scholarly journals Pharmacotherapy of Essential Tremor

2013 ◽  
Vol 5 ◽  
pp. JCNSD.S6561 ◽  
Author(s):  
Peter Hedera ◽  
FrantišEk Cibulčík ◽  
Thomas L. Davis
Keyword(s):  
Adverse Effect ◽  
Molecular Modeling ◽  
Movement Disorder ◽  
Essential Tremor ◽  
Clinical Observation ◽  
Treatment Algorithm ◽  
Invasive Therapy ◽  
Therapeutic Trials

Essential tremor (ET) is a common movement disorder but its pathogenesis remains poorly understood. This has limited the development of effective pharmacotherapy. The current therapeutic armamentaria for ET represent the product of careful clinical observation rather than targeted molecular modeling. Here we review their pharmacokinetics, metabolism, dosing, and adverse effect profiles and propose a treatment algorithm. We also discuss the concept of medically refractory tremor, as therapeutic trials should be limited unless invasive therapy is contraindicated or not desired by patients.

Facial schwannoma: results of a large case series and review

2008 ◽  
Vol 122 (11) ◽  
pp. 1139-1150 ◽  
Author(s):  
B McMonagle ◽  
A Al-Sanosi ◽  
G Croxson ◽  
P Fagan
Keyword(s):  
Facial Nerve ◽  
Current Literature ◽  
Clinical Observation ◽  
Surgical Intervention ◽  
Treatment Algorithm ◽  
Case Series ◽  
Tertiary Referral ◽  
Management Algorithm ◽  
Facial Function ◽  
Facial Rehabilitation

AbstractObjectives and hypothesis:To report a series of 53 cases of facial schwannoma, to review the current literature, addressing contentious issues, and to present a management algorithm.Study design:Retrospective case review combined with review of current literature.Materials and methods:A review of the case notes of 53 patients with intracranial and intratemporal facial schwannoma, from two tertiary referral centres, was undertaken. This represents the largest series of facial schwannomas with clinical correlations in the literature. Data relating to epidemiological, clinical and management details were tabulated and compared with other large series. A review of the current literature was performed, and a management algorithm presented.Results:There were 23 (43 per cent) female and 30 (57 per cent) male patients. Patients' ages at presentation ranged from five to 84 years, with a mean of 49 years. Twenty-five (47 per cent) of the tumours were present on the left side and 28 (53 per cent) on the right side. Hearing loss was the most common presenting symptom, being present in 31/53 (58 per cent) patients, followed by facial weakness in 27/53 (51 per cent). Two patients (4 per cent) were completely asymptomatic, and their facial neuromas were diagnosed incidentally. The schwannoma extended along more than one segment of the facial nerve in 39 patients (74 per cent), with the mean number of segments involved being 2.5. A conservative approach of clinical observation was undertaken in 20 patients (38 per cent). Thirty-three patients (62 per cent) underwent surgery, with a total of 36 procedures. The translabyrinthine approach was most common, being utilised in 17 of the 36 procedures. Two patients underwent revision surgery for residual or recurrent disease on three occasions. There was total removal of tumour in 21 cases; the remainder had subtotal or no removal with drainage or decompression of the tumours. Twenty-one nerve reconstructions were performed, and 18 facial rehabilitation procedures were performed on 14 patients.Discussion:The results of this case series are similar to those of other reported series. The diagnosis of facial schwannoma is now generally made pre-operatively, due to improved imaging techniques and heightened awareness. Clinical assessment of facial function and imaging form the mainstays of surveillance for these tumours. These tumours are managed via clinical observation or surgical intervention; the latter can range from simple procedures (such as drainage of cystic components) to aggressive tumour removal and facial nerve reconstruction. Facial rehabilitation procedures may also be applied. The timing of intervention is contentious; surgical intervention is indicated when facial function deteriorates to a House–Brackmann grade IV level.Conclusion:Facial schwannomas are rare lesions, and reported series are generally small. Due to the complex management issues involved, these tumours are best managed in a tertiary referral setting. Observation is preferred until facial function deteriorates to a House–Brackmann grade III level, at which time surgery is considered. When facial function deteriorates to House–Brackmann grade IV, surgical intervention is indicated. We advocate surgical management based on the treatment algorithm described.

