Postural and Intention Tremors: A Detailed Clinical Study of Essential Tremor vs. Parkinson's Disease.
Postural and Intention Tremors: A Detailed Clinical Study of Essential Tremor vs. Parkinson's Disease.
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DOI：
10.3389/fneur.2013.00051
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发表时间：
2013
影响因子：
3.4
通讯作者：
Louis ED
中科院分区：
文献类型：
--
作者：
Sternberg EJ;Alcalay RN;Levy OA;Louis ED
背景资料：据估计，30-50%的特发性震颤（ET）诊断是不正确的，这些患者的真正诊断通常是帕金森病（PD）或其他震颤障碍。关于ET和PD的震颤有一般性的陈述，但关于震颤更微妙特征的已发表数据令人惊讶地有限。姿势性震颤可能发生在这两种疾病，增加了困难。关于ET与PD中姿势性震颤的具体特征，有几个轶事印象，包括联合分布（例如，指骨、掌-指关节、腕），震颤方向性（例如，屈曲-伸展对旋前-旋后），以及存在意向性震颤。然而，几乎没有数据支持这些印象。方法：在这项横断面研究中，100例患者（ET，50 PD）进行了详细的神经系统检查录像。手臂震颤由运动障碍神经学家评定，他评估了多个关节的严重程度和方向性。结果如下：在持续的手臂伸展过程中，ET患者比PD患者表现出更多的腕部震颤而不是掌指和指关节震颤（p < 0.001），并且腕部屈曲-伸展震颤比腕部旋前-旋后震颤更多（p < 0.001）。在手指-鼻子-手指动作期间，ET患者中约有四分之一（28%）出现意向性震颤，而帕金森患者中几乎没有（4%）出现意向性震颤（p < 0.001）。结论：我们评估了ET和PD中姿势性震颤的位置、严重程度和方向性，以及意向性震颤的存在，观察了几个临床差异。我们希望详细的震颤在ET和PD的现象学数据将有助于执业医师划定这两种疾病。
Background: An estimated 30–50% of essential tremor (ET) diagnoses are incorrect, and the true diagnosis in those patients is often Parkinson’s disease (PD) or other tremor disorders. There are general statements about the tremor in these ET and PD, but published data on the more subtle characteristics of tremor are surprisingly limited. Postural tremor may occur in both disorders, adding to the difficulty. There are several anecdotal impressions regarding specific features of postural tremor in ET vs. PD, including joint distribution (e.g., phalanges, metacarpal-phalangeal joints, wrist), tremor directionality (e.g., flexion-extension vs. pronation-supination), and presence of intention tremor. However, there is little data to support these impressions. Methods: In this cross-sectional study, 100 patients (ET, 50 PD) underwent detailed videotaped neurological examinations. Arm tremor was rated by a movement disorder neurologist who assessed severity and directionality across multiple joints. Results: During sustained arm extension, ET patients exhibited more wrist than metacarpal-phalangeal and phalangeal joint tremor than did PD patients (p < 0.001), and more wrist flexion-extension tremor than wrist pronation-supination tremor (p < 0.001). During the finger-nose-finger maneuver, intention tremor was present in approximately one in four (28%) ET patients vs. virtually none (4%) of the Parkinson’s patients (p < 0.001). Conclusions: We evaluated the location, severity, and directionality of postural tremor in ET and PD, and the presence of intention tremor, observing several clinical differences. We hope that detailed phenomenological data on tremor in ET and PD will help practicing physicians delineate the two diseases.
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Jain, Samay;Lo, Steven E.;Louis, Elan D.
通讯作者：
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通讯作者：
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通讯作者：
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