| Article Access Statistics|
| Viewed||3953 |
| Printed||67 |
| Emailed||0 |
| PDF Downloaded||89 |
| Comments ||[Add] |
| Cited by others ||1 |
Click on image for details.
|NI FEATURE: THE QUEST - COMMENTARY
|Year : 2017 | Volume
| Issue : 5 | Page : 1083-1090
Review of tremor in Parkinson's disease and atypical parkinsonian disorders
Pooja Mailankody, M Netravathi, Pramod Kumar Pal
Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
|Date of Web Publication||6-Sep-2017|
Pramod Kumar Pal
Department of Neurology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru - 560 029, Karnataka
Source of Support: None, Conflict of Interest: None
Rest tremor (RT), a cardinal feature of Parkinson's disease (PD) is often accompanied by other types of tremor such as action tremor, which includes postural tremor, kinetic tremor, re-emergent tremor (ReT), and orthostatic tremor (OT). Literature on other tremors of PD, especially ReT and OT, is scarce. Tremor can be present in any of the atypical parkinsonian disorders such as progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration, and dementia with Lewy bodies. RT can even be the presenting symptom of these disorders. The objective of this review is to provide a comprehensive review of lesser known tremors in PD and to critically look at the prevalence of tremor in atypical Parkinsonian disorders.
Keywords: Action tremor, atypical Parkinsonian disorders, orthostatic tremor, parkinson's disease, prevalence
Key Message: The lesser known tremors in Parkinson's disease have been highlighted. The characteristics of tremors in atypical parkinsonian disorders have also been elucidated.
|How to cite this article:|
Mailankody P, Netravathi M, Pal PK. Review of tremor in Parkinson's disease and atypical parkinsonian disorders. Neurol India 2017;65:1083-90
Tremor is defined as a rhythmical, involuntary oscillatory movement of a body part. Rest tremor (RT) is one of the key features of Parkinson's disease (PD). In addition to RT, patients with PD can also have an action tremor (AT), which includes postural tremor (PT), kinetic tremor (KT), re-emergent tremor (ReT), and orthostatic tremor (OT).,,, More than 90% of the patients with PD have PT.,
According to Litvan's definition, atypical parkinsonian disorders are those which progress rapidly, show a poor or transient response to dopaminergic therapy, and are accompanied by atypical features like early autonomic failure, postural instability, vertical gaze palsy, pyramidal, or cerebellar signs. The atypical Parkinsonian disorders are progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), and dementia with Lewy bodies (DLB). Though not a cardinal manifestation, tremor can be present in any of these atypical parkinsonian disorders. There is sparse information on the clinical heterogeneity of tremor in these disorders. The objective of this article is to review the literature on different types of tremor in PD (excluding RT) and the prevalence of tremor in atypical parkinsonian disorders.
| » Materials and Methods|| |
Data for this review were identified by searching PubMed with the terms "Parkinson's disease," "re-emergent tremor," "orthostatic tremor," "progressive supranuclear palsy," "multiple system atrophy," "corticobasal degeneration," "dementia with Lewy bodies," " Parkinsonism More Details," "tremor," "rest tremor," "postural tremor," "action tremor," "intention tremor," "jerky tremor," "clinical," and "clinicopathological." Articles were included only if they were written in English and full texts were available. References from 1985 to 2015 were considered, including case reports and natural history, clinical, clinicopathological, and neurophysiological studies, summarizing rates of occurrence, tremor characteristics in patients with PD and atypical parkinsonian disorders.
Tremor, a key manifestation of PD, is found in more than 80% of the autopsy proven cases. Of the four cardinal manifestations of PD, tremor is the one which least responds to levodopa. The severity of tremor does not correlate with that of rigidity and bradykinesia.
RT of PD is classically described as pill rolling type with a frequency between 4 and 6 Hz.,, The tremor disappears at the beginning of a voluntary movement and increases on mental stress such as counting backwards and anxiety. The intensity of tremor can even decrease with increasing rigidity. When RT persists for more than 2 years without any other parkinsonian features, it is called monosymptomatic tremor at rest or benign tremulous parkinsonism. The most common site of RT is the upper limb. In a study of 81 patients with PD and clinically visible tremor, Zimmermann et al., found RT of the upper limbs in 83%, legs in 42%, head in 17%, tongue in 13%, and face in 12%.
