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      • Record: found
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      Changes in Midline Tremor and Gait Following Deep Brain Stimulation for Essential Tremor

      brief-report

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          Abstract

          Background

          Essential tremor (ET) is a common movement disorder characterized by kinetic and postural tremor in the upper extremities and frequently in the midline. Persons with ET often also exhibit gait ataxia. Previous studies have observed associations between midline tremor severity and gait ataxia in persons with ET, suggesting a common pathophysiology distinct from that of upper extremity tremor. However, a causal link between midline tremor and gait impairment has not been established.

          Methods

          We investigated tremor and gait in 24 persons with ET before and after implantation of unilateral deep brain stimulation into the ventralis intermedius nucleus of the thalamus.

          Results

          Stimulation significantly improved tremor in the targeted upper extremity and midline. However, gait was unaffected at the cohort level. Furthermore, improvement in midline tremor was not significantly associated with gait improvement.

          Discussion

          These findings revealed that midline tremor and gait impairment may be dissociable in persons with ET.

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          Most cited references31

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          Assessment of interrater and intrarater reliability of the Fahn-Tolosa-Marin Tremor Rating Scale in essential tremor.

          Elizabeth A Stacy, , Joseph Hulihan … (2007)
          The purpose of this study was to evaluate interrater and intrarater reliability of the Fahn-Tolosa-Marin Tremor Rating Scale (TRS) in essential tremor (ET). Proper treatment of ET is contingent upon correct assessment of the severity, loss of function, and disability related to tremor. Videotape recordings of 17 subjects with ET evaluated with the TRS were produced and sent to 59 raters. Once the raters returned the videotape and completed the score sheet, they were mailed a second tape with the same recordings presented in a different order. In the interrater reliability evaluation, modified Kappa statistics for seven tremor type composites ranged from 0.10 to 0.65 in the first videotape and 0.17 to 0.62 in the second videotape. Interrater reliabilities were greater for Part A items (magnitude of tremor in different body parts) than for Part B items (tremor in writing and drawings) of the TRS. The average Spearman correlation was 0.87, indicating very good consistency between the two videotapes, but correlations for Part A were somewhat better than for Part B. It is best when the same rater performs repeated measures of tremor on a patient, particularly when judging tremor in handwriting and drawings. Training of raters on use of the TRS would help standardize judgement.
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            The gait disorder of advanced essential tremor.

            H Stolze, G Petersen, R Wenzelburger … (2001)
            Gait disturbances of patients with essential tremor (ET) have been described anecdotally, but have never been investigated quantitatively. Recent studies provided evidence for a cerebellar-like hand tremor in some patients with ET. Therefore, we designed a study to assess cerebellar-like abnormalities of leg function. Twenty-five patients with ET, eight patients with cerebellar diseases (CD) and 21 age-matched healthy subjects were studied for their normal and tandem gait using a three-dimensional gait analysis system. During normal walking, CD and ET patients showed only slight abnormalities. However, ET patients exhibited abnormalities in tandem gait with an increased number of mis-steps and a broad-based, ataxic and dysmetric gait which was indistinguishable from the findings in CD. When ET patients were separated into groups of those with or without intention tremor of the hands, the gait disorder was found to be much more pronounced in the intention tremor group. Patients with this gait disorder were more severely disturbed in their activities of daily living, and suffer from an advanced stage of ET. The present results quantitatively describe a gait disturbance in advanced ET which affects tandem gait, but leaves normal gait almost unaffected. This is strong evidence for a cerebellar-like disturbance in ET.
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              Progressive gait ataxia following deep brain stimulation for essential tremor: adverse effect or lack of efficacy?

              Martin Reich, Joachim Brumberg, Nicolò Pozzi … (2016)
              Article 0 comments Cited 57 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Tremor Other Hyperkinet Mov (N Y)
                Journal ID (iso-abbrev): Tremor Other Hyperkinet Mov (N Y)
                Journal ID (publisher-id): TOHM
                Title: Tremor and Other Hyperkinetic Movements
                Publisher: Columbia University Libraries/Information Services
                ISSN (Electronic): 2160-8288
                Publication date (Electronic): 11 September 2019
                Publication date Collection: 2019
                Volume: 9
                Electronic Location Identifier: 10.7916/tohm.v0.684
                Affiliations
                [1 ]Department of Neurology, Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
                [2 ]Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
                [3 ]Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, USA
                [4 ]Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
                [5 ]Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, NL, MX
                [6 ]School of Kinesiology, Auburn University, Auburn, AL, USA
                [7 ]Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
                [8 ]Department of Neurosurgery, University of Florida, Gainesville, FL, USA
                [9 ]Department of Psychiatry, University of Florida, Gainesville, FL, USA
                [10 ]Department of History, University of Florida, Gainesville, FL, USA
                [11 ]Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
                Author notes
                [* ]To whom correspondence should be addressed. E-mail: cjhass@ 123456aa.ufl.edu
                [†]

                These authors are co-first authors.

                [‡]

                These authors are co-senior authors.

                Article
                Publisher ID: tre-09-684
                DOI: 10.7916/tohm.v0.684
                PMC ID: 6744814
                SO-VID: 2857d11d-77c4-4748-b1ea-ee62fe91c810
                Copyright © © 2019 Higuchi et al.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution–Noncommercial–No Derivatives License, which permits the user to copy, distribute, and transmit the work provided that the original authors and source are credited; that no commercial use is made of the work; and that the work is not altered or transformed.

                History
                Date received : 03 February 2019
                Date accepted : 14 June 2019
                Categories
                Subject: Brief Reports

                Keywords: essential tremor,gait,deep brain stimulation,thalamus,ataxia
                Data availability:
                Keywords: essential tremor, gait, deep brain stimulation, thalamus, ataxia

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