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In the last decades there has been progress in the treatment of essential tremor (TE) especially in the surgical field and to a lesser extent in the pharmacological field. We carry out a review of the currently available treatments. The first intervention is the use of non-pharmacological and non-surgical strategies (general advice, occupational therapy, speech therapy, psychotherapy). With discrete advances, the pharmacological treatment is not very satisfactory. Only 30-60% of patients have a positive response, and in these the anti-tremor effectiveness is 40-60%. The first-line drugs are still propranolol and primidone. In cases with severe tremor we will consider a surgical option, the method of choice being thalamotomy using high-intensity focused ultrasound. In the future we must continue to study the pathophysiology of TE, develop drugs specifically designed for TE and improve the technology of available invasive techniques.
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Tremor Essencial , Tremor Essencial/terapia , Tremor Essencial/tratamento farmacológico , Humanos , Propranolol/uso terapêutico , Primidona/uso terapêutico , Ablação por Ultrassom Focalizado de Alta Intensidade , Anticonvulsivantes/uso terapêutico , Tálamo , Antagonistas Adrenérgicos beta/uso terapêuticoRESUMO
INTRODUCTION: Unilateral Gamma Knife™ stereotactic radiosurgery on the ventral-intermediate nucleus of the thalamus is a minimally invasive neurosurgical option for refractory tremor. We describe the experience of Gamma Knife™ thalamotomy (GKT) in patients with essential tremor (ET) and tremor-dominant Parkinson's disease (PD) at our specialised stereotactic neurosurgery unit. METHODS: We reviewed the cases of patients treated with GKT between January 2014 and February 2018 with a minimum of 12 months' follow-up. We analysed clinical and demographic variables, indication, radiation dose, effectiveness (based on subscales of the Fahn-Tolosa-Marin [FTM] scale and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS] motor score), and adverse events. RESULTS: Thirteen patients were registered, 6 with a diagnosis of tremor-dominant PD, four with refractory ET, and three with ET and PD. Median age was 78 years (range, 62-83), with seven patients aged over 75 years. Four patients were receiving anticoagulants and two had history of stroke. The maximum radiation dose administered was 130 Gy. Mean (standard deviation) follow-up duration was 30.0 (14.5) months. Significant tremor improvement was observed on the FTM subscales: 63.6% at 12 months and 63.5% at the end of follow-up; MDS-UPDRS tremor items showed improvements of 71.3% at 12 months and 60.3% at the end of follow up. Eleven patients reported significant improvements in quality of life, and 3 reported mild and transient adverse effects. CONCLUSIONS: This is the largest series of patients with essential and parkinsonian tremor treated with GKT and followed up in the long term in Spain. GKT can be safe and effective in the long term in patients with refractory tremor, including in elderly patients and those receiving anticoagulants.
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Tremor Essencial , Doença de Parkinson , Radiocirurgia , Idoso , Humanos , Tremor/etiologia , Resultado do Tratamento , Qualidade de Vida , Radiocirurgia/efeitos adversos , Seguimentos , Imageamento por Ressonância Magnética , Tremor Essencial/radioterapia , Tremor Essencial/etiologia , Tremor Essencial/cirurgiaRESUMO
INTRODUCTION: The ventralis intermedius (Vim) nucleus of the thalamus is the usual surgical target for tremor. However, locating the structure may be difficult as it is not visible with conventional imaging methods; therefore, surgical procedures typically use indirect calculations correlated with clinical and intraoperative neurophysiological findings. Current ablative surgical procedures such as Gamma-Knife thalamotomy and magnetic resonance-guided focused ultrasound require new alternatives for locating the Vim nucleus. In this review, we compare Vim nucleus location for the treatment of tremor using stereotactic procedures versus direct location by means of tractography. DISCUSSION: The most widely used cytoarchitectonic definition of the Vim nucleus is that established by Schaltenbrand and Wahren. There is a well-defined limit between the motor and the sensory thalamus; Vim neurons respond to passive joint movements and are synchronous with peripheral tremor. The most frequently used stereotactic coordinates for the Vim nucleus are based on indirect calculations referencing the mid-commissural line and third ventricle, which vary between patients. Recent studies suggest that the dentato-rubro-thalamic tract is an optimal target for controlling tremor, citing a clinical improvement; however, this has not yet been corroborated. CONCLUSIONS: Visualisation of the cerebello-rubro-thalamic pathway by tractography may help in locating the Vim nucleus. The technique has several limitations, and the method requires standardisation to obtain more precise results. The utility of direct targeting by tractography over indirect targeting for patients with tremor remains to be demonstrated in the long-term.
