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Mechanisms and Emerging Therapies in Tremor Disorders pp 203–218Cite as

Dystonic Tremor

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Part of the book series: Contemporary Clinical Neuroscience ((CCNE))

Abstract

Tremor is the most common movement disorder, known since the time of Galen, and defined as a rhythmic involuntary movement of one or several regions of the body (Albanese and Jankovic 2012). Many attempts have been made in the last century to define and classify normal and pathological tremors, but a comprehensive summary did not exist until the Movement Disorder Society developed a first consensus statement (Deuschl et al. 1998). Among several types of tremor, essential tremor (ET) is the most common, although its epidemiology is still unclear (see also Chap. 10). The clinical signs and symptoms of ET are much broader than previously thought, ranging from a relatively benign postural tremor to a disabling kinetic or intention tremor that affects the hands and also the head (Leegwater-Kim et al. 2006). Even rest tremor has been observed in advanced ET. A tremor similar to ET may occur in dystonia and can be mistaken for non-dystonic tremor, particularly when it is isolated (Lalli and Albanese 2010). Various types of focal task-specific tremors (e.g., vocal tremor, primary writing tremor) have been described in the past 35 years and it is still a matter of debate whether these tremors are focal tremulous dystonias, focal essential tremors, or an independent condition.

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Abbreviations

CD:

Cervical dystonia

DAT-SPECT:

Dopamine transporter single photon emission computed tomography

DBS:

Deep brain stimulation

ET:

Essential tremor

PD:

Parkinson’s disease

PWT:

Primary writing tremor

SWEDD:

Scans without evidence of dopaminergic deficit.

References

  • Albanese A. The clinical expression of primary dystonia. J Neurol. 2003;250(10):1145–51.

    Article  PubMed  Google Scholar 

  • Albanese A. Dystonia: clinical approach. Parkinsonism Relat Disord. 2007;13 Suppl 3:S356–61.

    Article  PubMed  Google Scholar 

  • Albanese A, Jankovic J. Distinguishing clinical features of hyperkinetic disorders. In: Albanese A, Jankovic J, editors. Hyperkinetic movement disorders: differential diagnosis and treatment. 1st ed. London: Blackwell; 2012. p. 3–14.

    Google Scholar 

  • Albanese A, Lalli S. Is this dystonia? Mov Disord. 2009;24(12):1725–31.

    Article  PubMed  Google Scholar 

  • Albanese A, Lalli S. Distinguishing scan without evidence of dopaminergic depletion patients with asymmetric resting tremor from Parkinson’s disease: a clinical diagnosis of dystonia is required. Mov Disord. 2010;25(16):2899.

    Article  PubMed  Google Scholar 

  • Altenmuller E, Jabusch HC. Focal dystonia in musicians: phenomenology, pathophysiology, triggering factors, and treatment. Med Probl Perform Art. 2010;25(1):3–9.

    PubMed  Google Scholar 

  • Aminoff MJ, Dedo HH, Izdebski K. Clinical aspects of spasmodic dysphonia. J Neurol Neurosurg Psychiatry. 1978;41(4):361–5.

    Article  PubMed  CAS  Google Scholar 

  • Bain PG. The management of tremor. J Neurol Neurosurg Psychiatry. 2002;72 Suppl 1:I3–9.

    PubMed  Google Scholar 

  • Bain PG, Findley LJ, Britton TC, Rothwell JC, Gresty MA, Thompson PD, et al. Primary writing tremor. Brain. 1995;118(Pt 6):1461–72.

    Article  PubMed  Google Scholar 

  • Bara-Jimenez W, Catalan MJ, Hallett M, Gerloff C. Abnormal somatosensory homunculus in dystonia of the hand. Ann Neurol. 1998;44(5):828–31.

    Article  PubMed  CAS  Google Scholar 

  • Bara-Jimenez W, Shelton P, Hallett M. Spatial discrimination is abnormal in focal hand dystonia. Neurology. 2000;55(12):1869–73.

    Article  PubMed  CAS  Google Scholar 

  • Barkmeier JM, Case JL, Ludlow CL. Identification of symptoms for spasmodic dysphonia and vocal tremor: a comparison of expert and nonexpert judges. J Commun Disord. 2001;34(1–2):21–37.

    Article  PubMed  CAS  Google Scholar 

  • Benito-Leon J, Bermejo-Pareja F, Morales JM, Vega S, Molina JA. Prevalence of essential tremor in three elderly populations of central Spain. Mov Disord. 2003;18(4):389–94.

