frequency and low amplitude, quantitative tremorometry is neccessary to properly identify it. There is no tight correlation between lesion localization and quantitative characteristics of cerebellar tremor.


Assuntos
Doenças Cerebelares/complicações , Tremor/etiologia , Tremor/fisiopatologia , Adulto , Doenças Cerebelares/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Prevalência , Tremor/diagnóstico por imagem
15.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936346

RESUMO

A 71-year-old female patient presented with a 14-year history of slowly progressive distal limb numbness, paraesthesia and reduced vibration perception, ataxic gait and intentional tremor. Examination revealed with a length-dependent sensory neuropathy. Nerve conduction studies showed a chronic sensorimotor inflammatory demyelinating polyneuropathy. Intravenous immunoglobulin treatment (on two occasions) proved ineffective. Serum electrophoresis showed increased monoclonal IgM with kappa light chains. Anti-myelin-associated glycoprotein (MAG) levels were extremely elevated, >70 000 BTU. Bone marrow biopsy revealed 15%-20% small B cells and positive MYD88 mutation, indicative of Waldenstrom macroglobulinaemia. A diagnosis of Waldenstrom-associated anti-MAG paraprotein neuropathy with intentional (neurogenic) tremor was made. Repeat nerve conduction study showed a severe sensory demyelinating neuropathy with no axonal lesion. Treatment with rituximab was given for 1 month with minimal improvement. Repeat anti-MAG levels dropped to 53 670 BTU, with minimal clinical improvement.


Assuntos
Fatores Imunológicos/uso terapêutico , Glicoproteína Associada a Mielina/metabolismo , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico , Rituximab/uso terapêutico , Macroglobulinemia de Waldenstrom/diagnóstico , Idoso , Feminino , Marcha Atáxica/etiologia , Humanos , Imunoglobulina M/uso terapêutico , Paraproteínas/metabolismo , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/tratamento farmacológico , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/fisiopatologia , Resultado do Tratamento , Tremor/etiologia , Macroglobulinemia de Waldenstrom/tratamento farmacológico , Macroglobulinemia de Waldenstrom/fisiopatologia
16.
J Neuroeng Rehabil ; 16(1): 38, 2019 03 13.
Artigo em Inglês | MEDLINE | ID: mdl-30866977

RESUMO

BACKGROUND: A large population of patients with Parkinson's disease (PD) displays the symptom of resting tremor. However, the extent that resting tremor may affect the performance of movement control has not been evaluated specifically. This study aims at establishing methods to quantitatively evaluate motor performance in PD patients with tremor, and at analyzing the interfering effects of tremor on control of reaching movements. METHODS: Ten PD patients with tremor and Ten healthy control subjects were recruited to participate in this study. All patients and healthy control subjects performed point-to-point reaching movements with their tremor affected arm or preferred arm. We verified that a smoothing model of minimum-jerk trajectory (MJT) can be used to extract voluntary movement trajectory from tremor-corrupted movement trajectory in the reaching tasks by the patients. Performance indices of reaction time (RT) and movement time (MT) of reaching movements by the PD subjects with tremor were evaluated using MJT trajectories. Differences of RT and MT between the recorded trajectories and MJT in PD and control subjects were calculated to investigate the extent that tremor may affect their motor performance. Linear mixed-effects model was used to identify the contributions of tremor, bradykinesia and rigidity to the performance indices of RT and MT based on UPDRS scores. The power spectrum densities (PSD) of tremor were also evaluated using hand velocities to represent tremor intensity and to analyze their correlations with RT and MT. RESULTS: The MJT model demonstrated good fit to recorded trajectory with a more consistent estimation of motor performance for both PD and control subjects. The RT and MT of patients were found to be 43.4 and 79.5% longer respectively than those of healthy control subjects. Analysis of the linear mixed-effects model was not able to reveal that tremor, bradykinesia and rigidity each had a significant contribution to RT or MT in PD patients with tremor. However, the PSD of tremor was found to correlate significantly to RT, but not to MT, in both linear regression and linear mixed-effects model. CONCLUSIONS: The minimum-jerk trajectory and power spectrum densities are effective quantitative tools for evaluating motor performance for PD patients with tremor. Resting tremor is one of the factors prolonging the initiation of voluntary reaching movement in these patients.