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INTRODUCTION: The ventralis intermedius (VIM) nucleus of the thalamus is the usual surgical target for tremor. However, locating the structure may be difficult as it is not visible with conventional imaging methods; therefore, surgical procedures typically use indirect calculations correlated with clinical and intraoperative neurophysiological findings. Current ablative surgical procedures such as Gamma-Knife thalamotomy and magnetic resonance-guided focused ultrasound require new alternatives for locating the VIM nucleus. In this review, we compare VIM nucleus location for the treatment of tremor using stereotactic procedures versus direct location by means of tractography. DISCUSSION: The most widely used cytoarchitectonic definition of the VIM nucleus is that established by Schaltenbrand and Wahren. There is a well-defined limit between the motor and the sensory thalamus; VIM neurons respond to passive joint movements and are synchronous with peripheral tremor. The most frequently used stereotactic coordinates for the VIM nucleus are based on indirect calculations referencing the mid-commissural line and third ventricle, which vary between patients. Recent studies suggest that the dentato-rubro-thalamic tract is an optimal target for controlling tremor, citing a clinical improvement; however, this has not yet been corroborated. CONCLUSIONS: Visualisation of the cerebello-rubro-thalamic pathway by tractography may help in locating the VIM nucleus. The technique has several limitations, and the method requires standardisation to obtain more precise results. The utility of direct targeting by tractography over indirect targeting for patients with tremor remains to be demonstrated in the long-term.
Assuntos
Radiocirurgia , Tremor , Imagem de Tensor de Difusão/métodos , Humanos , Imageamento por Ressonância Magnética , Radiocirurgia/métodos , Tálamo/diagnóstico por imagem , Tálamo/cirurgia , Tremor/diagnóstico por imagem , Tremor/terapiaRESUMO
INTRODUCTION: Smartphone use in biomedical research is becoming more prevalent in different clinical settings. We performed a pilot study to obtain information on smartphone use by patients with essential tremor (ET) and healthy controls, with a view to determining whether performance of touchscreen tasks is different between these groups and describing touchscreen interaction factors. METHOD: A total of 31 patients with ET and 40 sex- and age-matched healthy controls completed a descriptive questionnaire about the use of smartphones. Participants subsequently interacted with an under-development Android application, and performed 4 tests evaluating typical touchscreen interaction gestures; each test was performed 5 times. RESULT: The type of smartphone use and touchscreen interaction were not significantly different between patients and controls. Age and frequency of smartphone use are key factors in touchscreen interaction. CONCLUSION: Our results support the use of smartphone touchscreens for research into ET, although further studies are required.