scholarly journals Research on Characteristics of Essential Tremor in the Latvian Population / Esenciālā Tremora Īpatnību Izpēte Latvijas Populācijā

2015 ◽  
Vol 69 (5) ◽  
pp. 259-264
Author(s):  
Ligita Smeltere ◽  
Elvīra Smeltere
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Movement Disorder ◽  
Essential Tremor ◽  
Severe Form ◽  
Progressive Development ◽  
Kinetic Tremor

Abstract Essential tremor (ET) is a common movement disorder, characterised by symptoms such as bilateral postural and kinetic tremor with prevalent manifestation in hands. The disease has chronic progressive development. In the case of continuous severe form it may resemble Parkinson’s disease (PD) and sometimes comorbidity with PD is possible. Although both diseases have different pathogenesis and treatment, some tremor characteristics for both are similar, thus causing difficulties and mistakes in diagnosing. The aim of the research was to determine ET characteristics within the Latvian population to identify possible causes for making mistakes.

scholarly journals Modeling mechanisms of tremor reduction for essential tremor using symmetric biphasic DBS

2019 ◽  
Author(s):  
Shane Lee ◽  
Wael F Asaad ◽  
Stephanie R Jones
Keyword(s):  
Deep Brain Stimulation ◽  
Side Effects ◽  
Movement Disorder ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Future Studies ◽  
Tremor Frequency ◽  
Ventral Intermediate Nucleus ◽  
Different Shapes ◽  
Deep Brain

AbstractEssential tremor (ET) is the most common movement disorder, in which the primary symptom is a prominent, involuntary 4–10 Hz movement. For severe, medication refractory cases, deep brain stimulation (DBS) targeting the ventral intermediate nucleus of the thalamus (VIM) can be an effective treatment for cessation of tremor and is thought to work in part by disrupting tremor frequency oscillations (TFOs) in VIM. However, DBS is not universally effective and may be further disrupting cerebellar-mediated activity in the VIM. Here, we applied biophysically detailed computational modeling to investigate whether the efficacy of DBS is affected by the mechanism of generation of TFOs or by the pattern of stimulation. We simulated the effects of DBS using standard, asymmetric pulses as well as biphasic, symmetric pulses to understand biophysical mechanisms of how DBS disrupts TFOs generated either extrinsically or intrinsically. The model results suggested that the efficacy of DBS in the VIM is affected by the mechanism of generation of TFOs. Symmetric biphasic DBS reduced TFOs more than standard DBS in both networks, and these effects were stronger in the intrinsic network. For intrinsic tremor frequency activity, symmetric biphasic DBS was more effective at reducing TFOs. Simulated non-tremor signals were also transmitted during symmetric biphasic DBS, suggesting that this type of DBS may help to reduce side effects caused by disruption of the cerebellothalamocortical pathway. Biophysical details in the model provided a mechanistic interpretation of the cellular and network dynamics contributing to these effects that can be empirically tested in future studies.Significance StatementEssential tremor (ET) is a common movement disorder, whose primary symptom is an involuntary rhythmic movement of the limbs or head. An area of the human tha-lamus demonstrates electrical activity that oscillates at the frequencies of tremor, and deep brain stimulation (DBS) in this area can reduce tremor. It is not fully understood how DBS affects tremor frequency activity in the thalamus, and studying different patterns of DBS stimulation may help to clarify these mechanisms. We created a computational model of different shapes of DBS and studied how they reduce different hypothesized generators of tremor frequency activity. A greater understanding of how DBS affects the thalamus may lead to improved treatments to reduce tremor and alleviate side effects in patients with ET.