Assuntos
Movimento/fisiologia , Doença de Parkinson/fisiopatologia , Tremor/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Tremor/etiologia
18.
Cerebellum ; 18(3): 519-526, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30830673

RESUMO

Cerebellar degenerative pathology has been identified in tremor patients; however, how the degenerative pathology could contribute to tremor remains unclear. If the cerebellar degenerative pathology can directly drive tremor, one would hypothesize that tremor is likely to occur in the diseases of cerebellar ataxia and follows the disease progression in such disorders. To further test this hypothesis, we studied the occurrence of tremor in different disease stages of classical cerebellar degenerative disorders: spinocerebellar ataxias (SCAs). We further separately analyzed postural tremor and rest tremor, two forms of tremor that both involve the cerebellum. We also explored tremor in different subtypes of SCAs. We found that 18.1% of SCA patients have tremor. Interestingly, SCA patients with tremor have worse ataxia than those without tremor. When stratifying patients into mild, moderate, and severe disease stages according to the severity of ataxia, moderate and severe SCA patients more commonly have tremor than those with mild ataxia, the effect most prominently observed in postural tremor of SCA3 and SCA6 patients. Finally, tremor can independently contribute to worse functional status in SCA2 patients, even after adjusting for ataxia severity. Tremor is more likely to occur in the severe stage of cerebellar degeneration when compared to mild stages. Our results partially support the cerebellar degenerative model of tremor.


Assuntos
Cerebelo/patologia , Ataxias Espinocerebelares/complicações , Ataxias Espinocerebelares/patologia , Tremor/etiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tremor/epidemiologia
19.
Brain Behav ; 9(4): e01219, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30815987

RESUMO

OBJECTIVES: to explore the association between cerebral small-vessel diseases (CSVDs) and motor symptoms in Parkinson's disease (PD). METHODS: 137 PD patients were recruited into the study. Detailed motor symptoms, including tremor, rigidity, bradykinesia, and axial impairment, were evaluated using Unified Parkinson's disease Rating Scale (UPDRS). Non-motor symptoms, including cognition, anxiety, and depression, were evaluated using Montreal Cognitive Assessment (MoCA), Hamilton anxiety scale (HAMA), and Hamilton depression scale (HAMD). Brain MRI was used to assess the subtypes of CSVDs, including lacunes, enlarged perivascular spaces (EPVS), and white matter hyperintensities (WMH). WMH were furtherly divided into deep WMH (DWMH) and periventricular hyperintensities (PVH). The association between CSVDs and motor symptoms was analyzed. Patients were divided into the postural instability and gait disability (PIGD) group and non-PIGD group. Demographic, clinical and CSVDs variables were compared between the two groups. RESULTS: CSVDs subtypes were all detected in the participants with different prevalence rates and severity degrees. We found a close association between EPVS in basal ganglia and the tremor score (p = 0.032), and between DWMH in the frontal and occipital lobes and the axial motor score (p < 0.05) through the spearman and multivariate liner regression analysis. Compared with the non-PIGD group, the PIGD group demonstrated more serious cognitive impairment and DWMH in the frontal and occipital lobes (p < 0.05). The demographic characteristics and vascular risk factors of the PIGD group were not different from those of the non-PIGD group. Cognitive impairment and DWMH in the frontal lobe were identified to be independent risk factors of PIGD motor phenotype. CONCLUSIONS: We identified a close association between the CSVDs and motor symptoms in PD and DWMH in the frontal lobe was a risk factor of PIGD motor phenotype, which supports the contribution of vascular pathology in PD.


Assuntos
Doenças de Pequenos Vasos Cerebrais/complicações , Doença de Parkinson/complicações , Idoso , Doenças de Pequenos Vasos Cerebrais/fisiopatologia , Cognição/fisiologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Exame Neurológico/efeitos adversos , Doença de Parkinson/fisiopatologia , Fenótipo , Fatores de Risco , Tremor/etiologia , Tremor/fisiopatologia
20.
Acta Med Port ; 32(2): 149-157, 2019 Feb 28.
Artigo em Português | MEDLINE | ID: mdl-30896396

RESUMO

Tremor is the commonest involuntary movement. The differential diagnosis is wide, and can be challenging even for experienced neurologists. Nonetheless, many tremors have a benign etiology and clinical course and, in many cases, non-neurologists are able to clinically manage these situations. This manuscript approaches the different types of tremor, their diagnosis, main differential diagnoses, the desired clinical approach, and therapeutic options of the most important conditions in clinical practice.


Assuntos
Tremor , Humanos , Tremor/classificação , Tremor/diagnóstico , Tremor/etiologia , Tremor/terapia
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