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Tremor Essencial , Smartphone , Gestos , Nível de Saúde , Humanos , Projetos PilotoRESUMO
INTRODUCTION: Unilateral Gamma Knife™ stereotactic radiosurgery on the ventral-intermediate nucleus of the thalamus is a minimally invasive neurosurgical option for refractory tremor. We describe the experience of Gamma Knife™ thalamotomy (GKT) in patients with essential tremor (ET) and tremor-dominant Parkinson's disease (PD) at our specialised stereotactic neurosurgery unit. METHODS: We reviewed the cases of patients treated with GKT between January 2014 and February 2018 with a minimum of 12 months' follow-up. We analysed clinical and demographic variables, indication, radiation dose, effectiveness (based on subscales of the Fahn-Tolosa-Marin [FTM] scale and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS] motor score), and adverse events. RESULTS: Thirteen patients were registered, 6 with a diagnosis of tremor-dominant PD, four with refractory ET, and three with ET and PD. Median age was 78 years (range, 62-83), with seven patients aged over 75 years. Four patients were receiving anticoagulants and two had history of stroke. The maximum radiation dose administered was 130 Gy. Mean (standard deviation) follow-up duration was 30.0 (14.5) months. Significant tremor improvement was observed on the FTM subscales: 63.6% at 12 months and 63.5% at the end of follow-up; MDS-UPDRS tremor items showed improvements of 71.3% at 12 months and 60.3% at the end of follow up. Eleven patients reported significant improvements in quality of life, and 3 reported mild and transient adverse effects. CONCLUSIONS: This is the largest series of patients with essential and parkinsonian tremor treated with GKT and followed up in the long term in Spain. GKT can be safe and effective in the long term in patients with refractory tremor, including in elderly patients and those receiving anticoagulants.
RESUMO
INTRODUCTION: Smartphones use in biomedical research is becoming more prevalent in different clinical settings. We performed a pilot study to obtain information on smartphone use by patients with essential tremor (ET) and healthy controls, with a view to determining whether performance of touchscreen tasks is different between these groups and describing touchscreen interaction factors. METHOD: A total of 31 patients with ET and 40 sex- and age-matched healthy controls completed a descriptive questionnaire about the use of smartphones. Participants subsequently interacted with an under-development Android application, and performed 4 tests evaluating typical touchscreen interaction gestures; each test was performed 5 times. RESULT: The type of smartphone use and touchscreen interaction were not significantly different between patients and controls. Age and frequency of smartphone use are key factors in touchscreen interaction. CONCLUSION: Our results support the use of smartphone touchscreens for research into ET, although further studies are required.
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El temblor esencial es el trastorno de movimiento más común en la actualidad, su prevalencia aumenta conforme lo hace la edad y se caracteriza principalmente por ser un temblor de acción de miembros superiores que puede llegar a afectar miembros inferiores, tronco y cabeza. Afecta directamente la calidad de vida de las personas al limitar las actividades del diario vivir llevando al desarrollo de trastornos como ansiedad y depresión. Objetivo. Describir los efectos adversos y la eficacia de los neuro estímulos periféricos no invasivos como opción terapéutica para el temblor esencial. Metodología. Se empleó la metodología de una revisión sistemática, basadas en las directrices PRISMA 2021 mediante la búsqueda de información en las siguientes bases de datos, PubMed, Scopus y Web of science. Además, se realizó una búsqueda especifica de todos los estudios centrados en la temática cuyo algoritmo de búsqueda se presenta a continuación, "terapia no invasiva" AND "temblor esencial" AND "neuroestimulación" AND "estimulación eléctrica transcutánea" en idioma español e inglés, entre los años 2017- 2022. Conclusión. La neuroestimulación eléctrica periférica no invasiva se presenta como una opción terapéutica prometedora en el tratamiento del temblor esencial. Los estudios han demostrado una mejora significativa en los síntomas del temblor en pacientes tratados con neuroestimulación eléctrica periférica no invasiva, lo que sugiere que este enfoque puede ser beneficioso para pacientes que no responden a otros tratamientos convencionales o que experimentan efectos secundarios adversos. Además, la neuroestimulación eléctrica periférica no invasiva es una técnica segura y bien tolerada por los pacientes.
Essential tremor is the most common movement disorder today, its prevalence increases with age and is characterized mainly as an action tremor of the upper limbs that can affect the lower limbs, trunk and head. It directly affects the quality of life of people by limiting the activities of daily living leading to the development of disorders such as anxiety and depression. Objective. To describe the adverse effects and efficacy of noninvasive peripheral neuro-stimuli as a therapeutic option for essential tremor. Methodology. The methodology of a systematic review was used, based on the PRISMA 2021 guidelines, by searching for information in the following databases: PubMed, Scopus and Web of science. In addition, a specific search was performed for all studies focused on the topic whose search algorithm is presented below, "noninvasive therapy" AND "essential tremor" AND "neurostimulation" AND "transcutaneous electrical stimulation" in Spanish and English language, between the years 2017- 2022. Conclusion. Noninvasive peripheral electrical neurostimulation is presented as a promising therapeutic option in the treatment of essential tremor. Studies have demonstrated significant improvement in tremor symptoms in patients treated with noninvasive peripheral electrical neurostimulation, suggesting that this approach may be beneficial for patients who do not respond to other conventional treatments or who experience adverse side effects. In addition, noninvasive peripheral electrical neurostimulation is a safe technique that is well tolerated by patients.