Five patients with PD and RT of the head were reviewed by Roze et al. Two of them had head tremor as the initial manifestation. Isolated RT of the head as a presenting symptom of PD was described in a case report by Gan et al. Both the frequency and response of tremor to levodopa were consistent with typical RT of PD. Patients with PD can have jaw tremor that is usually characterized by up and down movement of the jaw.,
AT, defined as tremor produced by voluntary muscle contraction, includes postural and kinetic tremor (KT). The AT of PD has a prevalence of 92%. Intention tremor is classified under KT. Electrophysiological studies have shown that AT contributes to both weakness and bradykinesia in patients with PD., AT can be present even in the absence of RT and at times be more severe than RT., AT is directly correlated with motor disability. Louis et al., studied 197 patients with PD to delineate the clinical correlates of AT. They excluded patients with re-emergent tremor (ReT). It was found that AT score had the best correlation with the RT scores, ipsilateral more than contralateral. There was no association of the severity of AT with age, age of onset, or disease duration. The different types of ATs seen in PD are PT, KT, and OT.
According to Deuschl, the PT of PD has a frequency greater than that of RT (by > 1.5 Hz) and can exist either in isolation or in combination with RT. This tremor is regarded as more incapacitating than the severe RT. Among the 50 patients evaluated by Koller et al., 92% had PT. More than 80% of the patients evaluated by Milanov et al., had PT. Jankovic et al., postulated that this tremor could be either an enhanced physiological tremor or a co-existent ET. In a retrospective case series by Chaudhuri et al., it was found that 13 patients presenting with asymmetrical PT developed PD after an average period of 19.2 years. This suggests that isolated PT could be the presenting feature of PD.
KT occurs during any voluntary movement. In a study of 870 patients with PD, 47% of the patients had marked to severe KT as evidenced by the evaluation of their spiral drawings. Among the patients recruited, 29 had neither RT nor PT. However, 12 among these 29 patients had KT during spiral drawing despite the absence of RT and PT. Wenzelburger et al., analyzed KT during the reach-to-grasp movement in 13 patients with tremor predominant PD. Among the 12 patients who had KT, it was found that the frequency of the tremor in the terminal period is higher than that of RT and PT. The authors postulated that KT was nothing but an enhanced physiological tremor.
Sternberg et al., studied 50 patients of PD and 50 patients of ET to look at the phenomenology of PT. They found that the PT in PD is distal involving the metacarpo-phalangeal joints rather than the proximal wrist and elbow joints. Though KT was present in 78% of the patients, intention tremor was found only in 4% of the patients with PD. The tremor ratings on Archimedes spiral drawings were significantly lower in patients with PD.
The term ReT was first coined by Jankovic in 1999 in a short report titled "Re-emergent tremor of PD." Jankovic, in the same paper, has variably called this an RT and a "PT with latency." Subsequently, authors have called it RT that emerges after a variable latency., In 1989, Koller et al., observed that in some patients, PT appears after a delay of several seconds and hypothesized that it could be due to resetting of RT. Among the 18 patients evaluated by Jankovic et al., 12 patients had ReT and the mean latency was 9.4 s. The frequency of ReT was found to be the same as that of RT. ReT was found in 4–66% of patients with tremor predominant PD.,, The duration of latency for the tremor to re-emerge ranges from 0.79 to 13 s.,,,,, A ReT of the tongue also has been reported in the literature.
Orthostatic tremor and pseudo-orthostatic tremor
Leu-Semenescu studied 11 PD patients with tremulousness of the lower limbs; 4 were found to have fast OT with a frequency of 13–18 Hz (same as that of primary OT); and 3 were found to have slow OT with a frequency of 4–6 Hz (same as that of RT). One patient with fast OT and all patients with slow OT were found to have co-existent RT in upper limb. However, RT and slow OT never co-existed in lower limbs. Even though the amplitude may come down, the frequency remains unchanged with levodopa treatment in fast OT., The fast OT responded to clonazepam in Leu-Semenescu's series. The slow OT showed a good response to levodopa. The term "Pseudo-Orthostatic Tremor" was used by Thomas et al., to describe the dopa-responsive, 6–7 Hz tremor that occurred in four patients on standing, who later developed parkinsonism. Of these four patients, two had genetic forms of PD (Parkin and Pink 1 gene mutations) and all had abnormalities on dopamine transporter imaging consistent with PD. Levodopa responsive leg tremor or pseudo-orthostatic tremor could also suggest parkin gene mutation.,, Four members in a Spanish family presented with leg tremor of which three patients later developed akinetic rigid syndrome. All of them had a good response to levodopa. DNA analysis showed mutation of the parkin gene in these four patients.