    Article  PubMed  Google Scholar 

  • Benito-Leon J, Bermejo-Pareja F, Louis ED. Incidence of essential tremor in three elderly populations of central Spain. Neurology. 2005;64(10):1721–5.

    Article  PubMed  Google Scholar 

  • Benito-Leon J, Louis ED, Bermejo-Pareja F. Risk of incident Parkinson’s disease and parkinsonism in essential tremor: a population based study. J Neurol Neurosurg Psychiatry. 2009;80(4):423–5.

    Article  PubMed  CAS  Google Scholar 

  • Berardelli A, Rothwell JC, Hallett M, Thompson PD, Manfredi M, Marsden CD. The pathophysiology of primary dystonia. Brain. 1998;121(Pt 7):1195–212.

    Article  PubMed  Google Scholar 

  • Berque P, Gray H, Harkness C, McFadyen A. A combination of constraint-induced therapy and motor control retraining in the treatment of focal hand dystonia in musicians. Med Probl Perform Art. 2010;25(4):149–61.

    PubMed  Google Scholar 

  • Boutsen F, Duffy JR, Dimassi H, Christman SS. Long-term phonatory instability in ataxic dysarthria. Folia Phoniatr Logop. 2011;63(4):216–20.

    Article  PubMed  Google Scholar 

  • Bressman SB, Sabatti C, Raymond D, De LD, Klein C, Kramer PL, et al. The DYT1 phenotype and guidelines for diagnostic testing. Neurology. 2000;54(9):1746–52.

    Article  PubMed  CAS  Google Scholar 

  • Brin MF, Lyons KE, Doucette J, Adler CH, Caviness JN, Comella CL, et al. A randomized, double masked, controlled trial of botulinum toxin type A in essential hand tremor. Neurology. 2001;56(11):1523–8.

    Article  PubMed  CAS  Google Scholar 

  • Byrnes ML, Thickbroom GW, Wilson SA, Sacco P, Shipman JM, Stell R, et al. The corticomotor representation of upper limb muscles in writer’s cramp and changes following botulinum toxin injection. Brain. 1998;121(Pt 5):977–88.

    Article  PubMed  Google Scholar 

  • Chou KL, Hurtig HI, Jaggi JL, Baltuch GH. Bilateral subthalamic nucleus deep brain stimulation in a patient with cervical dystonia and essential tremor. Mov Disord. 2005;20(3):377–80.

    Article  PubMed  Google Scholar 

  • Cohen LG, Hallett M. Hand cramps: clinical features and electromyographic patterns in a focal dystonia. Neurology. 1988;38(7):1005–12.

    Article  PubMed  CAS  Google Scholar 

  • Coubes P, Cif L, El FH, Hemm S, Vayssiere N, Serrat S, et al. Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long-term results. J Neurosurg. 2004;101(2):189–94.

    Article  PubMed  Google Scholar 

  • Couch JR. Dystonia and tremor in spasmodic torticollis. Adv Neurol. 1976;14:245–58.

    PubMed  CAS  Google Scholar 

  • Davis TL, Charles PD, Burns RS. Clonazepam-sensitive intermittent dystonic tremor. South Med J. 1995;88(10):1069–71.

    Article  PubMed  CAS  Google Scholar 

  • Defazio G, Abbruzzese G, Livrea P, Berardelli A. Epidemiology of primary dystonia. Lancet Neurol. 2004;3(11):673–8.

    Article  PubMed  Google Scholar 

  • Deuschl G. Dystonic tremor. Rev Neurol (Paris). 2003;159(10 Pt 1):900–5.

    CAS  Google Scholar 

  • Deuschl G, Heinen F, Guschlbauer B, Schneider S, Glocker FX, Lucking CH. Hand tremor in patients with spasmodic torticollis. Mov Disord. 1997;12(4):547–52.

    Article  PubMed  CAS  Google Scholar 

  • Deuschl G, Bain P, Brin M. Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee. Mov Disord. 1998;13 Suppl 3:2–23.

    PubMed  Google Scholar 

  • Deuschl G, Wenzelburger R, Loffler K, Raethjen J, Stolze H. Essential tremor and cerebellar dysfunction clinical and kinematic analysis of intention tremor. Brain. 2000;123(Pt 8):1568–80.

    Article  PubMed  Google Scholar 

  • Dogu O, Louis ED, Sevim S, Kaleagasi H, Aral M. Clinical characteristics of essential tremor in Mersin, Turkey–a population-based door-to-door study. J Neurol. 2005;252(5):570–4.