O tremor essencial é o distúrbio de movimento mais comum atualmente, sua prevalência aumenta com a idade e é caracterizado principalmente como um tremor de ação do membro superior que pode afetar os membros inferiores, o tronco e a cabeça. Ele afeta diretamente a qualidade de vida das pessoas ao limitar as atividades da vida diária, levando ao desenvolvimento de distúrbios como ansiedade e depressão. Objetivo. Descrever os efeitos adversos e a eficácia dos neuroestímulos periféricos não invasivos como opção terapêutica para o tremor essencial. Metodologia. Utilizamos a metodologia de uma revisão sistemática, com base nas diretrizes PRISMA 2021, buscando informações nos seguintes bancos de dados: PubMed, Scopus e Web of science. Além disso, foi realizada uma busca específica de todos os estudos focados no assunto cujo algoritmo de busca é apresentado a seguir, "terapia não invasiva" AND "tremor essencial" AND "neuroestimulação" AND "estimulação elétrica transcutânea" em espanhol e inglês, entre 2017 e 2022. Conclusão. A neuroestimulação elétrica periférica não invasiva é apresentada como uma opção terapêutica promissora no tratamento do tremor essencial. Estudos demonstraram melhora significativa nos sintomas do tremor em pacientes tratados com neuroestimulação elétrica periférica não invasiva, sugerindo que essa abordagem pode ser benéfica para pacientes que não respondem a outros tratamentos convencionais ou que apresentam efeitos colaterais adversos. Além disso, a estimulação elétrica nervosa periférica não invasiva é uma técnica segura e bem tolerada pelos pacientes.
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O tremor essencial é um distúrbio do movimento que alcança até 5% da população mundial, vinculando-se a transtornos psiquiátricos e sofrimento psíquico. O presente artigo teve como objetivo identificar a produção científica brasileira sobre este tremor, considerando os aspectos psicológicos associados. Foi realizada uma revisão sistemática da literatura nacional publicada entre 1993 e 2018. As bases de dados consultadas foram SciELO, MEDLINE, LILACS e periódicos CAPES, a partir dos descritores Tremor Essencial e Tremor and Essencial e tradução para o inglês. A análise com 14 artigos identificou somente dois citando os aspectos psicológicos. Este tipo de investigação é pertinente, pois o impedimento na realização de movimentos impacta nas atividades diárias e de socialização. Os achados demonstraram a escassez de pesquisas nacionais que abordem diretamente esta relação, evidenciando a necessidade de maiores investimentos neste campo de estudo.
Essential tremor is a movement disorder that reaches 5% of the world population, linked to a psychiatric disorder and psychic suffering. The present article aimed to identify the Brazilian scientific production on this tremor, considering the associated psychological aspects. A systematic review of the national literature published between 1993 and 2018 was carried out. The databases consulted were SciELO, MEDLINE, LILACS, and CAPES journals, from the descriptors Tremor Essential and Tremor and Essential, and translation into English. The analysis with 14 articles identified only two citing the psychological aspects. This type of investigation is pertinent, since the impediment in the accomplishment of movements impacts on the daily activities and socialization. The findings demonstrated the scarcity of national surveys that directly address this relationship, evidencing the need for greater investments in this field of study.
