Hand Tremor Questionnaire: A Useful Screening Tool for Differentiating Patients with Hand Tremor between Parkinson’s Disease and Essential Tremor

권겸일,유호성,이혜미,김미정,신혜원,박희경,유수연,성영희,정선주,고성범 대한신경과학회 2018 Journal of Clinical Neurology Vol.14 No.3

Background and Purpose Hand tremor is one of the most frequent symptoms in movement disorders, and differential diagnoses for hand tremor include Parkinson’s disease (PD) and essential tremor (ET). However, accurately differentiating between PD and ET in clinical practice remains challenging in patients presenting with hand tremor. We investigated whether a questionnaire-based survey could be useful as a screening tool in patients with hand tremor. Methods A questionnaire related to hand tremor consisting of 12 items was prospectively applied to patients with PD or ET in three movement-disorder clinics. Each question was analyzed, and a query-based scoring system was evaluated for differentiating hand tremors between PD and ET. Results This study enrolled 24 patients with PD and 25 patients with ET. Nine of the 12 questions differed significantly between PD and ET: 1 about resting tremor, 4 questions about action tremor, and 4 about asymmetry. A receiver operating characteristics curve analysis revealed that the 9-item questionnaire showed a good discrimination ability, with a sensitivity of 88% and a specificity of 84%. Conclusions The developed Hand Tremor Questionnaire might be a good screening tool for hand tremors in patients with PD and ET.

본태성 진전 환자의 진전특성에 대한 수행과제 및 부위의 영향

허재훈,김지원,권유리,엄광문,권도영,이찬녕,박건우,Heo, J.H.,Kim, J.W.,Kwon, Y.R.,Eom, Gwang-Moon,Kwon, D.Y.,Lee, C.N.,Park, K.W.,Manto, M. 대한의용생체공학회 2016 의공학회지 Vol.37 No.1

Essential tremor is a neurological disorder with a tremor of the arms and hands. It is well known that essential tremor is characterized by the postural tremor and the action tremor. There has been no report on the quantitative difference in the characteristics of two tremor types. The purpose of this study was to investigate the possible difference in tremor characteristics of postural and action tremors. Seventeen patients with essential tremor ($68.9{\pm}7.9years$, 7 men, 10 women) participated in this study. Patients performed the tasks of postural maintenance (arms outstretched) and daily actions (spiral drawing). Three-axes (pitch, roll and yaw) gyro sensors were attached on index finger, back of hand and forearm, from which the segment and the joint angular velocities were calculated. Outcome measure was the tremor amplitude defined as the root-mean-square mean of the vector-sum angular velocity at segments and joints. Two-way ANOVA showed that task and joint had main factor on the tremor amplitude (p < 0.05). Post-hoc analysis revealed that tremor amplitude at the metacarpo-phalangeal joint was not affected by task (p > 0.05). However, tremor amplitude at the wrist joint differed among the tasks (p < 0.05), and it was greater in the action tasks than in postural task. Tremor was greater at finger segments than at hand and forearm and it increased in action tasks. The results of this study would be helpful for the understanding and task-specific treatments of the essential tremor.

손떨림의 진단과 치료

정선주 대한의사협회 2012 대한의사협회지 Vol.55 No.10

Hand tremor is one of the most frequent movement disorders and embarrassing symptoms of a wide spectrum of diseases. Hand tremor can be classified by form in which the hand tremor occurs, the main distinction being whether the hand tremor occurs at rest or is produced by voluntary muscle contractions. Essential tremor is the most common pathologic tremor in humans. The clinical features of essential tremor are heterogeneous across patients. Parkinson’s disease is a common disease in the elderly with increasing prevalence over the last decade. Rest tremor is one of the cardinal motor features of Parkinson’s disease. Drug-induced hand tremor is also common and should be diagnosed accurately. Hand tremor in Wilson’s disease is very important to identify because the disease can be treatable. Here, the diagnosis and treatment of hand tremor were reviewed to provide a practical guide for managing patients with hand tremor.

Is an Isolated Weight-Holding Tremor a New Subtype of Isometric Tremor?