Tremors

2016 ◽  
Author(s):  
Alfonso Fasano ◽  
Günther Deuschl
Keyword(s):  
Movement Disorder ◽  
Essential Tremor ◽  
Involuntary Movement ◽  
The Body ◽  
Drug Induced ◽  
Parkinsonian Tremor ◽  
Dystonic Tremor ◽  
Physiologic Tremor ◽  
Disease Definition ◽  
Holmes Tremor

Tremor is the most common movement disorder and denotes a rhythmic and involuntary movement of one or several regions of the body. This review covers disease definition, essential tremor, enhanced physiologic tremor, parkinsonian tremor, dystonic tremor, orthostatic tremor, cerebellar tremor, Holmes tremor, neuropathic tremor, palatal tremor, drug-induced and toxic tremors, functional tremor, rare tremor syndromes, tremorlike conditions, and treatment of tremor. Figures show action tremor assessment, the central nervous system circuits of tremor, magnetic resonance imaging findings in specific tremor conditions, general management of tremor patients, an algorithm for the treatment of parkinsonian tremor, and an algorithm for the treatment of dystonic tremor and primary writing tremor. Tables list types of tremor according to the condition of activation, tremor conditions in newborns and during childhood, clinical features of the most common tremor syndromes, motor signs other than tremor and nonmotor features of essential tremor patients, Movement Disorder Society consensus criteria for the diagnosis of essential tremor, genetic and environmental causes of essential tremor, causes of enhanced physiologic tremor, drugs and toxins known to cause tremor, paroxysmal tremors, pseudorhythmic myoclonus in the differential diagnosis of tremor, and pharmacologic management of essential tremor. Key words: essential tremor, movement disorder, pathologic tremor, physiologic tremor, tremor This review contains 6 highly rendered figures, 7 videos, 11 tables, and 163 references.

Drug-induced agranulocytosis (clinical observation)

2021 ◽  
Vol 1 (30) ◽  
pp. 19-23
Author(s):  
N. A. Sokolova ◽  
L. V. Pozdnyakova ◽  
I. S. Tatarinova
Keyword(s):  
Adverse Effect ◽  
Clinical Observation ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Drug Induced ◽  
Life Threatening ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Antithyroid Agents ◽  
Stimulating Factor

The majority of agranulocytosis cases are caused by drugs, including nonsteroidal anti-inflammatory drugs, antibiotics, antithyroid agents, etc. Here, we report a case of severe agranulocytosis in a 67-year-old woman following nonsteroidal anti-inflammatory therapy which was successfully managed using recombinant human granulocyte colony-stimulating factor. Although metamizole, has been in use since 1922 in the management of postoperative pain, colic pain, cancer pain and migraine, agranulocytosis as a direct side effect of metamizole therapy has been rarely reported. It is important to keep in mind this rare but potentially life-threatening adverse effect of metamizole, when initiating therapy.

Effects of Fatigue Produced by Isokinetic Exercise on the Communication Ability of Aphasic Adults

1973 ◽  
Vol 16 (2) ◽  
pp. 222-230 ◽  
Author(s):  
Robert C. Marshall ◽  
Philip S. King
Keyword(s):  
Adverse Effect ◽  
Physical Therapy ◽  
Clinical Observation ◽  
Therapy Session ◽  
Isokinetic Exercise ◽  
Communicative Ability ◽  
Physical Therapy Session ◽  
Exercise Period ◽  
Communication Ability

The Porch Index of Communicative Ability (PICA) was administered to 16 aphasic adults following periods of isokinetic exercise and rest. Results support the previous clinical observation that fatigue, such as might be incurred in a typical physical therapy session, has an adverse effect upon aphasic patients' communication. Of the 16 subjects, 14 had lower overall PICA means following the exercise period, and overall group verbal, graphic, and PICA means were significantly lower when testing followed exercise than when testing followed rest.

scholarly journals Progressive gait ataxia following deep brain stimulation for essential tremor: adverse effect or lack of efficacy?

Brain ◽  
2016 ◽  
Vol 139 (11) ◽  
pp. 2948-2956 ◽  
Author(s):  
Martin M. Reich ◽  
Joachim Brumberg ◽  
Nicolò G. Pozzi ◽  
Giorgio Marotta ◽  
Jonas Roothans ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Gait Ataxia ◽  
Deep Brain
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