    Article  PubMed  Google Scholar 

  • Elbert T, Candia V, Altenmuller E, Rau H, Sterr A, Rockstroh B, et al. Alteration of digital representations in somatosensory cortex in focal hand dystonia. Neuroreport. 1998;9(16):3571–5.

    Article  PubMed  CAS  Google Scholar 

  • Elble RJ. Essential tremor frequency decreases with time. Neurology. 2000a;55(10):1547–51.

    Article  PubMed  CAS  Google Scholar 

  • Elble RJ. Diagnostic criteria for essential tremor and differential diagnosis. Neurology. 2000b;54 Suppl 4:S2–6.

    PubMed  CAS  Google Scholar 

  • Elble RJ. Report from a U.S. conference on essential tremor. Mov Disord. 2006;21(12):2052–61.

    Article  PubMed  Google Scholar 

  • Elble RJ, Moody C, Higgins C. Primary writing tremor. A form of focal dystonia? Mov Disord. 1990;5(2):118–26.

    Article  PubMed  CAS  Google Scholar 

  • Espay AJ, Hung SW, Sanger TD, Moro E, Fox SH, Lang AE. A writing device improves writing in primary writing tremor. Neurology. 2005;64(9):1648–50.

    Article  PubMed  CAS  Google Scholar 

  • Fahn S, Marsden CD, Calne DB. Classification and investigation of dystonia. In: Marsden CD, Fahn S, editors. Movement disorders 2. London: Butterworths; 1987. p. 332–58.

    Google Scholar 

  • Ferraz HB, de Andrade LA, Silva SM, Borges V, Rocha MS. Postural tremor and dystonia. Clinical aspects and physiopathological considerations. Arq Neuropsiquiatr. 1994;52(4):466–70.

    Article  PubMed  CAS  Google Scholar 

  • Gillivan-Murphy P, Miller N. Voice tremor: what we know and what we do not know. Curr Opin Otolaryngol Head Neck Surg. 2011;19(3):155–9.

    Article  PubMed  Google Scholar 

  • Hughes AJ, Lees AJ, Marsden CD. Paroxysmal dystonic head tremor. Mov Disord. 1991;6(1): 85–6.

    Article  PubMed  CAS  Google Scholar 

  • Jankovic J, Fahn S. Physiologic and pathologic tremors. Diagnosis, mechanism, and management. Ann Intern Med. 1980;93(3):460–5.

    PubMed  CAS  Google Scholar 

  • Jankovic J, Schwartz K. Botulinum toxin treatment of tremors. Neurology. 1991;41(8):1185–8.

    Article  PubMed  CAS  Google Scholar 

  • Jedynak CP, Bonnet AM, Agid Y. Tremor and idiopathic dystonia. Mov Disord. 1991;6(3): 230–6.

    Article  PubMed  CAS  Google Scholar 

  • Kagi G, Bhatia KP, Tolosa E. The role of DAT-SPECT in movement disorders. J Neurol Neurosurg Psychiatry. 2010;81(1):5–12.

    Article  PubMed  CAS  Google Scholar 

  • Kendall KA, Leonard RJ. Interarytenoid muscle botox injection for treatment of adductor spasmodic dysphonia with vocal tremor. J Voice. 2011;25(1):114–9.

    Article  PubMed  Google Scholar 

  • Kim JS. Delayed onset mixed involuntary movements after thalamic stroke: clinical, radiological and pathophysiological findings. Brain. 2001;124(Pt 2):299–309.

    Article  PubMed  CAS  Google Scholar 

  • Klawans HL, Glantz R, Tanner CM, Goetz CG. Primary writing tremor: a selective action tremor. Neurology. 1982;32(2):203–6.

    Article  PubMed  CAS  Google Scholar 

  • Lalli S, Albanese A. The diagnostic challenge of primary dystonia: evidence from misdiagnosis. Mov Disord. 2010;25(11):1619–26.

    Article  PubMed  Google Scholar 

  • Leegwater-Kim J, Louis ED, Pullman SL, Floyd AG, Borden S, Moskowitz CB, et al. Intention tremor of the head in patients with essential tremor. Mov Disord. 2006;21(11):2001–5.

    Article  PubMed  Google Scholar 

  • Lou JS, Jankovic J. Essential tremor: clinical correlates in 350 patients. Neurology. 1991;41(2 Pt 1): 234–8.

    Article  PubMed  CAS  Google Scholar 

  • Louis ED, Ottman R, Hauser WA. How common is the most common adult movement disorder? Estimates of the prevalence of essential tremor throughout the world. Mov Disord. 1998;13(1):5–10.

