Unusual tremor syndromes: know in order to recognise

Abstract

Tremor is a common neurological condition in clinical practice; yet, few syndromes are widely recognised and discussed in the literature. As a result, there is an overdiagnosis of well-known causes, such as essential tremor. Many important unusual syndromes should be considered in the differential diagnosis of patients with tremor. The objective of this review is to provide broad clinical information to aid in the recognition and treatment of various unusual tremor syndromes in the adult and paediatric populations. The review comprised of a comprehensive online search using PubMed, Ovid database and Google Scholar to identify the available literature for each unusual tremor syndrome. The review includes fragile X-associated tremor/ataxia syndrome, spinocerebellar ataxia type 12, tremors caused by autosomal recessive cerebellar ataxias, myorhythmia, isolated tongue tremor, Wilson's disease, slow orthostatic tremor, peripheral trauma-induced tremor, tardive tremor and rabbit syndrome, paroxysmal tremors (hereditary chin tremor, bilateral high-frequency synchronous discharges, head tremor, limb-shaking transient ischaemic attack), bobble-head doll syndrome, spasmus nutans and shuddering attacks. Rare tremors generally present with an action tremor and a variable combination of postural and kinetic components with resting tremors less frequently seen. The phenomenology of myorhythmia is still vague and a clinical definition is proposed. The recognition of these entities should facilitate the correct diagnosis and guide the physician to a prompt intervention.

Systematic review of movement disorders and oculomotor abnormalities in Whipple's disease

“…Some of the cases we reviewed predated that report. Since then various definitions of myorhythmia, both in the context of WhD and distinct from it, have been proposed in the literature . The consensus is that myorhythmia represents a slow (1‐4 Hz) rhythmic or semirhythmic form of segmental myoclonus.…”

What is “essential” about essential tremor? A diagnostic placeholder

“…We would prefer upholding the general concept of distinct types of tremor in PD (types II and III tremor) as well as “tremor associated with dystonia” and “with dystonia gene” introduced in the first consensus classification . Having a designation of “ET plus” distracts from the proper evaluation of patients with, for example, tremor and ataxia for whom such disorders as fragile X–associated tremor/ataxia syndrome, spinocerebellar ataxia 12, and so on are pertinent to investigate …”

“…13 Having a designation of "ET plus" distracts from the proper evaluation of patients with, for example, tremor and ataxia for whom such disorders as fragile X-associated tremor/ataxia syndrome, spinocerebellar ataxia 12, and so on are pertinent to investigate. 14…”

Antipsychotic-Induced Tardive Syndromes: Clinical Features and Treatment Approaches

“…Kişisel duyarlılık, ileri yaş, kadın cinsiyet, ailesel yatkınlık ve AIDS antipsikotiklere bağlı tremor için risk faktör-leri arasındadır. 53,54 Geç tremor, ilk olarak Jankovic tarafından tanımlanmıştır. 12 Antipsikotik ilaç kullanan hastalarda, parkinsonizm belirtileri olmaksızın, görülen yüksek amplütüdlü (3-5 Hz arası), orta frekanslı, postural, hareket veya dinlenme tremorunun gö-rüldüğü geç bir sendromdur.…”