Tremor associated with dystonia or "dystonic tremor" has been described in patients with a clinical diagnosis of PD, both in young and adult patients with PD.,,, In adults, the imaging studies revealed that they had no evidence of dopaminergic deficit and hence they were considered to have a diagnosis of Scans Without Evidence of Dopaminergic Deficit (SWEDDs). Task or position specificity, thumb extension type of tremor, presence of head tremors, and absence of fatiguing of repetitive movements are the features characteristic of SWEDDs., A 5-year follow-up study of 16 patients with asymmetric upper limb tremor associated with dystonia showed that only a minority of patients (12.5%) developed decreased nigrostriatal uptake on DaT scan. Dystonia may also be present in early onset PD with or without associated tremor.
In a questionnaire-based study, Shulman et al., found that 44% of PD patients had a sensation of internal tremor, which was closely associated with anxiety. Internal tremor was present at rest in 30% of the patients and during anxiety in 64% of the patients. It was unrelated to the Unified Parkinson's Disease Rating Scale (UPDRS) score, Hoehn and Yahr (H&Y) stage, duration of the disease, or the presence of observable tremor. Also, there was poor response to levodopa.
Progressive supranuclear palsy
PSP is a gradually progressive atypical Parkinsonism with the age of onset usually after 40 years. It is characterized by vertical supranuclear gaze palsy, nuchal rigidity, and postural instability with falls., According to Golbe et al., minimal or absent tremor was one of the diagnostic criteria required for diagnosis of PSP. A review of literature by Kristensen  in 1985 suggested that tremor in PSP is an exception. Later in 1996, Litvan et al., proposed a new criteria, which did not include tremor in the characteristics of PSP. The prevalence of tremor is high in PSP and can range from 6 to 44%.,,,,,,,,, It may even be one of the initial manifestations. The tremor is mostly symmetrical and its presence is associated with longer duration of survival in patients with PSP., The frequency of tremor in PSP was found to be lower (3 Hz) than that of parkinsonian RT (usually 4–6 Hz). Around 10–12% of the patients with ET were found to have PSP in some autopsy series., OT as the presenting symptom of PSP has been reported. Resting tremor of the jaw and symptomatic palatal tremor also have been reported in PSP.,,, The prevalence of different types of tremor in PSP found in different studies have been described in [Table 1].
Multiple system atrophy
Multiple system atrophy (MSA) is a progressive neurodegenerative disorder in which parkinsonism is accompanied by cerebellar, pyramidal, and/or autonomic features. In addition to RT, PT, and intention tremor, an irregular jerky PT may be seen , [Table 2]. PT is the most common type of tremor in MSA.,,,,
RT can be present in 12–53% of patients with MSA.,,,,,,,,,,,,, A recent review by Kaindlstorfer et al., pointed out that the characteristic jerky PT in MSA does not satisfy the criteria for tremor and hence the term minipolymyoclonus might be more suitable on electrophysiological grounds.
Tison et al., found that 50% of the patients had tremor at their initial visit (10 months after the presenting symptom) and 62% developed it on follow-up. Among the tremor types, PT was the most frequent and RT was more often atypical (fast, irregular, myoclonic or present during action, posture, or intention) rather than pill rolling. Typical pill rolling RT was documented in 12% of the patients with MSA, whereas it was found in 74% of patients with PD. Thirty-two percent of the patients developed intention tremor after a follow-up of 62 months compared to the 2% who had it at the initial visit, which was probably secondary to cerebellar involvement. On the contrary, two other longitudinal studies found that the progression of the disease had no impact on the occurrence or severity of MSA.,
Both RT and PT were found to be more frequent in MSA-P (with Parkinsonian features) than with MSA-C (with cerebellar features).,,, The results of both the European and Japanese studies were similar with respect to RT and intention tremor. However, the frequency of PT was found to be lesser in MSA-P as compared to MSA-C in the Japanese cohort (10.1% of MSA-C and 8.7% of MSA-P patients) contrary to the European group.,,,, Jerky PT was found to be more common in MSA-P than MSA-C., Intention tremor was found to be more common in MSA-C than MSA-P. However, patients with MSA-P were also found to have intention tremor.,
In a retrospective study of 16 patients who primarily presented with unilateral lower limb RT, Hellmann et al., found that four patients had a diagnosis of MSA. Palatal tremor has been reported in MSA.
