Abstract
Tremor is a common neurological sign, but it has little diagnostic value unless it is properly characterized with a thorough history and physical exam. Broadly speaking, tremor may be the only physical abnormality (isolated tremor), or it may be combined with other neurologic or systemic signs (combined tremor). Essential tremor is the most common example of an isolated tremor syndrome, and rest tremor with parkinsonism is the most common combined tremor syndrome. However, there are many other isolated and combined tremor syndromes that occur in the elderly. These tremor disorders include dystonic tremor, action tremor with ataxia, focal and task-specific tremors, isolated bi-brachial tremor, and orthostatic tremor. Four tremor syndromes may occur acutely or subacutely: (1) whole body tremulousness with myoclonus, (2) isolated bi-brachial action tremor, (3) rest tremor with parkinsonism, and (4) focal or unilateral tremor with associated focal signs. The differential diagnosis and treatment of these tremor syndromes are summarized in this chapter.
References
Jankovic J, Schwartz KS, Ondo W. Re-emergent tremor of Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1999;67:646–50.
McKeon A, Pittock SJ, Glass GA, Josephs KA, Bower JH, Lennon VA, et al. Whole-body tremulousness: isolated generalized polymyoclonus. Arch Neurol. 2007;64(9):1318–22.
Caviness JN. Myoclonus and neurodegenerative disease—what’s in a name? Parkinsonism Relat Disord. 2003;9(4):185–92. doi:S1353802002000548 [pii].
Morgan JC, Sethi KD. Drug-induced tremors. Lancet Neurol. 2005;4(12):866–76.
Brigo F, Erro R, Marangi A, Bhatia K, Tinazzi M. Differentiating drug-induced parkinsonism from Parkinson’s disease: an update on non-motor symptoms and investigations. Parkinsonism Relat Disord. 2014;20(8):808–14. doi:10.1016/j.parkreldis.2014.05.011.
Raina GB, Cersosimo MG, Folgar SS, Giugni JC, Calandra C, Paviolo JP, et al. Holmes tremor: clinical description, lesion localization, and treatment in a series of 29 cases. Neurology. 2016;86(10):931–8. doi:10.1212/WNL.0000000000002440.
Elble RJ. Tremor disorders. Curr Opin Neurol. 2013;26(4):413–9. doi:10.1097/WCO.0b013e3283632f46.
Kim YJ, Pakiam AS-I, Lang AE. Historical and clinical features of psychogenic tremor: a review of 70 cases. Can J Neurol Sci. 1999;26:190–5.
Raethjen J, Kopper F, Govindan RB, Volkmann J, Deuschl G. Two different pathogenetic mechanisms in psychogenic tremor. Neurology. 2004;63(5):812–5.
Hallett M. Physiology of psychogenic movement disorders. J Clin Neurosci. 2010;17(8):959–65.
Thenganatt MA, Jankovic J. Psychogenic tremor: a video guide to its distinguishing features. Tremor Other Hyperkinet Mov (N Y). 2014;4:253. doi:10.7916/D8FJ2F0Q.
McKeon A, Ahlskog JE, Bower JH, Josephs KA, Matsumoto JY. Psychogenic tremor: long term prognosis in patients with electrophysiologically-confirmed disease. Mov Disord. 2009;24:72–6.
Elble RJ. What is essential tremor? Curr Neurol Neurosci Rep. 2013b;13(6):353. doi:10.1007/s11910-013-0353-4.
Lorenz D, Poremba C, Papengut F, Schreiber S, Deuschl G. The psychosocial burden of essential tremor in an outpatient- and a community-based cohort. Eur J Neurol. 2011;18(7):972–9. doi:10.1111/j.1468-1331.2010.03295.x.
Louis ED, Clark LN, Ottman R. Familial versus sporadic essential tremor: what patterns can one decipher in age of onset? Neuroepidemiology. 2015;44(3):166–72. doi:10.1159/000381807.
Deuschl G, Petersen I, Lorenz D, Christensen K. Tremor in the elderly: essential and aging-related tremor. Mov Disord. 2015;30(10):1327–34. doi:10.1002/mds.26265.
Louis ED. ‘Essential tremor’ or ‘the essential tremors’: is this one disease or a family of diseases? Neuroepidemiology. 2013;42(2):81–9. doi:10.1159/000356351.
Zesiewicz TA, Elble RJ, Louis ED, Gronseth GS, Ondo WG, Dewey RB Jr, et al. Evidence-based guideline update: treatment of essential tremor: report of the quality standards subcommittee of the American Academy of Neurology. Neurology. 2011;77:1752–5. doi:10.1212/WNL.0b013e318236f0fd. WNL.0b013e318236f0fd [pii].