El temblor esencial es un trastorno del movimiento que alcanza el 5% de la población mundial, vinculado a un trastorno psiquiátrico y el sufrimiento psíquico. El presente artículo tuvo como objetivo identificar la producción científica brasileña sobre este temblor, considerando los aspectos psicológicos asociados. Se realizó una revisión sistemática de la literatura nacional publicada entre 1993 y 2018. Las bases de datos consultadas fueron SciELO, MEDLINE, LILACS y revistas CAPES, a partir de los descriptores Tremor Essencial y Tremor and Essencial, y traducción al inglés. El análisis con 14 artículos identificó solamente dos citando los aspectos psicológicos. Este tipo de investigación es pertinente, pues el impedimento en la realización de movimientos impacta en las actividades diarias y socialización. Los hallazgos demostraron la escasez de investigaciones nacionales que aborden directamente esta relación, evidenciando la necesidad de mayores inversiones en este campo de estudio.
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Introducción: La estimulación cerebral profunda es una técnica difundida y validada para eltratamiento de múltiples dolencias neurológicas y psiquiátricas, entre ellas el temblor esencial. Objetivo: Evaluar si existe un correlato clínico-anatómico, para un paciente con TE, entre la mejor estimulación lograda y los tractos involucrados. Para esto se realiza una descripción de la técnica utilizada, incluyendo el procesamiento de imágenes necesario. Material y métodos: Se presenta el caso de un paciente de 53 años de edad, con una historia de 23 años de temblor esencial progresivo e incapacitante. Se realizó un implante de DBS bilateral en Vim. Se realizó un post procesamiento de imágenes con un método desarrollado por nuestro equipo a través del cual se permitió evaluar gráficamente el área de estimulación cerebral y sus relaciones con los tractos implicados en la patología (dento-rubro-talámico, haz piramidal y haz lemniscal). Resultados: El paciente presentó una mejoría del 55% medido por escala de temblor de Tolosa. Se obtuvo una correlación anatómica y funcional de lo esperado según imágenes y la respuesta clínica del paciente. Se constataron efectos adversos cuando la estimulación implicaba fibras del haz piramidal y lemniscal, presentando los mejores efectos clínicos cuando el haz dento-rubro-talámico era influenciado por el área de acción del campo eléctrico. Conclusiones: En este reporte mostramos la aplicabilidad de DTI y tractografía para explicar los efectos de la programación de los pacientes con estimulación cerebral profunda.
Introduction: Deep brain stimulation is a widespread and validated technique for the treatment of multiple neurological and psychiatric disorders, including essential tremor. Objective: To evaluate if there is a clinical-anatomical correlate, for a patient with essential tremor, between the best stimulation achieved and the tracts involved. For this, a description of the technique used is made, including the necessary image processing. Methods: We present the case of a 53-year-old patient with a 23-year history of progressive and disabling essential tremor. A bilateral DBS implant was performed on Vim. We performed a post-processing of images with a method developed by our team through which we were able to graphically evaluate the area of brain stimulation and its relationships with the tracts involved in the pathology (dento-rubro-thalamic tract, pyramidal tract and lemniscal tract). Conclusions: In this report we showed the applicability of DTI and tractography to explain the clinical effects of the programming features in patients with deep brain stimulation.
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Estimulação Elétrica Nervosa Transcutânea , Tremor Essencial , Imagem de Tensor de Difusão , Transtornos MentaisRESUMO
RESUMEN OBJETIVO: La enfermedad de Parkinson (EP) y el temblor esencial (TE) son las patologías que con más frecuencia presentan temblor como manifestación crucial, no obstante, a pesar de que su fisiopatología, diagnóstico y tratamiento son totalmente distintos. El síntoma de temblor suele acarrear un desafío clínico para su correcto enfoque, lo cual lleva frecuentemente a confusión y subsecuentemente a tratamientos erróneos. En este estudio se pretende caracterizar, individualizar y describir las manifestaciones atípicas del temblor en pacientes con diagnóstico de EP y TE con el objetivo de proporcionar herramientas para aumentar la efectividad del diagnóstico de estas condiciones. METODOLOGÍA: Estudio observacional, de corte transversal, en el cual se describió cada variable por medio de medidas de tendencia central y dispersión para variables cuantitativas y frecuencias absolutas y relativas para las variables categóricas. RESULTADOS: Se encontraron manifestaciones típicas y atípicas para ambas patologías, siendo el temblor en reposo la manifestación atípica más frecuente en TE; se encontró en el 35 % de los pacientes (p = 0,0001). Para la EP, un 40 % de los pacientes presentaron temblor postural (p = 0,001) como manifestación atípica. CONCLUSIONES: Los signos atípicos del temblor en la EP y en el TE deben ser tomados en cuenta al establecer el diagnóstico clínico de ambas patologías, para intentar disminuir la posibilidad de generar un diagnóstico erróneo con un tratamiento inadecuado.