A patient of MSA can present with RT as an initial manifestation and even have the typical pill rolling type of tremor, which may lead to an erroneous diagnosis of PD. The poor response of tremor to levodopa in MSA as compared to PD is not a useful criterion for making a diagnosis.
CBD is a clinicopathological entity characterized by asymmetric rigidity, apraxia, alien hand, dystonia, and parkinsonism. Irregular RT, pill rolling type of RT, and coarse AT can be seen in patients with CBD ,,, [Table 3].
Dementia with Lewy bodies
Dementia with Lewy bodies (DLB) is clinically characterized by parkinsonism, dementia, visual hallucinations, and fluctuating cognition. RT is less common in DLB according to the recent criteria. The frequency of RT can be as high as 87% in DLB ,,, [Table 4]. An association of DLB and OT has also been noted.,
Overflow of tremor is a characteristic feature of DLB. In terms of frequency of tremor and response to treatment, RT of DLB is similar to that of PD. Lesser severity of disease and better scores on cognitive testing in patients with tremor suggest that tremor in DLB is a predictor of good prognosis.
| » Conclusions|| |
This article highlights some of the lesser known tremors in PD. We have also tried to elucidate the characteristics of tremors in atypical parkinsonian disorders. ReT is an entity which needs to be better characterized in terms of both phenomenology and electrophysiology. Levodopa responsive pseudo-OT of the leg should raise the suspicion of parkin gene mutation. RT, though classically described as a core feature of PD, can be a presenting feature in other atypical parkinsonian disorders as well. RT was found in 6–44% of patients with PSP, 12–53% of patients with MSA, 19–21% of patients with CBD, and 40–87% of patients with DLB. This challenges the specificity of RT as a cardinal sign of PD. Presence of RT implies a better prognosis in PSP, MSA, and DLB. Irregular jerky tremor is a characteristic feature of MSA. "Overflow" of tremor is a phenomenon that has been described in DLB.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| » References|| |
Deuschl G, Bain P
Brin M. Ad-Hoc-Scientific-Committee. Consensus statement of the Movement Disorder Society on Tremor. Mov Disord 1998;13:2-23.
Jankovic J, Schwartz KS, Ondo W. Re-emergent tremor of Parkinson's disease. J Neurol Neurosurg Psychiatry 1999;67:646-50.
Leu-Semenescu S, Roze E Vidailhet M, Legrand AP, Trocello JM, Cochen V, Sangla S, et al
. Myoclonus or tremor in orthostatism: An under-recognized cause of unsteadiness in Parkinson's disease. Mov Disord 2007;22:2063-9.
Thomas A, Bonanni L, Antonini A, Barone P, Onofrj M. Dopa-responsive pseudo-orthostatic tremor in parkinsonism. Mov Disord 2007;22:1652-6.
Findley LJ, Gresty MA, Halmagyi GM. Tremor, the cogwheel phenomenon and clonus in Parkinson's disease. J Neurol Neurosurg Psychiatry 1981;44:534-46.
Louis ED, Levy G, Côte LJ, Mejia H, Fahn S, Marder K. Clinical correlates of action tremor in Parkinson disease. Arch Neurol 2001;58:1630-34.
Koller WC, Vetere-Overfield B, Barter R. Tremors in early Parkinson's disease. Clin Neuropharmacol 1989;12:293-7.
Litvan I. What is an Atypical Parkinsonian Disorder? In: Litvan I, editor. Atypical Parkinsonian disorders: Clinical and research aspects. New Jersey: Humana Press; 2005. p. 1-9.
Louis ED, Klatka LA Liu Y, Fahn S. Comparison of extrapyramidal features in 31 pathologically confirmed cases of diffuse Lewy body disease and 34 pathologically confirmed cases of Parkinson's disease. Neurology 1997;48:376-80.
Parkinson J. An essay on the shaking palsy. Whitingham Rowland; 1817.