Deuschl G, Raethjen J, Hellriegel H, Elble R. Treatment of patients with essential tremor. Lancet Neurol. 2011;10(2):148–61. doi:10.1016/S1474-4422(10)70322-7.
Louis ED. Treatment of essential tremor: are there issues we are overlooking? Front Neurol. 2011;2:91. doi:10.3389/fneur.2011.00091.
Hopfner F, Erhart T, Knudsen K, Lorenz D, Schneider SA, Zeuner KE, et al. Testing for alcohol sensitivity of tremor amplitude in a large cohort with essential tremor. Parkinsonism Relat Disord. 2015;21(8):848–51. doi:10.1016/j.parkreldis.2015.05.005.
Witjas T, Carron R, Krack P, Eusebio A, Vaugoyeau M, Hariz M, et al. A prospective single-blind study of Gamma Knife thalamotomy for tremor. Neurology. 2015; doi:10.1212/WNL.0000000000002087.
Huss DS, Dallapiazza RF, Shah BB, Harrison MB, Diamond J, Elias WJ. Functional assessment and quality of life in essential tremor with bilateral or unilateral DBS and focused ultrasound thalamotomy. Mov Disord. 2015;30(14):1937–43. doi:10.1002/mds.26455.
Tolosa E, Wenning G, Poewe W. The diagnosis of Parkinson’s disease. Lancet Neurol. 2006;5(1):75–86.
Selikhova M, Kempster PA, Revesz T, Holton JL, Lees AJ. Neuropathological findings in benign tremulous Parkinsonism. Mov Disord. 2013;28(2):145–52. doi:10.1002/mds.25220.
Pogarell O, Gasser T, van Hilten JJ, Spieker S, Pollentier S, Meier D, et al. Pramipexole in patients with Parkinson’s disease and marked drug resistant tremor: a randomised, double blind, placebo controlled multicentre study. J Neurol Neurosurg Psychiatry. 2002;72(6):713–20.
Munhoz RP, Picillo M, Fox SH, Bruno V, Panisset M, Honey CR, et al. Eligibility criteria for deep brain stimulation in Parkinson’s disease, tremor, and dystonia. Can J Neurol Sci. 2016;43(4):462–71. doi:10.1017/cjn.2016.35.
Erro R, Rubio-Agusti I, Saifee TA, Cordivari C, Ganos C, Batla A, et al. Rest and other types of tremor in adult-onset primary dystonia. J Neurol Neurosurg Psychiatry. 2014;85(9):965–8. doi:10.1136/jnnp-2013-305876.
Balint B, Bhatia KP. Isolated and combined dystonia syndromes—an update on new genes and their phenotypes. Eur J Neurol. 2015;22(4):610–7. doi:10.1111/ene.12650.
Fasano A, Bove F, Lang AE. The treatment of dystonic tremor: a systematic review. J Neurol Neurosurg Psychiatry. 2014;85(7):759–69. doi:10.1136/jnnp-2013-305532.
Klockgether T. Sporadic ataxia with adult onset: classification and diagnostic criteria. Lancet Neurol. 2010;9(1):94–104. doi:10.1016/S1474-4422(09)70305-9.
Schöls L, Bauer P, Schmidt T, Schulte T, Riess O. Autosomal dominant cerebellar ataxias: clinical features, genetics, and pathogenesis. Lancet Neurol. 2004;3(5):291–304.
Alusi SH, Glickman S, Aziz TZ, Bain PG. Tremor in multiple sclerosis. J Neurol Neurosurg Psychiatry. 1999;66(2):131–4.
Hassan A, Ahlskog JE, Rodriguez M, Matsumoto JY. Surgical therapy for multiple sclerosis tremor: a 12-year follow-up study. Eur J Neurol. 2012;19(5):764–8. doi:10.1111/j.1468-1331.2011.03626.x.
Wenning GK, Tison F, Ben Shlomo Y, Daniel SE, Quinn NP. Multiple system atrophy: a review of 203 pathologically proven cases. Mov Disord. 1997;12(2):133–47. doi:10.1002/mds.870120203.
Hagerman PJ, Hagerman RJ. Fragile X-associated tremor/ataxia syndrome. Ann N Y Acad Sci. 2015;1338:58–70. doi:10.1111/nyas.12693.
Weiss D, Mielke C, Wachter T, Bender B, Liscic RM, Scholten M, et al. Long-term outcome of deep brain stimulation in fragile X-associated tremor/ataxia syndrome. Parkinsonism Relat Disord. 2015;21(3):310–3. doi:10.1016/j.parkreldis.2014.12.015.
