What is the functional significance of nondominant arm tremor in essential tremor?

Louis, Elan D.; Gerbin, Marina; Mullaney, Mary M.

doi:10.1002/mds.23284

Cited by 11 publications

(8 citation statements)

References 16 publications

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“…A 10-item tremor disability questionnaire (range: 0–20, higher scores indicate greater disability) was administered ( 33 , 34 ). Participants were asked about their difficulty with a range of daily activities: “carrying a cup of coffee,” “dialing a telephone,” etc.…”

Section: Methodsmentioning

confidence: 99%

The Experience of Essential Tremor Caregivers: Burden and Its Correlates

et al. 2017

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BackgroundEssential tremor (ET) is associated with physical and cognitive impairments, as well as embarrassment, avoidance of social settings, and related difficulties that negatively impact the lives of patients. In similar disease contexts, burden on friends and relatives acting as caregivers has been noted and has well-documented implications. There has been no study examining caregiver burden related to ET.MethodsData were gathered from 55 ET participants enrolled in a clinical study and their caregivers. The Zarit Burden Interview was used to assess caregiver burden. To assess clinical features that may be associated with burden, we collected several variables including the Montreal Cognitive Assessment, self-reported tremor disability, a videotaped neurological examination, questionnaires assessing ET participants’ suffering, caregivers’ perceptions of that suffering, and both caregiver and ET participant depressive symptoms. Spearman’s correlations were performed between caregiver burden and clinical features, and we created a multivariate linear regression model predicting caregiver burden.ResultsMany ET caregivers provide little to no care and experience little to no burden. However, some caregivers (11%) provide over 25 h of care/week, and 13% experience high levels of burden. Caregivers most commonly provided assistance with writing and cooking. Increased burden was associated with the ET participants’ decreased cognition, more caregiving tasks, more hours/week of caregiving activities, a longer duration of care, more ET participant falls/year, more medications taken by the ET participant, and more depressive symptoms in both the ET participant and the caregiver (all p < 0.05). ET participants’ suffering and their caregivers’ perceptions of suffering were both associated with increased burden. Neither tremor severity score nor self-reported tremor disability score was associated with increased caregiver burden. Using a multivariate linear regression model, we found that caregivers’ increased perception of their partners’ suffering was the best predictor of caregiver burden.ConclusionWhile not all relatives and friends of ET patients provide extensive care or experience high burden, there is a group reporting high levels of caregiver burden that requires the attention and counseling of clinicians. This burden is associated with primarily non-tremor symptoms of ET and with caregivers’ perception that their partners are suffering.

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Section: Methodsmentioning

confidence: 99%

The Experience of Essential Tremor Caregivers: Burden and Its Correlates

et al. 2017

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“…With disease progression, tremor can interfere with activities of daily functioning such as eating and grooming. Tremors in both dominant and non-dominant hands can cause functional disability 23. Older patients have more rapid progression of tremor.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Essential tremor: diagnosis and management

Shanker

2019

BMJ

117

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Essential tremor is one of the most common movement disorders in adults and can affect both children and adults. An updated consensus statement in 2018 redefined essential tremor as an isolated action tremor present in bilateral upper extremities for at least three years. Tremor may also be present in other locations, commonly the neck or the vocal cords. Patients with additional neurologic symptoms are now categorized as “essential tremor plus.” Additional clinical features associated with the condition include but are not limited to cognitive impairment, psychiatric disorders, and hearing loss. When treatment is needed, propranolol and primidone are considered first line treatments. Patients who are severely affected are often offered deep brain stimulation. Although the ventral intermediate nucleus of the thalamus is the traditional surgical target, the caudal zona incerta is also being studied as a possible superior alternative. Magnetic resonance imaging guided high intensity focused ultrasound is a newer surgical alternative that may be ideal for patients with substantial medical comorbidities. Current research explores novel oral treatments, chemodenervation, and noninvasive neuromodulation for treatment of essential tremor.

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“…Essential tremor (ET) is an adult-onset neurological disorder that is common in older adults [1]. Its prevalence of 2-5% [2,3] exceeds the prevalence of epilepsy, multiple sclerosis, or stroke [4].…”

Section: Introductionmentioning

confidence: 99%

Comparative Evaluation of Magnetic Resonance-Guided Focused Ultrasound Surgery for Essential Tremor

Kim

Jung

Park

et al. 2017

Stereotact Funct Neurosurg

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Background: Treatment options for patients with drug-resistant essential tremor (ET) are limited. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is an emerging technique to treat refractory ET. Objectives: To present MRgFUS as an alternative to radiofrequency (RF) thalamotomy or deep brain stimulation (DBS) for ET treatment. Methods: We retrospectively analyzed 59 patients who underwent unilateral surgery for drug-resistant ET. Treatments included RF thalamotomy (n = 17), DBS (n = 19), and MRgFUS (n = 23). The outcomes measured were tremor severity and treatment-related complications. Results: At 1 month postoperatively, 100% of RF thalamotomy patients, 89.5% of DBS patients, and 91.3% of MRgFUS patients exhibited absent/mild tremor (successful treatment); other patients exhibited partial relief. At 12 months postoperatively, treatment success for each procedure was observed in 70.6, 84.2, and 78.3% of patients, respectively. At 1 month postoperatively, treatment-related complications had occurred in 58.8, 5.3, and 13.0% of patients, respectively. At 12 months postoperatively, side effects persisted in 11.8, 21.1, and 4.4% of patients, respectively. No statistical differences in treatment success were observed between treatments or over time. Complication rates differed between treatment modalities (p < 0.01) and were lowest in the MRgFUS group. Conclusions: Patients with drug-resistant ET received equivalent results from RF thalamotomy, DBS, and MRgFUS. DBS and MRgFUS resulted in fewer treatment-related complications.

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What is the functional significance of nondominant arm tremor in essential tremor?

Cited by 11 publications

References 16 publications

The Experience of Essential Tremor Caregivers: Burden and Its Correlates

The Experience of Essential Tremor Caregivers: Burden and Its Correlates

Essential tremor: diagnosis and management

Comparative Evaluation of Magnetic Resonance-Guided Focused Ultrasound Surgery for Essential Tremor

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