Rondot P. Pathophysiology of Parkinsonian tremor. In: Desmedt JE, editor. Physiological Tremor, Pathological Tremor and Clonus vol 5 Progress in Clinical Neurophysiology. Basel: Karger; 1978. p. 138-49.
Raethjen J, Austermann K, Witt K, Zeuner KE, Papengut F, Deuschl G. Provocation of Parkinsonian tremor. Mov Disord 2008;23:1019-23.
Winogrodzka A, Wagenaar RC, Bergmans P, Vellinga A, Booij J, van Royen EA, et al
. Rigidity decreases resting tremor intensity in Parkinson's disease: A [(123) I] beta-CIT SPECT study in early, nonmedicated patients. Mov Disord 2001;16:1033-40.
Zimmermann R, Deuschl G, Hornig A, Schulte-Mönting J, Fuchs G, Lücking CH. Tremors in Parkinson's disease: Symptom analysis and rating. Clin Neuropharmacol 1994;17:303-14.
Roze E, Coêlho-Braga MC, Gayraud D, Legrand AP. Head tremor in Parkinson's disease. Mov Disord 2006;21:1245-8.
Gan J, Xie-Brustolin J Gervais-Bernard H, Vallet AE, Broussolle E, Thobois S. Possible Parkinson's disease revealed by a pure head resting tremor. J Neurol Sci 2009;279:121-3.
Adams RD, Victor M. Tremors, myoclonus, spasms and tics. In: Ropper AH Brown RH, editors. Principles of Neurology. 8th
ed. New York: McGraw-Hill; 2005. p. 80-99.
Ben-Pazi H, Bergman H, Goldberg JA, Giladi N, Hansel D, Reches A, et al
. Synchrony of rest tremor in multiple limbs in Parkinson's disease: Evidence for multiple oscillators. J Neural Transm 2001;108:287-96.
Brown P, Corcos DM, Rothwell JC. Does parkinsonian action tremor contribute to muscle weakness in Parkinson's disease? Brain 1997;120:401-8.
Carboncini MC, Manzoni D, Strambi S, Bonuccelli U, Pavese N, Andre P, et al
. The relation between EMG activity and kinematic parameters strongly supports a role of the action tremor in parkinsonian bradykinesia. Mov Disord 2001;16:47-57.
Lance JW, Schwab RS, Peterson EA. Action tremor and the cogwheel phenomenon in Parkinson's disease. Brain 1963;86:95-110.
Hadar U, Rose FC. Is parkinsonian arm tremor a resting tremor? Eur Neurol 1993;33:221-8.
Forssberg H, Ingvarsson PE Iwasaki N, Johansson RS, Gordon AM. Action tremor during object manipulation in Parkinson's disease. Mov Disord 2000;15:244-54.
Milanov I. Clinical and electromyographic examinations of Parkinsonian tremor. Parkinsonism Relat Disord 2000;6:229-35.
Chaudhuri KR, Buxton-Thomas M, Dhawan V, Peng R, Meilak C, Brooks DJ. Long duration asymmetrical postural tremor is likely to predict development of Parkinson's disease and not essential tremor: Clinical follow up study of 13 cases. J Neurol Neurosurg Psychiatry 2005;76:115-7.
Kraus PH, Lemke MR, Reichmann H. Kinetic tremor in Parkinson's disease – An underrated symptom. J Neural Transm 2006;113:845-53.
Wenzelburger R, Raethjen J, Löffler K, Stolze H, Illert M, Deuschl G. Kinetic tremor in a reach-to-grasp movement in Parkinson's disease. Mov Disord 2000;15:1084-94.
Sternberg EJ, Alcalay RN, Levy OA, Louis ED. Postural and intention tremors: A detailed clinical study of essential tremor vs. Parkinson's disease. Front Neurol 2013;4:1-8.
Deuschl G, Papengut F, Hellriegel H. The phenomenology of parkinsonian tremor. Parkinsonism Relat Disord 2012;18:S87-9.
Hallett M. Parkinson's disease tremor: Pathophysiology. Parkinsonism Relat Disord 2012;18:S85-6.
Onofrj M, Varanese S, Bonanni L, Taylor JP, Antonini A, Valente EM, et al
. Cohort study of prevalence and phenomenology of tremor in dementia with Lewy bodies. J Neurol 2013;260:1731-42.
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;25:560-9.
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;81:1223-8.
