Movement disorders
Henry J. Woodford in Essential Geriatrics, 2022
Drug-induced parkinsonism typically presents as a rapid onset of symmetrical bradykinesia.18 The onset is days to weeks after starting an anti-dopamine medication. A parkinsonian tremor can occur but is uncommon. It is usually reversible over weeks to months on discontinuation of the offending agent but symptoms may become permanent. Typical antipsychotic medications are more likely to induce parkinsonism than atypical ones (see page 135). Anti-dopaminergic anti-emetics (e.g. metoclopramide), monoamine depletors (e.g. reserpine) and some calcium channel blockers (e.g. cinnarizine) are occasionally implicated. Sodium valproate can precipitate tremor and, rarely, parkinsonism. Discontinuation of the offending drug, when possible, is the most useful strategy. The use of levodopa in combination with the offending neuroleptic agent to treat drug-induced parkinsonism is ineffective and illogical. Anticholinergic agents were used in the past to control such symptoms but they are associated with cognitive impairment and should be avoided (see page 48).
Arthropod-borne virus encephalitis
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
The original descriptions of the encephalitis of WEEV noted the rapid onset of fever, headache, vomiting and depressed level of consciousness [25,26]. The incubation period has been cited as between one and two weeks. Study of the 1975 epidemic in North Dakota and Western Minnesota by Leech et al. demonstrated significantly more cases of febrile headache and aseptic meningitis than of encephalitis [30]. Stiff neck as part of the whole spectrum of illness has been reported in several cases series. Tremors may occur. The acute course of the encephalitis has tended to be ten days to two weeks. When coma occurred, it usually reversed within four days. While there is a wide variation in the reported mortality, probably reflecting the different populations studied, overall it has been under 5% [31].
The Acute Unwanted Effects of Beta2 Receptor Agonist Therapy
Richard Beasley, Neil E. Pearce in The Role of Beta Receptor Agonist Therapy in Asthma Mortality, 2020
Among the various beta2 agonists, oral terbutaline produced more tremor than oral salbutamol214 and oral fenoterol215; so it may be that tremor could be alleviated by substituting one beta2 agonist for another.161 Oral theophyllines increase the likelihood but not the intensity of tremor on starting oral terbutaline therapy.195,196 In clinical practice tremor is only a significant cause of morbidity on initiating beta2 agonist therapy. Inhaled therapy rarely leads to troublesome tremor. It is likely to be more of a problem for patients with a prominent tremor prior to treatment. It will also affect the lives of elderly patients whose manual dexterity may already be adversely affected by joint problems or neurological disease.
The quality of life in individuals with Parkinson’s Disease: is it related to functionality and tremor severity? A cross-sectional study
Published in Physiotherapy Theory and Practice, 2023
Buse Kilinc, Nilufer Cetisli-Korkmaz, Levent Sinan Bir, Ahmet Dogucem Marangoz, Hande Senol
The tremor, which could be physiological and pathological, is defined as oscillatory, rhythmic, and involuntary movements (Bhatia et al., 2018). It is thought to originate from three sources: peripheral, central, and mechanical and is classified under two headings, as clinical features and etiology (i.e. acquired, genetic, or idiopathic) (Bhatia et al., 2018; Kamble and Pal, 2018). Resting tremor is typical in PD, usually at a frequency of 4–6 Hz, and begins asymmetrically (Saifee, 2019). It affects the distal joints rather than the proximal joints, and is often seen in different parts of the body such as hands, legs, tongue, lips, and jaw (Louis, 2019; Saifee, 2019). Archimedes spiral drawing, and electrophysiological measurements are used in the evaluation of tremor rating scales (Elble et al., 2013; Vial et al., 2019). Electrophysiological measurements could facilitate the diagnosis and treatment approaches for PD in individuals with tremor (Vial et al., 2019). Electromyography (EMG) is used to distinguish PD tremor from enhanced physiological and essential tremor, and to evaluate the effects of deep brain stimulation on PD tremor (Wang et al., 2020; Zhang, Xing, Ma, and Feng, 2017). EMG has proven to be a reliable method to distinguish different types of tremor, measure the pathological tremors and the changes that occur under the influence of weight loading or concentration (Spieker, Jentgens, Boose, and Dichgans, 1995; Zhang, Xing, Ma, and Feng, 2017).
Contemporary challenges in the diagnosis and management of chronic inflammatory demyelinating polyneuropathy
Published in Expert Review of Neurotherapeutics, 2022
Pain, cramps, and unpleasant sensory symptoms, although unusual in early stages and often suggestive of other diagnoses, may become prominent and require targeted therapy [98]. Fatigue is very common and likely to result from multiple factors, including neuropsychological, with no demonstrated relation to the degree of peripheral nerve damage, and no evidence-based drugs [99]. Hence, fatigue-management programmes with multidisciplinary involvement are ideal in such cases, although frequently unavailable. Tremor is uncommonly severe but may be disabling in some patients in whom it may be considered the predominant symptom [100]. Treatments used which mirror those for essential tremor, are of variable effect, but perseverance is appropriate in highly symptomatic individuals. Restless legs syndrome may be common and occasionally disturbingly symptomatic but respond well to available therapies [101]. Neuropsychiatric manifestations, including anxiety and depression may occur linked to understandable difficulties coming to terms with a long-term disabling disease, but with also, in turn, direct consequences on physical function, treatment response and its amplitude, as well as the applicability of patient reported outcome measures [102]. Targeted treatment is highly desirable and may be very helpful in contributing to global improvement.
Brain microstructural changes and cognitive function in non-demented essential tremor patients: a diffusion tensor imaging study
Published in International Journal of Neuroscience, 2021
Y. Sengul, H. O. Temur, Z. Corakcı, H. S. Sengul, H. Dowd, I. Ustun, A. Alkan, E. D. Louis
We recruited 81 consecutive patients with tremor between 18 and 76 years old who visited the general or movement disorders clinic of the Neurology Department of the Bezmialem Foundation University Hospital, Eyup Sultan, and Fatih Additional Buildings in Istanbul, Turkey, during the six-month period between January 2018 and July 2018. The study was conducted according to the ethical principles stated in the Declaration of Helsinki and was approved by the Ethical Committee of the Bezmialem Foundation University Hospital. Written informed consent was obtained from the participants after the nature of the procedures had been fully explained. Sociodemographic characteristics, family history (first- and second-degree), and duration of disease were recorded. We ruled out other possible causes of tremor using the following blood tests: thyroid hormone, vitamin B12, folate, other biochemical blood tests (e.g. liver and kidney functions), and hemogram. An ophthalmologist examined patients for Kayser-Fleischer rings in those younger than 45 years.