SUMMARY OBJECTIVE: Parkinson's disease (PD) and essential tremor (ET) are the most prevalent pathologies in which tremor is an important symptom. Despite the fact that both conditions exhibit a totally different pathophysiology, diagnosis criteria and treatment, the clinical assessment of this manifestation tends to generate bias and confusion, leading to misdiagnosis and subsequently wrong prescriptions. This study intents to assess both typical and atypical features of PD and ET and provide some insights about the relevance of clinical judgement to provide better treatments. METHODOLOGY: This is an observational cross-sectional study with a sample of 20 PD patients and 20 ET patients. Each variable was described using measure of central tendency and dispersion for quantitative variables and absolute and relative frequencies for categorical ones. RESULTS: Typical and atypical manifestations were found in both pathologies, tremor at rest was the most frequent atypical manifestation in ET presented in 35 %% of patients (p = 0.0001). For PD 40 %% of patients showed postural tremor being the most frequent atypical characteristic (p = 0.001). CONCLUSIONS: Atypical signs in PD and ET must be taken into account to avoid misdiagnosis. The clinical phenomenology of both diseases concerning tremor can overlap, and tremor interpretation can improve patient care.
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Doença de Parkinson , Sinais e Sintomas , Tremor , Tremor EssencialRESUMO
RESUMEN INTRODUCCIÓN: El temblor esencial es el temblor más común. No se ha descrito la asociación entre diabetes y temblor esencial. El objetivo de este estudio de casos y controles es documentar la asociación entre diabetes mellitus y temblor esencial. MÉTODOS: Se realizó un estudio de casos y controles en población clínica de pacientes incidentes con temblor esencial, pareados por edad y género, a quienes se les interrogó sobre antecedente de diabetes mellitus. Se determinó el OR mediante regresión logística condicionada. RESULTADOS: Se estudiaron 262 casos de temblor esencial y 262 controles. El antecedente de diabetes mellitus se encontró en 39 casos con temblor esencial y en 24 controles, lo que representa una asociación positiva entre los dos (OR 2,15, IC95 % 1,05 a 4,41). DISCUSIÓN: Este estudio de casos y controles en una población clínica muestra que los pacientes con temblor esencial tienen dos veces más probabilidad de tener el antecedente de diabetes mellitus.
SUMMARY INTRODUCTION: The essential tremor is the most common tremor. It has not been described the association between diabetes and essential tremor. The objective of this case-control study is to document the association between diabetes mellitus and essential tremor. METHODS: It was carried out a case-control study in incident patients of clinical population with essential tremor, paired by age and gender, who they were interrogated the antecedent of diabetes mellitus. The OR was determined by means of conditioned logistical regression. RESULTS: 262 cases of essential tremor and 262 controls were studied. The antecedent of diabetes mellitus was in 39 cases with essential tremor and in 24 controls, with an OR 2.15 (95 %% CI 1.05 to 4.41). DISCUSSION: This case-control study in a clinical population shows that the patients with essential tremor have 2 times more probability of having the antecedent of diabetes mellitus.