Uchida K, Hirayama M, Yamashita F, Hori N, Nakamura T, Sobue G. Tremor is attenuated during walking in essential tremor with resting tremor but not parkinsonian tremor. J Clin Neurosci 2011;18:1224-8.
Fekete R, Li J. Clinical differentiation of essential tremor and Parkinson's disease. Clin Med Insights Case Rep 2013;6:67-74.
Delil S, Bölükbaşı F, Yeni N, Kızıltan G. Re-emergent tongue tremor as the presenting symptom of Parkinson's disease. Balkan Med J 2015;32:127-8.
Apartis E, Tison F
Arné P, Jedynak CP, Vidailhet M. Fast orthostatic tremor in Parkinson's disease mimicking primary orthostatic tremor. Mov Disord 2001;16:1133-6.
Wills A, Brusa L Wang H, Brown P, Marsden C. Levodopa may improve orthostatic tremor: Case report and trial of treatment. J Neurol Neurosurg Psychiatry 1999;66:681-4.
Infante J. Pseudo-orthostatic and resting leg tremor in a large Spanish family with homozygous truncating parkin mutation. Mov Disord 2009;24:144-7.
Rawal N, Periquet M, Lohmann E, Lücking CB, Teive HA, Ambrosio G, et al
. New parkin mutations and atypical phenotypes in families with autosomal recessive parkinsonism. Neurology 2003;60:1378-81.
Khan NL, Graham E, Critchley P, Schrag AE, Wood NW, Lees AJ, et al
. Parkin disease: A phenotypic study of a large case series. Brain 2003;126:1279-92.
Schneider SA, Edwards MJ, Mir P, Cordivari C, Hooker J, Dickson J, et al
. Patients with adult-onset dystonic tremor resembling parkinsonian tremor have scans without evidence of dopaminergic deficit (SWEDDs). Mov Disord 2007;22:2210-5.
Batla A, Erro R, Stamelou M, Schneider SA, Schwingenschuh P, Ganos C, et al
. Patients with scans without evidence of dopaminergic deficit: A long-term follow-up study. Mov Disord 2014;29:1820-5.
Shulman LM, Singer C, Bean JA, Weiner WJ. Internal tremor in patients with Parkinson's disease. Mov Disord 1996;11:3-7.
Golbe LI, Davis PH, Schoenberg BS, Duvoisin RC. Prevalence and natural history of progressive supranuclear palsy. Neurology 1988;38:1031-4.
Litvan I, Agid Y, Calne D, Campbell G, Dubois B, Duvoisin RC, et al
. Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): Report of the NINDS-SPSP international workshop. Neurology 1996;47:1-9.
Kristensen MO. Progressive supranuclear palsy – 20 years later. Acta Neurol Scand 1985;71:177-89.
Nath U, Ben-Shlomo Y, Thomson RG, Lees AJ, Burn DJ. Clinical features and natural history of progressive supranuclear palsy: A clinical cohort study. Neurology 2003;60:910-6.
Williams DR, de Silva R, Paviour DC, Pittman A, Watt HC, Kilford L, et al
. Characteristics of two distinct clinical phenotypes in pathologically proven progressive supranuclear palsy: Richardson's syndrome and PSP-parkinsonism. Brain 2005;128:1247-58.
Birdi S, Rajput AH, Fenton M, Donat JR, Rozdilsky B, Robinson C, et al
. Progressive supranuclear palsy diagnosis and confounding features: Report on 16 autopsied cases. Mov Disord 2002;17:1255-64.
Masucci EF, Kurtzke JF. Tremor in progressive supranuclear palsy. Acta Neurol Scand 1989;80:296-300.
Cordato NJ, Halliday GM, Caine D, Morris JG. Comparison of motor, cognitive, and behavioral features in progressive supranuclear palsy and Parkinson's disease. Mov Disord 2006;21:632-8.
Collins SJ, Ahlskog JE, Parisi JE, Maraganore DM. Progressive supranuclear palsy: Neuropathologically based diagnostic clinical criteria. J Neurol Neurosurg Psychiatry 1995;58:167-73.
Litvan I, Mangone CA, McKee A, Verny M, Parsa A, Jellinger K, et al
. Natural history of progressive supranuclear palsy and clinical predictors of survival: A clinicopathological study. J Neurol Neurosurg Psychiatry 1996 60:615-20.
