Essential Tremor

Essential tremor is a common neurologic problem seen widely at all levels of patient care. It should be differentiated from secondary causes of tremor and Parkinson disease. It can be managed with commonly used drugs. However, severe, resistant, or atypical cases should be referred to a specialist for evaluation and the possible use of botulinum toxin or deep brain stimulation.

This study sought to assess the psychometric attributes of the Quality of Life in Essential Tremor Questionnaire (QUEST) by undertaking an independent validation.This was an observational, multicenter, cross-sectional study carried out in Neurology Departments of general hospitals. The following assessments were applied: Louis Rating Scale, Clinical Assessment of Tremor, Clinical Global Impression of Severity (CGI-ET), Hospital Anxiety and Depression Scale (HADS), EQ-5D, and QUEST (Spanish version).One hundred and eighteen consecutive patients were included. According to the CGI-ET, most of patients had mild (42.4%) or moderate (43.2%) impact of tremor on performing daily activities. Fully computable QUEST data were 60.2%. The QUEST Summary Index (QUEST-SI) displayed marginal floor or ceiling effect. On the whole, QUEST internal consistency and reproducibility were satisfactory (Cronbach's alpha values: 0.73–0.86; QUEST-SI intraclass correlation coefficient: 0.77). Factor analysis identified eight factors (73.6% of the variance) that could be grouped into six, relatively coincident with the questionnaire's dimensions. The QUEST-SI correlated moderately with the EQ-5D index (rS = −0.40), HADS—Depression (rS = 0.39), and CGI-ET (rS = 0.39), and strongly with the QUEST scale for self-evaluation of tremor severity (rS = 0.63). The standard error of measurement was 8.00.Apart from a substantial problem of acceptability, most of the tested psychometric attributes of the QUEST resulted satisfactory.

Deep brain stimulation (DBS) is highly effective neurosurgery for idiopathic Parkinson's disease (IPD), essential tremor (ET) and primary dystonia. DBS involves stereotactic surgical implantation of a battery-operated stimulator into deep brain nuclei. Irish patients are referred abroad for DBS and have to travel repeatedly for pre and post-operative care resulting in stress, anxiety and hardship. Safe pre and post-operative care of these complex, ageing patients is compromised by the absence of a DBS service in Ireland. Moreover, both DBS surgery and the subsequent post-operative care abroad incurs substantial cost to the state. The Dublin Neurological Institute at the Mater Misericordiae University Hospital (DNI) is a non-profit institute for the care of patients with neurological diseases. The DNI developed, in collaboration with the Mater Private Hospital (MPH) and the Walton Centre, Liverpool, a DBS programme in 2008/2009. We performed DBS at the Mater Campus on three caref...

Objectives: In epilepsy patients many factors affct the quality of the life and sleep. The determinations of these factors are important in the dimension of improving both quality of life and sleeping. The aim of our study is to examine how socio-economic and clinical variables might inflence the quality of life and sleep in young male patients with epilepsy.
Methods: Participants were recruited from our outpatient clinic and diagnosed as epilepsy by a neurologist. Only male patients were included. All patients completed a semi-structured interview form for epilepsy patients as well as the Quality of Life in Epilepsy Inventory (QOLIE-31), the Beck Depression Inventory (BDI) and Pittsburgh Sleep Disorders Index (PSDI) under the supervision of the same neurology specialist. Finally,
obtained test results in epilepsy patients were evaluated and examined the relationship among socio-economic and clinical factors.
Results: The lowest score of the QOLIE-31 sub-scores of the patients were about “seizure concern”. Age, duration of the disease and drug use did not signifiantly effct the total scores of QOLIE-31, BDI and PSDI. QOLIE-31 total scores of patients with moderate-to-good level of economic status were better than the ones with poor economic status. Patients with frequent number of seizures had more concerns and burnout than the ones with rare number of seizures. Also sleep disorder scores were worse with the patients who had frequent seizures.
Conclusion: Epilepsy patients have high anxiety to have seizure. On the other hand low economic status, having frequent number of seizures, sleep disturbances and presence of depressive symptoms decrease the quality of life. Detection and correction of these factors would improve sleep and quality of life in these patients and also would increase treatment compliance and success.

Role of basal ganglia: Vesalius and Piccolomini distinguished subcortical nuclei from cortex and white matter in the 16th century. Willis' mistaken concept in the late 17th century that the corpus striatum was the seat of motor power persisted for 200 years and formed the basis of mid-19th-century localizations of movement disorders to the striatum (chorea by Broadbent and Jackson, and athetosis by Hammond). By the late 19th century, many movement disorders were described but for most no pathologic correlate was known. Tremor: Descriptions of tremors progressed from Galen's definition in the 2nd century; to Galileo's physiologic tremor in 1610; separation of involuntary movements during action and at rest in the 17th and 18th centuries by de la Boë Sylvius and van Sweiten; description of Parkinson's disease by Parkinson, discrimination of the rest tremor of Parkinson's disease from the intention tremor of multiple sclerosis by Charcot, and recognition of familial...