    Article  PubMed  CAS  Google Scholar 

  • Louis ED, Rios E, Henchcliffe C. Mirror movements in patients with essential tremor. Mov Disord. 2009;24:2211–7.

    Article  PubMed  Google Scholar 

  • Ludlow CL, Connor NP. Dynamic aspects of phonatory control in spasmodic dysphonia. J Speech Hear Res. 1987;30(2):197–206.

    PubMed  CAS  Google Scholar 

  • Ludlow CL, Naunton RF, Terada S, Anderson BJ. Successful treatment of selected cases of abductor spasmodic dysphonia using botulinum toxin injection. Otolaryngol Head Neck Surg. 1991;104(6):849–55.

    PubMed  CAS  Google Scholar 

  • Marsden CD. Dystonia: the spectrum of the disease. In: Yahr MD, editor. The basal ganglia. New York: Raven; 1976. p. 351–67.

    Google Scholar 

  • Masuhr F, Wissel J, Muller J, Scholz U, Poewe W. Quantification of sensory trick impact on tremor amplitude and frequency in 60 patients with head tremor. Mov Disord. 2000;15(5):960–4.

    Article  PubMed  CAS  Google Scholar 

  • McDaniel KD, Cummings JL, Shain S. The “yips”: a focal dystonia of golfers. Neurology. 1989;39(2 Pt 1):192–5.

    Article  PubMed  CAS  Google Scholar 

  • Midi I, Dogan M, Koseoglu M, Can G, Sehitoglu MA, Gunal DI. Voice abnormalities and their relation with motor dysfunction in Parkinson’s disease. Acta Neurol Scand. 2008;117(1): 26–34.

    PubMed  CAS  Google Scholar 

  • Miwa H, Hatori K, Kondo T, Imai H, Mizuno Y. Thalamic tremor: case reports and implications of the tremor-generating mechanism. Neurology. 1996;46(1):75–9.

    Article  PubMed  CAS  Google Scholar 

  • Modugno N, Nakamura Y, Bestmann S, Curra A, Berardelli A, Rothwell J. Neurophysiological investigations in patients with primary writing tremor. Mov Disord. 2002;17(6):1336–40.

    Article  PubMed  Google Scholar 

  • Munchau A, Schrag A, Chuang C, MacKinnon CD, Bhatia KP, Quinn NP, et al. Arm tremor in cervical dystonia differs from essential tremor and can be classified by onset age and spread of symptoms. Brain. 2001;124:1765–76.

    Article  PubMed  CAS  Google Scholar 

  • Ohye C, Miyazaki M, Hirai T, Shibazaki T, Nakajima H, Nagaseki Y. Primary writing tremor treated by stereotactic selective thalamotomy. J Neurol Neurosurg Psychiatry. 1982;45(11): 988–97.

    Article  PubMed  CAS  Google Scholar 

  • Pal PK, Samii A, Schulzer M, Mak E, Tsui JK. Head tremor in cervical dystonia. Can J Neurol Sci. 2000;27(2):137–42.

    PubMed  CAS  Google Scholar 

  • Papapetropoulos S, Singer C. Treatment of primary writing tremor with botulinum toxin type a injections: report of a case series. Clin Neuropharmacol. 2006;29(6):364–7.

    Article  PubMed  Google Scholar 

  • Pesenti A, Barbieri S, Priori A. Limb immobilization for occupational dystonia: a possible alternative treatment for selected patients. Adv Neurol. 2004;94:247–54.

    PubMed  Google Scholar 

  • Plaha P, Khan S, Gill SS. Bilateral stimulation of the caudal zona incerta nucleus for tremor control. J Neurol Neurosurg Psychiatry. 2008;79(5):504–13.

    Article  PubMed  CAS  Google Scholar 

  • Priori A, Pesenti A, Cappellari A, Scarlato G, Barbieri S. Limb immobilization for the treatment of focal occupational dystonia. Neurology. 2001;57(3):405–9.

    Article  PubMed  CAS  Google Scholar 

  • Pullman SL, Goodin DS, Marquinez AI, Tabbal S, Rubin M. Clinical utility of surface EMG: report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology. 2000;55(2):171–7.

    Article  PubMed  CAS  Google Scholar 

  • Racette BA, Dowling J, Randle J, Mink JW. Thalamic stimulation for primary writing tremor. J Neurol. 2001;248(5):380–2.

    Article  PubMed  CAS  Google Scholar 

  • Rajput AH, Offord KP, Beard CM, Kurland LT. Essential tremor in Rochester, Minnesota: a 45-year study. J Neurol Neurosurg Psychiatry. 1984;47(5):466–70.

