Essential pitfalls in “essential” tremor

Espay, Alberto J.; Lang, Anthony E.; Erro, Roberto; Merola, Aristide; Fasano, Alfonso; Berardelli, Alfredo; Bhatia, Kailash P.

doi:10.1002/mds.26919

Cited by 84 publications

(75 citation statements)

References 61 publications

(93 reference statements)

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“…25 Essential tremor can be viewed more as a syndrome of different clinical features than a single entity. 10 The presence of ET can cause significant functional and psychological disability, and hence the term "benign" has largely been abandoned in its nomenclature. 14 The incidence is higher in the white than in the African American population.…”

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confidence: 99%

A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor

Mohammed

Patra

Nanda

2018

Neurosurgical Focus

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OBJECTIVEMagnetic resonance–guided focused ultrasound (MRgFUS) is a novel technique that uses high-intensity focused ultrasound to achieve target ablation. Like a lens focusing the sun’s rays, the ultrasound waves are focused to generate heat. This therapy combines the noninvasiveness of Gamma Knife thalamotomy and the real-time ablation of deep brain stimulation with acceptable complication rates. The aim of this study was to analyze the overall outcomes and complications of MRgFUS in the treatment of essential tremor (ET).METHODSA meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was made by searching PubMed, Cochrane library database, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Patients with the diagnosis of ET who were treated with MRgFUS were included in the study. The change in the Clinical Rating Scale for Tremor (CRST) score after treatment was analyzed. The improvement in disability was assessed with the Quality of Life in Essential Tremor Questionnaire (QUEST) score. The pooled data were analyzed by the DerSimonian-Laird random-effects model. Tests for bias and heterogeneity were performed.RESULTSNine studies with 160 patients who had ET were included in the meta-analysis. The ventral intermediate nucleus was the target in 8 of the studies. The cerebellothalamic tract was targeted in 1 study. There was 1 randomized controlled trial, 6 studies were retrospective, and 2 were prospective. The mean number of sonications given in various studies ranged from 11 ± 3.2 to 22.5 ± 7.5 (mean ± SD). The maximum delivered energy ranged from 10,320 ± 4537 to 14,497 ± 6695 Joules. The mean of peak temperature reached ranged from 53°C ± 2.3°C to 62.0°C ± 2.5°C. On meta-analysis with the random-effects model, the pooled percentage improvements in the CRST Total, CRST Part A, CRST Part C, and QUEST scores were 62.2%, 62.4%, 69.1%, and 46.5%, respectively. Dizziness was the most common in-procedure complication, occurring in 43.4%, followed by nausea and vomiting in 26.85% (pooled percentage). At 3 months, ataxia was the most common complication, occurring in 32.8%, followed by paresthesias in 25.1% of the patients. At 12 months posttreatment, the ataxia had significantly recovered and paresthesias became the most common persisting complication, at 15.3%.CONCLUSIONSThe MRgFUS therapy for ET significantly improves the CRST scores and improves the quality of life in patients with ET, with an acceptable complication rate. Therapy with MRgFUS is a promising frontier in functional neurosurgery.

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A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor

Mohammed

Patra

Nanda

2018

Neurosurgical Focus

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“…Patients who have tremor alone may be diagnosed initially with ET but, later, are at a level of diagnostic uncertainty when they develop dystonia. It is difficult to ascertain whether to categorize their condition as tremor in dystonia or as ET with dystonia . Tremor found in dystonia may be differentiated from that of ET by clinical evaluation (irregular, asymmetrical, the presence of sensory tricks in tremor with dystonia) and neurophysiological tests (less tremor amplitude, impaired blink reflex, abnormal temporal and somatosensory discrimination thresholds in tremor with dystonia) …”

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Tremor in Dystonia: A Cross‐sectional Study from India

Pandey

Sarma

2017

Movement Disord Clin Pract

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View Supplementary Video 1 View Supplementary Video 2 View Supplementary Video 3 View Supplementary Video 4 View Supplementary Video 5 Background Tremor is an important phenotypic motor feature in dystonia, but there is limited literature regarding its prevalence and phenomenology. Methods This cross‐sectional study included 90 patients with adult‐onset, isolated dystonia from a tertiary care movement disorder center in India. Patients were assessed for tremor in the head and in different body parts. Surface electromyography studies of tremor were recorded of the involved limb in different positions. Results Tremor was present in 41 patients (45.55%) who had dystonia, including 21 of 41 patients (51.21%) with cervical dystonia, 15 of 34 (44.11%) with limb dystonia, and 5 of 15 (33.33%) with cranial dystonia. Significantly later age at presentation (47.19 ± 14.55 years vs. 40.39 ± 13.74 years; P = 0.012) and longer disease duration (5.11 ± 5.85 years vs. 2.60 ± 2.57 years; P = 0.004) were observed in patients with versus without tremor. Upper limb tremor was present in 33 patients, head tremor was present in 14, and leg tremor was present in 2. Tremor was present in 17 of 25 patients (68%) with segmental dystonia and in 6 of 9 (66.66%) with multifocal dystonia. Tremor was least frequent in patients with focal dystonia (18 of 56 patients; 32.14%). Conclusions Tremor was common (>45%) in patients with primary adult‐onset dystonia. Patients who had tremor were older and had a longer duration of symptoms. Patients with segmental and multifocal dystonia had more tremor than those with focal dystonia. In contrast to some other studies, the current patients had more upper limb tremor than head tremor, and a combination of dystonic tremor and tremor associated with dystonia was more common than isolated dystonic tremor.

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“…The construct of essential tremor (ET) likely generated the greatest challenge, and indeed the consensus statement admitted that some of the members of the task force wanted to abandon the term altogether. Its acceptance as a syndrome is a recognition that, collectively, ET never had the genetic, biological/molecular, or pathologic correlates expected of a disorder . This is a major step forward because the concept of ET as “one of the most common neurological diseases ” remains in use .…”

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“…Its acceptance as a syndrome is a recognition that, collectively, ET never had the genetic, biological/molecular, or pathologic correlates expected of a disorder. 2 This is a major step forward because the concept of ET as "one of the most common neurological diseases" remains in use. 3 The consensus statement further aims to adopt the 2-axis approach proposed as a classification scheme for dystonia (axis 1, clinical characteristics; axis 2, etiology).…”

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confidence: 99%