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Comorbidade , Tremor Essencial , Diabetes MellitusRESUMO
Resumo: Tremor é o distúrbio do movimento mais frequente na população, e pode estar associado a exposição a agrotóxicos. O objetivo foi avaliar a chance de tremor essencial em 442 guardas de endemias do Estado do Rio de Janeiro, Brasil, expostos a agrotóxicos. Foram selecionados 51 casos e 204 controles (1:4). Todos os participantes responderam a um questionário sobre aspectos sociodemográficos, ocupacionais e toxicológicos. A influência da exposição a agrotóxicos sobre o desenvolvimento do tremor foi estimada por regressão logística não condicional, ajustada por covariáveis selecionadas. A idade média da população estudada foi de 49 (DP = 7) anos, sendo a diferença entre casos (média = 50,8; DP = 6,9) e controles (média = 48,5; DP = 6,9) estatisticamente significativa (p = 0,03). Além disso, aqueles com 16 a 16,9 anos de aplicação de agrotóxicos foram os que estiveram sob maior chance de apresentar a doença (OR ajustada = 4,60; IC95%: 1,29-16,41). Nossos resultados sugerem que o período entre 16 e 16,9 anos de aplicação de agrotóxicos teve impacto importante para o desenvolvimento dessa doença.
Abstract: Tremor is the most frequent movement disorder in the population and can be associated with pesticide exposure. The aim was to assess the odds of essential tremor in 442 endemic disease control agents in Rio de Janeiro State, Brazil, exposed to pesticides. Fifty-one cases and 204 controls were selected (1:4). All participants answered a questionnaire on socio-demographic, occupational, and toxicological items. The influence of pesticide exposure on the development of tremor was estimated by non-conditional logistic regression, adjusted for selected covariables. Mean age of the study population was 49 (SD = 7) years, and the difference between cases (mean = 50.8; SD = 6.9) and controls (mean = 48.5; SD = 6.9) was statistically significant (p = 0.03). Those with 16 to 16.9 years of pesticide use showed the highest odds of essential tremor (adjusted OR = 4.60; 95%CI: 1.29-16.41). Our results suggest that 16 to 16.9 years of pesticide exposure had a major impact on the development of essential tremor.
Resumen: El temblor es el disturbio de movimiento más frecuente en la población y puede estar asociado a la exposición a pesticidas. El objetivo fue evaluar la oportunidad del temblor esencial en 442 empleados públicos del sector de endemias del estado de Río de Janeiro, Brasil, expuestos a pesticidas. Se seleccionaron 51 casos y 204 controles (1:4). Todos los participantes respondieron a un cuestionario sobre aspectos sociodemográficos, ocupacionales y toxicológicos. La influencia de la exposición a pesticidas sobre el desarrollo del temblor fue estimada por regresión logística no condicional, ajustada por covariables seleccionadas. La edad media de la población estudiada fue de 49 (DP = 7) años, siendo la diferencia entre casos (media = 50,8; DP = 6,9) y controles (media = 48,5; DP = 6,9) estadísticamente significativa (p = 0,03). Además, aquellos de 16 a 16,9 años de servicio de fumigación con pesticidas fueron los que estuvieron bajo la mayor oportunidad de presentar la enfermedad (OR ajustada = 4,60; IC95%: 1,29-16,41). Nuestros resultados sugieren que el período entre 16 y 16,9 años de fumigación con pesticidas tuvo un impacto importante para el desarrollo de esa enfermedad.
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Humanos , Masculino , Feminino , Praguicidas/toxicidade , Exposição Ocupacional/efeitos adversos , Tremor Essencial/induzido quimicamente , Fatores de Tempo , Brasil , Estudos de Casos e Controles , Modelos Logísticos , Inquéritos e Questionários , Doenças Endêmicas , Pessoa de Meia-IdadeRESUMO
Introducción: El temblor esencial constituye el trastorno de movimiento más frecuente, se caracteriza por un temblor cinético postural de 4-12 Hz de frecuencia. Es una enfermedad crónica, progresiva y neurodegenerativa que tiene una repercusión heterogénea sobre la calidad de vida. Materiales y métodos: Se analizó la presencia de comorbilidades aplicando el índice de Charlson corregido, se valoró la correlación de estas patologías sobre la calidad de vida, ámbito emocional y funcionalidad de pacientes con temblor esencial. Resultados: Se estudiaron 132 pacientes con temblor esencial y no se encontró una correlación significativa entre la presencia de ansiedad, depresión y el estado cognitivo con la calidad de vida de éstos pacientes. Discusión: Las comorbilidades, medidas con el índice de Charlson, no se correlacionan con la calidad de vida y sus distintas esferas en pacientes con temblor esencial.