Cubo E, Stebbins GT, Golbe LI, Nieves A, Leurgans S, Goetz CG, et al
. Application of the unified Parkinson's disease rating scale in progressive supranuclear palsy: Factor analysis of the motor scale. Mov Disord 2000;15:276-9.
Carrilho PE, Barbosa ER. Progressive supranuclear palsy in a sample of Brazilian population: Clinical features of 16 patients. Arq Neuropsiquiatr 2002;60:917-22.
Josephs KA, Dickson DW. Diagnostic accuracy of progressive supranuclear palsy in the Society for Progressive Supranuclear Palsy brain bank. Mov Disord 2003;18:1018-26.
Louis ED, Babij R, Ma K, Cortés E, Vonsattel JP. Essential tremor followed by progressive supranuclear palsy: Postmortem reports of 11 patients. J Neuropathol Exp Neurol 2013;72:8-17.
Rajput A, Robinson CA, Rajput AH. Essential tremor course and disability: A clinicopathologic study of 20 cases. Neurology 2004;62:932-6.
de Bie RM, Chen R, Lang AE. Orthostatic tremor in progressive supranuclear palsy. Mov Disord 2007;22:1192-4.
Louis ED, Bain PG, Hallett M, Jankovic J, Vonsattel JP. What is it? Difficult to pigeon hole tremor: A clinical-pathological study of a man with jaw tremor. Tremor Other Hyperkinet Mov (N
Suyama N, Kobayashi S, Isino H, Iijima M, Imaoka K. Progressive supranuclear palsy with palatal myoclonus. Acta Neuropathol 1997;94:290-3.
Berlot R, Kojović M. Palatal tremor in progressive supranuclear palsy: A case report. Parkinsonism Relat Disord 2015;21:335-6.
Kulkarni PK, Muthane UB, Taly AB, Jayakumar PN, Shetty R, Swamy HS. Palatal tremor, progressive multiple cranial nerve palsies, and cerebellar ataxia: A case report and review of literature of palatal tremors in neurodegenerative disease. Mov Disord 1999;14:689-93.
Gouider-Khouja N, Vidailhet M, Bonnet AM, Pichon J, Agid Y. "Pure" striatonigral degeneration and Parkinson's disease: A comparative clinical study. Mov Disord 1995;10:288-94.
Quinn N. Multiple system atrophy – The nature of the beast. J Neurol Neurosurg Psychiatry 1989;52:78-89.
Tison F, Yekhlef F, Chrysostome V, Balestre E, Quinn NP, Poewe W, et al
. Parkinsonism in multiple system atrophy: Natural history, severity (UPDRS-III), and disability assessment compared with Parkinson's disease. Mov Disord 2002;17:701-9.
Geser F, Seppi K, Stampfer-Kountchev M, Köllensperger M, Diem A, Ndayisaba JP, et al
. The European Multiple System Atrophy-Study Group (EMSA-SG). J Neural Transm 2005;112:1677-86.
Gilman S, May SJ, Shults CW, Tanner CM, Kukull W, Lee VM. The North American Multiple System Atrophy Study Group. J Neural Transm 2005;112:1687-94.
Köllensperger M, Geser F, Ndayisaba JP, Boesch S, Seppi K, Ostergaard K, et al
. Presentation, diagnosis, and management of multiple system atrophy in Europe: Final analysis of the European multiple system atrophy registry. Mov Disord 2010;25:2604-12.
Wenning GK, Geser F, Krismer F, Seppi K, Duerr S, Boesch S, et al
. The natural history of multiple system atrophy: A prospective European cohort study. Lancet Neurol 2013;12:264-74.
Petrovic IN, Ling H, Asi Y, Ahmed Z, Kukkle PL, Hazrati LN, et al
. Multiple system atrophy-parkinsonism with slow progression and prolonged survival: A diagnostic catch. Mov Disord 2012;27:1186-90.
Wüllner U, Schmitz-Hübsch T, Abele M, Antony G, Bauer P, Eggert K. Features of probable multiple system atrophy patients identified among 4770 patients with parkinsonism enrolled in the multicentre registry of the German Competence Network on Parkinson's disease. J Neural Transm 2007;114:1161-5.
Bjornsdottir A, Gudmundsson G, Blondal H, Olafsson E. Incidence and prevalence of multiple system atrophy: A nationwide study in Iceland. J Neurol Neurosurg Psychiatry 2013;84:136-40.