Hassan A, Ahlskog JE, Matsumoto JY, Milber JM, Bower JH, Wilkinson JR. Orthostatic tremor: clinical, electrophysiologic, and treatment findings in 184 patients. Neurology. 2016;86(5):458–64. doi:10.1212/WNL.0000000000002328.
Kobylecki C, Silverdale MA, Dick JP, Kellett MW, Marshall AG. Dystonia associated with idiopathic slow orthostatic tremor. Tremor Other Hyperkinet Mov (N Y). 2015;5:351. doi:10.7916/D8RF5TP4.
Glass GA, Ahlskog JE, Matsumoto JY. Orthostatic myoclonus: a contributor to gait decline in selected elderly. Neurology. 2007;68(21):1826–30.
Contarino MF, Bour LJ, Schuurman PR, Blok ER, Odekerken VJ, van den Munckhof P, et al. Thalamic deep brain stimulation for orthostatic tremor: clinical and neurophysiological correlates. Parkinsonism Relat Disord. 2015;21(8):1005–7. doi:10.1016/j.parkreldis.2015.06.008.
Erro R, Schneider SA, Stamelou M, Quinn NP, Bhatia KP. What do patients with scans without evidence of dopaminergic deficit (SWEDD) have? New evidence and continuing controversies. J Neurol Neurosurg Psychiatry. 2015; doi:10.1136/jnnp-2014-310256.
Menendez-Gonzalez M, Tavares F, Zeidan N, Salas-Pacheco JM, Arias-Carrion O. Diagnoses behind patients with hard-to-classify tremor and normal DaT-SPECT: a clinical follow up study. Front Aging Neurosci. 2014;6:56. doi:10.3389/fnagi.2014.00056.
Bajaj NP, Gontu V, Birchall J, Patterson J, Grosset DG, Lees AJ. Accuracy of clinical diagnosis in tremulous parkinsonian patients: a blinded video study. J Neurol Neurosurg Psychiatry. 2010;81(11):1223–8.
Schwingenschuh P, Ruge D, Edwards MJ, Terranova C, Katschnig P, Carrillo F, et al. Distinguishing SWEDDs patients with asymmetric resting tremor from Parkinson’s disease: a clinical and electrophysiological study. Mov Disord. 2010;25(5):560–9.
Baizabal-Carvallo JF, Cardoso F, Jankovic J. Myorhythmia: phenomenology, etiology, and treatment. Mov Disord. 2015;30(2):171–9. doi:10.1002/mds.26093.
Masucci EF, Kurtzke JF, Saini N. Myorhythmia: a widespread movement disorder. Clinicopathological correlations. Brain. 1984;107(Pt 1):53–79.
Maki F, Sato S, Watanabe K, Yanagisawa T, Hagiwara Y, Shimizu T, et al. Vim thalamotomy in a patient with Holmes’ tremor and palatal tremor—pathophysiological considerations. BMC Neurol. 2015;15:26. doi:10.1186/s12883-015-0277-5.
Schwartz MA, Selhorst JB, Ochs AL, Beck RW, Campbell WW, Harris JK, et al. Oculomasticatory myorhythmia: a unique movement disorder occurring in Whipple’s disease. Ann Neurol. 1986;20(6):677–83.
Ala A, Walker AP, Ashkan K, Dooley JS, Schilsky ML. Wilson’s disease. Lancet. 2007;369(9559):397–408. doi:10.1016/S0140-6736(07)60196-2.
Machado A, Chien HF, Deguti MM, Cancado E, Azevedo RS, Scaff M, et al. Neurological manifestations in Wilson’s disease: report of 119 cases. Mov Disord. 2006;21(12):2192–6. doi:10.1002/mds.21170.
Saifee TA, Schwingenschuh P, Reilly MM, Lunn MP, Katschnig P, Kassavetis P, et al. Tremor in inflammatory neuropathies. J Neurol Neurosurg Psychiatry. 2013;84(11):1282–7. doi:10.1136/jnnp-2012-303013.
Acknowledgements
This work was supported by the Spastic Paralysis Research Foundation of Kiwanis International, Illinois-Eastern Iowa District.
Disclosures Rodger Elble receives research grant support from the Spastic Paralysis Research Foundation of Kiwanis International, Illinois-Eastern Iowa District, and he received consulting fees from Sage Therapeutics. He was also paid by InSightec to rate videotaped exams of patients undergoing thalamotomy with high-intensity focused ultrasound.
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Elble, R.J. (2017). Tremor. In: Tousi, B., Cummings, J. (eds) Neuro-Geriatrics. Springer, Cham. https://doi.org/10.1007/978-3-319-56484-5_20
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