Hand tremor in patients with spasmodic torticollis

Abstract

The occurrence of hand tremors in patients with spasmodic torticollis (ST) was investigated in 55 patients by clinical and quantitative measurements. Ten patients had first-order or second-order relatives affected with postural tremor. Although 40% of the patients had a medical history and clinical findings for mild postural and action tremor of the hands, only four had moderate tremor amplitudes. One patient had a severe tremor, including resting tremor, and two had mild voice tremor. A positive correlation was found between hand and head tremor. Patients with hand tremor were younger at the onset of ST than were those without. The mean amplitudes of postural tremor were only slightly higher than for the controls and much smaller than those found in classic essential tremor. The tremor caused only mild disabilities. The tremor frequencies were indistinguishable from physiologic tremor. Further analysis of the tremor records showed evidence for physiologic tremor mechanisms only. We conclude that slightly enhanced postural hand tremors are common in ST but have a low amplitude and are only rarely clinically relevant for ST patients. Although the present data support the notion of an enhanced risk of postural tremor in families of patients affected with ST, none of the criteria allowed the separation of the hand tremor of ST from other postural/action tremors and especially from enhanced physiologic tremor. Thus, the present data do not support the classification of hand tremor in ST as either "dystonic" or essential tremor.

A Clinical Profile of 125 Patients with Writer's Cramp

“…Presentation of the patients with WC is quite variable and ranges from mild involvement with abnormal posturing of only the fingers while writing to severe forms where there may be involvement of the wrist, elbow and the shoulder. It is known to be associated with other dystonias mainly cervical dystonia [3]. Many different therapeutic options have been used in WC ranging from anti-dystonic medications such as anti-cholinergics, baclofen, benzodiazepines, injection of botulinum toxin and sensory motor training [4].…”

Dystonia with Tremors: A Clinical Approach

“…Cervical dystonia has been reported in 0.6~30% of patients with ET (Critchley, 1972;Baxter and Lal, 1979;Martinelli and Gabellini, 1982;Rajput et al, 1984;Lou and Jankovic, 1991;Koller et al, 1994;TallonBarranco et al,1997, as cited in Munchau et al, 2001. Additionally, postural and kinetic tremors are found in 4-55% of patients with cervical dystonia (Patterson and Little, 1943;Couch, 1976;Chan et al, 1991;Lang et al, 1992;Dubinski et al, 1993;Deuschl et al, 1997Deuschl et al, , 1998, as cited in Munchau et al, 2001). In 1991, Lou and Jankovic reported 47% of patients with ET had dystonia, but this analysis found no support for the differentiation of ET subtypes although it was heterogenous in its clinical presentation (Lou and Jankovic, 1991).…”

“…However, in a study on tremors with 55 cervical dystonia patients, hand tremors in patients with cervical dystonia more closely resembled an enhanced physiological tremor than a dystonic tremor or ET (Deuschl et al 1997). In addition, arm tremors in patients with cervical dystonia was found to develop either before or simultaneously with the onset of torticollis; such a temporal relationship does not correspond to a dystonic tremor either (Munchanu et al, 2001).…”

“…It is uncertain whether this type of tremor is the cormorbid occurrence of ET along with dystonia (Lou & Jankovic, 1991) or is a distinct entity (Deuschl et al, 1997;Munchanu., 2001;Shaikh et al, 2008). A typical type is an upper limb postural tremor in patients with cervical dystonia.…”

“…A typical example of this type is an isolated tremor occurring in a patient with first-degree relatives with spasmodic torticollis (Deuschl et al, 1997;Yanagisawa et al, 1972).…”