용석우,박동규,윤정한,백종삼 연세대학교의과대학 2020 Yonsei medical journal Vol.61 No.7

A weight-holding tremor is a rare type of hand tremor that occurs only when someone holds some weight. Here we report three cases of isolated weight-holding tremors, of which one patient was diagnosed with Parkinson’s disease (PD) and the others as a variant of essential tremor (ET). A 68-year-old woman presented with a left-hand tremor that appeared only when she held objects with some weight. Her tremor was reminiscent of the re-emergent tremor of PD, and dopamine transporter imaging revealed reduced uptake at the right posterior putamen. A 21-year-old man and a 71-year-old woman also presented with similar weightholding tremors. However, these tremors were not re-emergent, and no signs of parkinsonism were observed during follow-up. Although the underlying etiologies of these tremors differed, all three tremors worsened as the held weight increased. These tremors could be isolated isometric tremors, but further research is needed to clarify the nature of this rare tremor.

Efficacy of Thalamotomy and Thalamic Deep Brain Stimulation for the Treatment of Head Tremor

Choi, Seung-Jin,Lee, Kyung-Jin,Ji, Cheol,Ahn, Jae-Geun,Choi, Hyun-Chul,Kim, Moon-Chan The Korean Neurosurgical Society 2005 Journal of Korean neurosurgical society Vol.37 No.5

Objective: Stereotactic thalamic procedure is well known to be a effective treatment for disabling upper limb tremor of essential tremor. However, the effect of this procedure for head tremor, which is midline symptom of that disease entity, has not been sufficiently established. The authors discuss the result of stereotactic thalamic operations for head tremor of their patients who suffered from essential tremor. Methods: We evaluated 4 patients of essential tremor who had head tremor combined with both upper limb tremor. One patient underwent unilateral ventralis intermedius thalamotomy, two patients had unilateral Vim deep brain stimulation(DBS) and one patient had unilateral Vim thalamotomy and contralateral DBS. Postoperative results of tremor were evaluated using our proposed scale. Results: Contralateral upper limb tremors to surgical side were markedly resolved in all patients but there was no meaningful effect for head tremor in 3 patients who underwent unilateral thalamic surgery. In a patient having simultaneously unilateral thalamotomy and contralateral DBS, remarkable improvement of head tremor was observed. Conclusion: Although it is difficult to evaluate the efficacy of thalamic surgery for axial symptom of essential tremor with a few cases, simultaneous unilateral thalamotomy and contralateral DBS would be expected to induce favorable outcomes for head tremor with significant economical advantages.

가속도계를 이용한 진전현상의 분석을 통한 파킨슨병과 본태성 진전의 판별

이홍지,이웅우,전효선,김상경,김한별,전범석,박광석,Lee, Hongji,Lee, Woongwoo,Jeon, Hyoseon,Kim, Sangkyong,Kim, Hanbyul,Jeon, Beom S.,Park, Kwangsuk 대한의용생체공학회 2015 의공학회지 Vol.36 No.4

Discrimination of Parkinson's disease (PD) from Essential tremor (ET) is often misdiagnosed in clinical practice. Since tremor is time-varying signal, and dominant and harmonic frequencies are shown in tremor only with moderate or severe symptom, there are some limitations to use frequency related features. Moreover, patients with PD or ET can suffer from both resting tremor and postural tremor. In this study, 28 patients with PD and 17 patients with ET were enrolled. Tremor was measured with accelerations on the more affected hand during resting and postural conditions. The ratio of root mean square (RMS) of resting tremor to RMS of postural tremor, the mean coefficients of autocorrelation function (ACF), and the mean of differences of two adjacent coefficients of ACF at resting and postural were calculated and compared between PD and ET. The performance showed 98% accuracy with support vector machine and leave-one-out cross validation. In addition, the method accurately differentiated the patients with tremor-dominant PD from patients with ET, with 100% accuracy. Therefore, the developed algorithm can assist clinicians in diagnosing and categorizing patients with tremor, especially, patients with mild symptom or the early stage of a disease, for proper treatment.

