The Cerebellum

, Volume 15, Issue 2, pp 152–158 | Cite as

Perverted Head-Shaking and Positional Downbeat Nystagmus in Essential Tremor

  • Young Eun Kim
  • Ji Soo Kim
  • Hui-Jun Yang
  • Ji Young Yun
  • Han-Joon Kim
  • Gwanhee Ehm
  • Jong-Min Kim
  • Beom S. Jeon
Original Paper

Abstract

Even though the pathophysiology is not completely understood, cerebellar dysfunction has been invoked in essential tremor (ET). We evaluated cerebellar dysfunction in ET with the presence of perverted head-shaking (pHSN) and positional downbeat nystagmus (pDBN) which are known to reflect cerebellar dysfunction. First, we reviewed the videooculography (VOG) of 185 patients with ET from March 2007 to April 2010. Seventeen of 28 patients with pHSN and pDBN were followed up for at least a 1.8-year interval from baseline to determine the clinical course. And then, we recruited 52 consecutive patients with ET and compared their ocular motor findings with 51 normal controls using VOG. Among the 185 patients with ET, 28 (15.1 %) showed pHSN (n = 23, 12.4 %) or pDBN (n = 8, 4.3 %). Seventeen of them who were followed up did not develop Parkinsonism or other neurologic deficits during the observation period. The subsequent case-control study showed a higher prevalence of pHSN or pDBN (11/52, 21.2 %, pHSN in nine and pDBN in five) in patients with ET than in the normal controls (2/51, 3.9 %, pHSN only, P = 0.015). The tremor rating scale or involved body sites did not differ between the patients with and without pHSN/pDBN. pHSN and pDBN were more common in patients with ET than in the normal controls. This result supports that cerebellar dysfunction is associated with ET.

Keywords

Essential tremor Positional downbeat nystagmus Perverted head-shaking nystagmus Ocular motor abnormality Videooculography 

Notes

Acknowledgments

This study was supported by grant no. 04-2011-1060 from the SNUH Research Fund.

Conflict of Interest

None.

References

  1. 1.
    Raethjen J, Deuschl G. The oscillating central network of essential tremor. Clin Neurophysiol: Off J Int Fed Clin Neurophysiol. 2012;123:61–4. doi: 10.1016/j.clinph.2011.09.024.CrossRefGoogle Scholar
  2. 2.
    Louis ED. Essential tremor. Lancet Neurol. 2005;4:100–10. doi: 10.1016/s1474-4422(05)00991-9.CrossRefPubMedGoogle Scholar
  3. 3.
    Chandran V, Pal PK. Essential tremor: beyond the motor features. Parkinsonism Relat Disord. 2012;18:407–13. doi: 10.1016/j.parkreldis.2011.12.003.CrossRefPubMedGoogle Scholar
  4. 4.
    Louis ED. Essential tremor: evolving clinicopathological concepts in an era of intensive post-mortem enquiry. Lancet Neurol. 2010;9:613–22. doi: 10.1016/s1474-4422(10)70090-9.CrossRefPubMedGoogle Scholar
  5. 5.
    Gitchel GT, Wetzel PA, Baron MS. Slowed saccades and increased square wave jerks in essential tremor. Tremor and other hyperkinetic movements. 2013; 3.Google Scholar
  6. 6.
    Kim JS, Ahn KW, Moon SY, Choi KD, Park SH, Koo JW. Isolated perverted head-shaking nystagmus in focal cerebellar infarction. Neurology. 2005;64:575–6. doi: 10.1212/01.WNL.0000150729.87682.79.CrossRefPubMedGoogle Scholar
  7. 7.
    Helmchen C, Hagenow A, Miesner J, Sprenger A, Rambold H, Wenzelburger R, et al. Eye movement abnormalities in essential tremor may indicate cerebellar dysfunction. Brain J Neurol. 2003;126:1319–32.CrossRefGoogle Scholar
  8. 8.
    Leigh RJ, Zee DS. The neurology of eye movements. Oxford University Press; http://www.loc.gov/catdir/toc/ecip0517/2005022301.html. http://www.loc.gov/catdir/enhancements/fy0637/2005022301-d.html.
  9. 9.
    Lee JY, Lee WW, Kim JS, Kim HJ, Kim JK, Jeon BS. Perverted head-shaking and positional downbeat nystagmus in patients with multiple system atrophy. Mov Disord: Off J Mov Disord Soc. 2009;24:1290–5. doi: 10.1002/mds.22559.CrossRefGoogle Scholar
  10. 10.
    Elble RJ. Diagnostic criteria for essential tremor and differential diagnosis. Neurology. 2000;54:S2–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Fahn S, Tolosa E, Concepcion M. Clinical rating scale for tremor. In: Tolosa E, Jankovic J, editors. Parkinson’s disease and movement disorders. Baltimore: Williams and Wilkins; 1993. p. 271–80.Google Scholar
  12. 12.
    Bain PG, Findley LJ, Atchison P, Behari M, Vidailhet M, Gresty M, et al. Assessing tremor severity. J Neurol Neurosurg Psychiatry. 1993;56:868–73.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Marti S, Straumann D, Buttner U, Glasauer S. A model-based theory on the origin of downbeat nystagmus. Exp Brain Res. 2008;188:613–31. doi: 10.1007/s00221-008-1396-7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Young Eun Kim
    • 1
    • 2
  • Ji Soo Kim
    • 3
  • Hui-Jun Yang
    • 2
    • 4
  • Ji Young Yun
    • 2
    • 5
  • Han-Joon Kim
    • 2
    • 6
  • Gwanhee Ehm
    • 2
    • 6
  • Jong-Min Kim
    • 2
    • 3
  • Beom S. Jeon
    • 2
    • 6
  1. 1.Department of NeurologyHallym University Sacred Heart Hospital, Hallym University College of MedicineAnyangKorea
  2. 2.Department of Neurology and Movement Disorder Center, Parkinson Study GroupSeoul National University HospitalSeoulKorea
  3. 3.Department of NeurologySeoul National University Bundang Hospital, Seoul National University College of MedicineSeoulKorea
  4. 4.Department of NeurologyUlsan University HospitalUlsanKorea
  5. 5.Department of NeurologyEwha Womans University Mokdong HospitalSeoulKorea
  6. 6.Department of NeurologySeoul National University Hospital, Seoul National University College of MedicineSeoulKorea

Personalised recommendations