One is the corticostriatothalamocortical hap through the basal ganglia, whose physiologic task is the integration of different muscle groups for complex movement programs. Two sets of neuronal networks are of particular importance ( Fig. This concept has more recently received renewed attention after systematic pathologic studies of patients with essential tremor revealed characteristic pathologic changes. The second principle is that of a permanent structural pathology with signs of neurodegeneration. 6 Complete reversibility of some tremor symptoms after alcohol ingestion or with medication has been interpreted as evidence for an overwhelmingly or exclusively functional disturbance. This hyperexcitability has been studied with neurophysiologic techniques in humans and animals, and modeled in dynamic mathematical paradigms. One emphasizes a functional hyperexcitability and rhythmic oscillation of neuronal loops in the absence of structural changes. Two basic principles have been postulated in tremorogenesis. Progress has been achieved in mapping tremors to certain structures or pathways in the nervous system, even though the exact pathophysiology of tremor is still incompletely understood. In this article, we provide the clinician with a review of the assessment, pathophysiology, and treatment of the more common forms of tremor. A fraction of patients with tremor has such severe symptoms that surgical procedures, such as deep brain stimulation (DBS), may be necessary. The overall effectiveness of pharmacologic treatments of tremor unfortunately remains mediocre, and patients frequently decide to discontinue such treatments. 5 The majority of patients with tremor have relatively mild symptoms and some may benefit from reassurance alone. Treatment is tailored individually, taking into account the objectively measurable tremor severity, the degree of disability or impairment experienced by the patient, including embarrassment in social situations, as well as the patient’s preference among the various treatment options. The patient’s history and a targeted neurologic examination will usually suffice to diagnose the cause of the tremor.Ī wide array of treatment modalities are available for tremor, and most depend on the type or the underlying cause of the tremor. 3, 4 When assessing a patient with tremor, the phenomenology on the tremor, the presence or absence of other neurologic signs or symptoms, and the possible modifying influence of medications or alcohol are important factors to be determined. 1, 2 It is the most commonly encountered movement disorder symptom, and is frequently evaluated and treated in family medicine, internal medicine, emergency medicine, and of course in neurology practices. Tremor is defined as a rhythmical, involuntary oscillatory movement of a body part that is produced by alternating contractions of reciprocally innervated muscles. An individualized approach to treatment of tremor patients is important, taking into account the degree of disability, including social embarrassment, which the tremor causes in the patient’s life. Further differential diagnoses described in this review include drug- or toxin-induced tremor, neuropathic tremor, psychogenic tremor, orthostatic tremor, palatal tremor, tremor in Wilson’s disease, and tremor secondary to cerebral lesions, such as Holmes’ tremor (midbrain tremor). Enhanced physiologic tremor, intention tremor, and dystonic tremor are discussed. Tremor at rest is typical for Parkinson’s disease, but may arise independently of a dopaminergic deficit. Essential tremor is characterized primarily by postural and action tremors, may be a neurodegenerative disorder with pathologic changes in the cerebellum, and can be treated with a wide range of pharmacologic and nonpharmacologic methods. The pathophysiology of the more common forms of tremor is outlined, and treatment options are discussed. The authors review the clinical examination, classification, and diagnosis of tremor. Tremor is the most common movement disorder presenting to an outpatient neurology practice and is defined as a rhythmical, involuntary oscillatory movement of a body part.
0 kommentar(er)