Introduction: Essential tremor is the most frequent movement disorder, is characterized as a postural tremor of 4-12 Hz frequency. Is a chronic, progressive and neurodegenerative disease that has a heterogeneous impact on quality of life, considering that it is a prevalent disease in older adults who have comorbidities aging, it is necessary to determine to what extent these comorbidities affect different areas of quality of life. Methods: The presence of comorbidities were analyzed using the Charlson index adjusted for age, focused on the relation of these comorbidities with the quality of life, emotional scope and functionality of patients with essential tremor. Results: One hundred and thirty two patientes with essential tremor were studied. We did not find a significant correlation between the presence of anxiety, depression and cognitive status with the quality of life of these patients. Discusion: Comorbidities assessed by the Charlson index do not correlate with quality of life in patients with essential tremor.
Assuntos
Humanos , Qualidade de Vida , Comorbidade , Tremor EssencialRESUMO
Se realizó un estudio observacional, descriptivo y transversal de 175 pacientes con trastornos del movimiento que asistieron a la Consulta de Neurología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" desde el 2007 hasta el 2010, con vistas a describir la morbilidad en estos. Dichas afecciones iniciaron durante la quinta y sexta décadas de la vida en la mayoría de los integrantes de la casuística, con una frecuencia superior de la enfermedad de Parkinson, el temblor esencial y las distonías, y prevalencia del sexo masculino y el color de la piel mestizo. La electromiografía de los músculos agonistas y antagonistas evidenció el predominio del temblor de reposo y la disfunción en la inhibición recíproca, sobre todo en la enfermedad de Parkinson.
An observational, descriptive and cross-sectional study of 175 patients with movement disorders who attended the Neurology Department in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital was carried out from 2007 to 2010, aimed at describing the morbidity in them. These disorders began during the fifth and sixth decades of life in most of the members of the case material, with a higher frequency of Parkinson disease, the essential tremor and dystonias, and prevalence of the male sex and half-bred skin. The electromyography of the agonistic and antagonistic muscles evidenced the prevalence of the rest tremor and the disorder in the reciprocal inhibition, mainly in the Parkinson disease.
RESUMO
Introduction: Essential tremor is commonly considered as a benign and high prevalence disease; however its study is not systematized even in its definition. Methods: We did a literature review related to essential tremor enhanced with our own experience in this matter. Results: We performed a critical review of different issues of essential tremor from definition to association to others neurological diseases. We focused on controversial points and lesser known issues by a non specialist physician. Discussion: We analyzed the complexity of this disease, its association with other neurological diseases, in particular Parkinson disease and cognitive decline. We proposed different variants ofessential tremor according prognosis. Conclusion: Essential tremor is a heterogeneous disease from clinical and etiological point of view. There are variants with different long term outcome.
Introducción: El temblor esencial es habitualmente considerado una patología benigna y de alta prevalencia, sin embargo su estudio ha sido poco sistematizado, aún en la misma definición del cuadro. Método: Se realiza una revisión de la literatura, enriquecida con la propia experiencia de los autores en el tema. Resultados: Se analizan de manera crítica diversos tópicos relacionados con temblor esencial, desde su definición hasta la asociación con otras patologías neurológicas, haciendo hincapié en puntos de mayor controversia y poco conocidos por el médico no especializado en el tema. Discusión: Se analiza la complejidad del cuadro, su asociación con una serie de patologías neurológicas, en particular enfermedad de Parkinson y deterioro cognitivo, proponiéndose variantes de temblor esencial de acuerdo a su pronóstico. Conclusión: El temblor esencial es un cuadro heterogéneo tanto clínicamente como desde una perspectiva etiológica. Existen variantes con distinto pronóstico a largo plazo.