양혈구풍탕가미방(養血驅風湯加味方)으로 호전된 진전 환자 4례에 대한 증례 보고

김홍준,김우성,박형진,조창현,원진희,김유경,Kim, Hong-Joon,Kim, Woo-Sung,Park, Hyoung-Jin,Cho, Chang-Hyun,Won, Jin-Hee,Kim, Yu-Kyung 대한한방내과학회 2004 大韓韓方內科學會誌 Vol.25 No.4

Tremor is a rhythmic and involuntary muscular contraction characterized by oscillations of a part of the body. Tremor is a symptom of many disorders, including Parkinson's disease, essential tremor, orthostatic tremor, cerebellar disease, peripheral neuropathy and alcohol withdrawal. The appropriate treatment of tremor depends on accurate diagnosis of it's cause. Some tremors respond to treatment of underlying conditions. Senile tremor and Parkinson's tremor are more common in aged people. Yanghyulgupung-tang is effective herbal medication in blood deficiency-type senile tremor. Four cases of senile tremor and Parkinson's tremor are reported. All four patient were treated with Yanghyulgupungtang-gamibang and improvement was seen in all four.

알츠하이머 치매노인들의 wrist tremors 특성

고영규(Ko Young-Gyu) 한국체육과학회 2008 한국체육과학회지 Vol.17 No.2

Tremor is a periodic oscillation phenomenon that involuntarily occurs in a range of anatomical units. It has been well known that central nervous system (CNS) factors are important determiners of tremor. The present study on tremor associated with Alzhiemer are important from a clinical perspective because tremor analysis technique have been advocated as a sensitive clinical tool to determine the onset of neurological diseases. Thus, the purpose of the present study was to investigate the characteristics of wrist tremor to develope a diagnostic system of Alzheimer‘s disease through the measurement and analysis of tremor. The wrist tremors were measured from 30 Alzheimer patients and 30 normal people by using an accelrometry. The time domain and frequency properties of the wrist tremor acceleration signals were compared between the two groups by performing a power spectrum density analysis on the acceleration time-series for each trial. The frequency domain analysis on the wrist tremor showed that the Alzheimer patients and normal elderly revealed the similar modal frequency in 1-6 ㎐, 7-15 ㎐, and 1-15 ㎐ frequency bandwidths. However, in the time domain analysis the Alzheimer patients revealed the significantly less degree of the acceleration than the normal elderly. These results suggest that for more accurate differentiation between two groups the time domain analysis is appropriate for the tremor of the proximal segments while the frequency domain analysis is recommended for the tremor of the distal segments.

본태성 진전증의 임상 양상

김상수,김대현,김재우 대한신경과학회 1999 대한신경과학회지 Vol.17 No.4

Usefulness of F-18 FP-CIT PET to predict dopamine-responsive hand tremor in patients other than Parkinson's disease : Two case reports

Yu, Kwang Jae,Lee, Byung Joo,Han, Jin,Park, Donghwi Williams & Wilkins Co 2018 Medicine Vol.97 No.22

<▼1><P>Supplemental Digital Content is available in the text</P></▼1><▼2><P><B>Abstract</B></P><P><B>Rationale:</B></P><P>Treating the patients with hand tremors is clinically difficult, because a wide range of disorders can result in hand tremors. Therefore, when treatment for hand tremors begins, various pharmacological options have to be considered. In clinical practice, a practical approach is to initially check hand tremor patients for signs of Parkinson's disease (PD), because patients with PD can benefit from dopamine treatment. However, only part of patients with PD tends to show a meaningful improvement in hand tremors for dopamine treatment. On the other hand, dopamine treatment may help with hand tremors of patients with other disorders, but dopamine responsiveness can‘t be predicted by clinical assessment alone.</P><P><B>Patients concerns:</B></P><P>Hand tremors.</P><P><B>Diagnoses:</B></P><P>Hemiplegic patients (A 78-year-old man with cerebral infarction and a 65-year-old woman with traumatic brain injury) with hemi-sided hand tremor.</P><P><B>Interventions:</B></P><P>Fluorinated N-3-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) nortropane (F-18 FP-CIT) positron emission tomography (PET) and dopamine agonist.</P><P><B>Outcomes:</B></P><P>After the medication, hemi-side hand tremor dramatically improved.</P><P><B>Lessons:</B></P><P>Collectively, a dysfunction of the dopaminergic nigro-striatal pathway may lead to abnormal findings of F-18 FP-CIT PET, and these abnormal findings in brain-lesion patients with hand tremor may help predict dopamine responsiveness of hand tremor. We believe that our report may be helpful in the diagnosis and treatment of hand tremor in patients with brain-lesion.</P></▼2>