Wenning GK, Tison F, Ben Shlomo Y, Daniel SE, Quinn NP. Multiple system atrophy: A review of 203 pathologically proven cases. Mov Disord 1997;12:133-47.
Wenning GK, Ben Shlomo Y, Magalhães M, Daniel SE, Quinn NP. Clinical features and natural history of multiple system atrophy: An analysis of 100 cases. Brain 1994;117:835-45.
Tada M, Onodera O, Ozawa T, Piao YS, Tada M, Kakita A, et al
. Early development of autonomic dysfunction may predict poor prognosis in patients with multiple system atrophy. Arch Neurol 2007;64:256-60.
Yabe I, Soma H, Takei A, Fujiki N, Yanagihara T, Sasaki H. MSA-C is the predominant clinical phenotype of MSA in Japan: Analysis of 142 patients with probable MSA. J Neurol Sci 2006;249:115-21.
Kaindlstorfer C, Granata R, Wenning GK. Tremor in multiple system atrophy – A review. Tremor Other Hyperkinet Mov (NY). 2013;3.
Seppi K, Schocke MF, Donnemiller E, Esterhammer R, Kremser C, Scherfler C, et al
. Comparison of diffusion weighted imaging and [123I] IBZM-SPECT for the differentiation of patients with the Parkinson variant of multiple system atrophy from those with Parkinson's disease. Mov Disord 2004;19:1438-45.
Hellmann MA, Melamed E, Steinmetz AP, Djaldetti R. Unilateral lower limb rest tremor is not necessarily a presenting symptom of Parkinson's disease. Mov Disord 2010;25:924-7.
Wenning GK, Litvan I, Jankovic J, Granata R, Mangone CA, McKee A, et al
. Natural history and survival of 14 patients with corticobasal degeneration confirmed at postmortem examination. J Neurol Neurosurg Psychiatry 1998;64:184-9.
Murray R, Neumann M, Forman MS, Farmer J, Massimo L, Rice A, et al
. Cognitive and motor assessment in autopsy-proven corticobasal degeneration. Neurology 2007;68:1274-83.
Ling H, O'Sullivan SS, Holton JL, Revesz T, Massey LA, Williams DR, et al
. Does corticobasal degeneration exist? A clinicopathological re-evaluation. Brain 2010;133:2045-57.
Kouri N, Murray ME, Hassan A, Rademakers R, Uitti RJ, Boeve BF, et al
. Neuropathological features of corticobasal degeneration presenting as corticobasal syndrome or Richardson syndrome. Brain 2011;134:3264-75.
McKeith IG, Dickson DW, Lowe J, Emre M, O'Brien JT, Feldman H. Diagnosis and management of dementia with Lewy bodies: Third report of the DLB Consortium. Neurology 2005;65:1863-72.
Byrne EJ, Lennox G, Lowe J, Godwin-Austen RB. Diffuse Lewy body disease: Clinical features in 15 cases. J Neurol Neurosurg Psychiatry 1989;52:709-17.
Aarsland D, Ballard C, McKeith I, Perry RH, Larsen JP. Comparison of extrapyramidal signs in dementia with Lewy bodies and Parkinson's disease. J Neuropsychiatry Clin Neurosci 2001;13:374-9.
Ballard C, McKeith I, Burn D, Harrison R, O'Brien J, Lowery K, et al
. The UPDRS scale as a means of identifying extrapyramidal signs in patients suffering from dementia with Lewy bodies. Acta Neurol Scand 1997;96:366-71.
Mestre TA, Lang AE, Ferreira JJ, Almeida V, de Carvalho M, Miyasaki J, et al
. Associated movement disorders in orthostatic tremor. J Neurol Neurosurg Psychiatry 2012;83:725-9.
Yaltho TC, Ondo WG. Orthostatic tremor: A review of 45 cases. Parkinsonism Relat Disord 2014;20:723-5.
[Table 1], [Table 2], [Table 3], [Table 4]
|This article has been cited by|
||The Effect of Parkinson Disease Tremor Phenotype on Cepstral Peak Prominence and Transglottal Airflow in Vowels and Speech
| ||Brittany R. Burk,Christopher R. Watts |
| ||Journal of Voice. 2018; |
|[Pubmed] | [DOI]|