Tremor amplitude is logarithmically related to 4- and 5-point tremor rating scales

Elble, Rodger J.; Pullman, Seth L.; Matsumoto, Joseph Y.; Raethjen, Jan; Deuschl, Günther; Tintner, Ron

doi:10.1093/brain/awl190

Cited by 166 publications

(185 citation statements)

References 12 publications

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“…The Bain scale (Bain et al., 1993) evaluated severity of patient's head, voice tremors, and postural tremor of the both upper and lower limbs. The modified FTM rating scale (Elble et al., 2006) graded severity of the tremor during daily life activities, specifically finger‐ and dot‐pointing, Archimedes spiral drawing, drawing of a straight line and sine wave, handwriting, and water pouring for both hands. Physiological tremor measures were recorded in the vertical axis using a tri‐axial accelerometer, that is, Tremorometer (160‐Hz sampling rate, 2 mg resolution; FlexAble‐Systems, Fountain Hills, AZ) (Caligiuri & Tripp, 2004).…”

Section: Methodsmentioning

confidence: 99%

White matter measures correlate with essential tremor severity—A pilot diffusion tensor imaging study

et al. 2018

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BackgroundAn evolving pathophysiological concept of essential tremor (ET) points to diffuse brain network involvement, which emphasizes the need to investigate white matter (WM) changes associated with motor symptoms of ET.ObjectivesTo investigate ET‐related WM changes and WM correlates of tremor severity using tremor clinical rating scales and accelerometry.MethodsTract‐based spatial statistics (TBSS) approach was utilized to compare 3 Tesla diffusion tensor imaging (DTI) data from 12 ET patients and 10 age‐ and gender‐matched healthy individuals. Clinical scales, tremor frequency and amplitude as measured by accelerometry were correlated with DTI data.Results ET patients demonstrated mean (MD) and radial diffusivity (RD) abnormalities in tracts involved in primary and associative motor functions such as bilateral corticospinal tracts, the superior longitudinal fascicles, and the corpus callosum but also in nonmotor regions including the inferior fronto‐occipital and longitudinal fascicles, cingulum bundles, anterior thalamic radiations, and uncinate fascicles. A combined tremor frequency and amplitude score correlated with RD and MD in extensive WM areas, which partially overlapped the regions that were associated with tremor frequency. No significant relationship was found between DTI measures and clinical rating scales scores.ConclusionsThe results show that ET‐related diffusion WM changes and their correlates with tremor severity are preferentially located in the primary and associative motor areas. In contrast, a relationship between WM was not detected with clinical rating scales. Accelerometry parameters may, therefore, serve as a potentially useful clinical measures that relate to WM deficits in ET.

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Section: Methodsmentioning

confidence: 99%

White matter measures correlate with essential tremor severity—A pilot diffusion tensor imaging study

et al. 2018

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“…Presently, a new scale [the essential tremor rating assessment scale (TETRAS)] is under development for tremor rating [14]. Another tool is accelerometry, which informed early propranolol and primidone trials, and there is good correlation between clinical ratings and log-transformed transducer measures of tremor, as predicted by the Weber-Fechner laws of psychophysics [15]. Action tremor can be reliably measured with spiral drawing [16,17].…”

Section: Measurements Of Tremormentioning

confidence: 99%

“…At least 50 % of patients experienced some benefit, and occasional "dramatic responders" have been [27] Acetazolamide/methazolamide Olanzapine Clozapine (18-75 mg) [28] Amantadine Pregabalin Flunarizine (10 mg) [29] Carisbamate Tiagabine Nadolol (120-240 mg) [30] Isoniazid Sodium oxybate Nimodipine (120 mg) [31] Levetiracetam Zonisamide Botulinum toxin (depending on injected muscles) Patients in the surgical studies usually have much higher tremor amplitudes. Tremor amplitude estimation is based on standard algorithms computed as change in tremor rating scale and change in tremor amplitude on accelerometry [9,15] described. However, there are no known predictors of response [45].…”

Section: Primidonementioning

confidence: 99%

“…However, side effects are common and frequently doselimiting (see below). The average study cohort size was 18 adults (range, [11][12][13][14][15][16][17][18][19][20][21][22], and thus similar to beta blocker studies, but many randomized patients in studies did not complete the trials. Besides drowsiness and dizziness reported by most patients on total daily dosages of 500 mg or more, children, elderly, and patients with comorbid psychiatric disorders are prone to develop depression, cognitive, and behavioral effects.…”