To determine placement of electrodes after deep brain stimulation (DBS) surgery, a novel toolbox that facilitates both reconstruction of the lead electrode trajectory and the contact placement is introduced. Using the toolbox, electrode placement can be reconstructed and visualized based on the electrode-induced artifacts on post- operative magnetic resonance (MR) or computed tomography (CT) images.
Correct electrode placement is essential for efficacious treatment with DBS. Post-operative knowledge about the placement of DBS electrode contacts and trajectories is a promising tool for clinical evaluation of DBS effects and adverse effects. It may help clinicians in identifying the best stimulation contacts based on anatomical target areas and may even shorten test stimulation protocols in the future.
Fifty patients that underwent DBS surgery were analyzed in this study. After normalizing the post-operative MR/CT volumes into standard Montreal Neurological Institute (MNI)-stereotactic space, electrode leads (n = 104) were detected by a novel algorithm that iteratively thresholds each axial slice and isolates the centroids of the electrode artifacts within the MR/CT-images (MR only n = 32, CT only n = 10, MR and CT n = 8). Two patients received four, the others received two quadripolar DBS leads bilaterally, summing up to a total of 120 lead localizations. In a second reconstruction step, electrode contacts along the lead trajectories were reconstructed by using templates of electrode tips that had been manually created beforehand. Reconstructions that were made by the algorithm were finally compared to manual surveys of contact localizations.
The algorithm was able to robustly accomplish lead reconstructions in an automated manner in 98% of electrodes and contact reconstructions in 69% of electrodes. Using additional subsequent manual refinement of the recon- structed contact positions, 118 of 120 electrode lead and contact reconstructions could be localized using the toolbox.
Taken together, the toolbox presented here allows for a precise and fast reconstruction of DBS contacts by proposing a semi-automated procedure. Reconstruction results can be directly exported to two- and three- dimensional views that show the relationship between DBS contacts and anatomical target regions. The toolbox is made available to the public in form of an open-source MATLAB repository.

Background: The microTargeting™ platform (MTP) stereotaxy system (FHC Inc., Bowdoin, Me., USA) was FDA approved in 2001 utilizing rapid-prototyping technology to create custom platforms for human stereotaxy procedures. It has also been called the STarFix (surgical targeting fixture) system since it is based on the concept of a patient- and procedure-specific surgical fixture. This is an alternative stereotactic method by

To compare the efficacy of clonidine vs propranolol in the control of essential tremor, a double-blind randomized controlled trial with a one year follow-up was designed to obtain 80 % power and 95 % confidence level. The participants (186 patients with the essential tremor diagnosis) were recruited from the community, 122 (65.6 %) of these patients completed the trial. They were assessed using a Clinical-Evaluation Scale for Tremor and were examined 5 times, once at baseline and 4 times during the treatment phase. We used ANOVA with Bonferroni corrections, a p> value of 0.01 was considered significant. Dropouts due to side effects were compared using the Fisher's exact X (2) test for two tails, a p>value of 0.05 was considered statistically significant. Propranolol as well as clonidine (p> = 0.005) proved to be statistically efficacious (p> = 0.0005). Propranolol was not more efficacious than clonidine (p> = 0.4). Dropouts were significantly higher in the clonidi...

Objective: To perform an evidence-based review of the safety and efficacy of botulinum neurotoxin (BoNT) in the treatment of movement disorders.Methods: A literature search was performed including MEDLINE and Current Contents for therapeutic articles relevant to BoNT and selected movement disorders. Authors reviewed, abstracted, and classified articles based on American Academy of Neurology criteria (Class I–IV).Results: The highest quality literature available for the respective indications was as follows: blepharospasm (two Class II studies); hemifacial spasm (one Class II and one Class III study); cervical dystonia (seven Class I studies); focal upper extremity dystonia (one Class I and three Class II studies); focal lower extremity dystonia (one Class II study); laryngeal dystonia (one Class I study); motor tics (one Class II study); and upper extremity essential tremor (two Class II studies).Recommendations: Botulinum neurotoxin should be offered as a treatment option for the t...

Palatal tremor is a rare movement disorder characterized by rhythmic movement of the soft palate. There are two subtypes: essential and symptomatic palatal tremor. Essential palatal tremor is characterized by tinnitus and an absence of other neurological deficits. Different treatment options have been used to treat palatal tremor, with varying success rates. Here we describe a patient with essential palatal tremor and who was treated with botulinum toxin injections.

Objective: Essential tremor (ET), characterized by postural
and kinetic tremor seen on hands and arms, is the most common movement disorder that causes significant disability. Besides the motor symptoms such as tremor, ET is also often accompanied by psychiatric symptoms such as anxiety and depression. We identified our objectives as to compare the level of anxiety and depression in young male patients with ET with the normal and to determine the relationship between this level and tremor severity and duration of illness.
Method: 37 male patients with ET who were admitted to
neurology clinic of our hospital and diagnosed according
to Washington Heights-Inwood Genetic Study of Essential
Tremor (WHIGET) diagnostic criteria and 32 healthy
volunteers that were matched for age, gender and education level with this patient group have been included in this study. The tremor severity scores of ET patients were determined. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were administered to the both groups. The results were compared between two groups.
Results: Both groups were similar in terms of their age and level of education. The BAI and BDI scores of the patient group were 21.83±13.01 and 17.45±1.66 in order, and 11.03±9.19 and 9.68±8.67 in the control group respectively. The BAI and BDI scores of the patient group were significantly higher than those of the control group (in order p: 0.000 and p: 0.003). Both the BAI and BDI scores didn’t correlate with the disease duration and total tremor scores.
Conclusion: The level of anxiety and depression was significantly higher in young male patients with ET when compared to control group. The anxiety and depression scores were not correlated with the duration of illness and tremor severity.