Section: Primidonementioning

confidence: 99%

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The Treatment of Tremor

Schneider

Deuschl

2014

Neurotherapeutics

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Tremor is a hyperkinetic movement disorder characterized by rhythmic oscillations of one or more body parts. It can be disabling and may impair quality of life. Various etiological subtypes of tremor are recognized, with essential tremor (ET) and Parkinsonian tremor being the most common. Here we review the current literature on tremor treatment regarding ET and head and voice tremor, as well as dystonic tremor, orthostatic tremor, tremor due to multiple sclerosis (MS) or lesions in the brainstem or thalamus, neuropathic tremor, and functional (psychogenic) tremor, and summarize main findings. Most studies are available for ET and only few studies specifically focused on other tremor forms. Controlled trials outside ET are rare and hence most of the recommendations are based on a low level of evidence. For ET, propranolol and primidone are considered drugs of first choice with a mean effect size of approximately 50 % tremor reduction. The efficacy of topiramate is also supported by a large double-blind placebocontrolled trial, while other drugs have less supporting evidence. With a mean effect size of about 90 % deep brain stimulation in the nucleus ventralis intermedius or the subthalamic nucleus may be the most potent treatment; however, there are no controlled trials and it is reserved for severely affected patients. Dystonic limb tremor may respond to anticholinergics. Botulinum toxin improves head and voice tremor. Gabapentin and clonazepam are often recommended for orthostatic tremor. MS tremor responds only poorly to drug treatment. For patients with severe MS tremor, thalamic deep brain stimulation has been recommended. Patients with functional tremor may benefit from antidepressants and are best be treated in a multidisciplinary setting. Several tremor syndromes can already be treated with success. But new drugs specifically designed for tremor treatment are needed. ET is most likely covering different entities and their delineation may also improve treatment. Modern study designs and long-term studies are needed.

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“…Numerous methods with different sensors, including EMG [2,15,17,25,44], spirograms [7,37], and gyroscopes [23,32,38], have been used to quantify tremor. Accelerometers have been applied outside the operating room (OR) for a wide variety of purposes, e.g., to characterize pathological tremor [8,13], to compare it with physiological tremor [20,35,36], and to evaluate the severity and evolution of tremor [28,29,40] and the tremor-alleviating effect of drugs or DBS [22,36,47].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative acceleration measurements to quantify improvement in tremor during deep brain stimulation surgery

Shah

Coste

Lemaire

et al. 2016

Med Biol Eng Comput

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Intraoperative acceleration measurements to quantify improvement in tremor during deep brain stimulation surgery. Medical and Biological Engineering and Computing, Springer Verlag, 2017, 55 (5) AbstractDeep brain stimulation (DBS) surgery is extensively used in the treatment of movement disorders. Nevertheless, methods to evaluate the clinical response during intraoperative stimulation tests to identify the optimal position for the implantation of the chronic DBS lead remain subjective. In this paper, we describe a new, versatile method for quantitative intraoperative evaluation of improvement in tremor with an acceleration sensor that is mounted on the patient's wrist during surgery. At each anatomical test position, the improvement in tremor compared to the initial tremor is estimated on the basis of extracted outcome measures. This method was tested on 15 tremor patients undergoing DBS surgery in two centers. Data from 359 stimulation tests were acquired. Our results suggest that accelerometric evaluation detects tremor changes more sensitively than subjective visual ratings. The effective stimulation current amplitudes identified from the quantitative data (1.1 ± 0.8 mA) are lower than those identified by visual evaluation (1.7 ± 0.8 mA) for similar improvement in tremor. Additionally, if these data had been used to choose the chronic implant position of the DBS lead, 15 of the 26 choices would have been different. These results show that our method of accelerometric evaluation can potentially improve DBS targeting.

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Tremor amplitude is logarithmically related to 4- and 5-point tremor rating scales

Cited by 166 publications

References 12 publications

White matter measures correlate with essential tremor severity—A pilot diffusion tensor imaging study

White matter measures correlate with essential tremor severity—A pilot diffusion tensor imaging study

The Treatment of Tremor

Intraoperative acceleration measurements to quantify improvement in tremor during deep brain stimulation surgery

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