    Article  PubMed  CAS  Google Scholar 

  • Rivest J, Marsden CD. Trunk and head tremor as isolated manifestations of dystonia. Mov Disord. 1990;5(1):60–5.

    Article  PubMed  CAS  Google Scholar 

  • Rosenbaum F, Jankovic J. Focal task-specific tremor and dystonia: categorization of occupational movement disorders. Neurology. 1988;38(4):522–7.

    Article  PubMed  CAS  Google Scholar 

  • Rothwell JC, Traub MM, Marsden CD. Primary writing tremor. J Neurol Neurosurg Psychiatry. 1979;42(12):1106–14.

    Article  PubMed  CAS  Google Scholar 

  • Schwartzman RJ, Kerrigan J. The movement disorder of reflex sympathetic dystrophy. Neurology. 1990;40(1):57–61.

    Article  PubMed  CAS  Google Scholar 

  • Shukla G, Behari M. A clinical study of non-parkinsonian and non-cerebellar tremor at a specialty movement disorders clinic. Neurol India. 2004;52(2):200–2.

    PubMed  Google Scholar 

  • Soland VL, Bhatia KP, Volonte MA, Marsden CD. Focal task-specific tremors. Mov Disord. 1996;11(6):665–70.

    Article  PubMed  CAS  Google Scholar 

  • Stacy M. Epidemiology, clinical presentation, and diagnosis of cervical dystonia. Neurol Clin. 2008;26 Suppl 1:23–42.

    Article  PubMed  Google Scholar 

  • Stolze H, Petersen G, Raethjen J, Wenzelburger R, Deuschl G. The gait disorder of advanced essential tremor. Brain. 2001;124(Pt 11):2278–86.

    Article  PubMed  CAS  Google Scholar 

  • Sulica L, Louis ED. Clinical characteristics of essential voice tremor: a study of 34 cases. Laryngoscope. 2010;120(3):516–28.

    Article  PubMed  Google Scholar 

  • Svetel M, Pekmezovic T, Jovic J, Ivanovic N, Dragasevic N, Maric J, et al. Spread of primary dystonia in relation to initially affected region. J Neurol. 2007;254(7):879–83.

    Article  PubMed  Google Scholar 

  • Tas N, Karatas GK, Sepici V. Hand orthosis as a writing aid in writer’s cramp. Mov Disord. 2001;16(6):1185–9.

    Article  PubMed  CAS  Google Scholar 

  • Velickovic M, Benabou R, Brin MF. Cervical dystonia pathophysiology and treatment options. Drugs. 2001;61(13):1921–43.

    Article  PubMed  CAS  Google Scholar 

  • Watts C, Nye C, Whurr R. Botulinum toxin for treating spasmodic dysphonia (laryngeal dystonia): a systematic Cochrane review. Clin Rehabil. 2006;20(2):112–22.

    Article  PubMed  Google Scholar 

  • Wenning GK, Kiechl S, Seppi K, Muller J, Hogl B, Saletu M, et al. Prevalence of movement disorders in men and women aged 50-89 years (Bruneck Study cohort): a population-based study. Lancet Neurol. 2005;4(12):815–20.

    Article  PubMed  Google Scholar 

  • White LJ, Klein AM, Hapner ER, Delgaudio JM, Hanfelt JJ, Jinnah HA, et al. Coprevalence of tremor with spasmodic dysphonia: a case-control study. Laryngoscope. 2011;121(8):1752–5.

    Article  PubMed  Google Scholar 

  • Zeuner KE, Peller M, Knutzen A, Hallett M, Deuschl G, Siebner HR. Motor re-training does not need to be task specific to improve writer’s cramp. Mov Disord. 2008;23(16):2319–27.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Fondazione Istituto Neurologico Carlo Besta, Via G. Celoria, 11, 20133, Milano, Italy

    Stefania Lalli M.D., Ph.D. & Alberto Albanese M.D.

  2. Istituto di Neurologia, Università Cattolica del Sacro Cuore, Milano, Italy

    Alberto Albanese M.D.

Authors
  1. Stefania Lalli M.D., Ph.D.
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  2. Alberto Albanese M.D.
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Correspondence to Alberto Albanese M.D. .

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Editors and Affiliations

  1. , Unité d'Etude due Mouvement (UEM), Neurologie ULB Erasme, N/A, Bruxelles, N/A, Belgium

    Giuliana Grimaldi

  2. route de Lennik 808, Bruxelles, 1070, Belgium

    Mario Manto

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Lalli, S., Albanese, A. (2013). Dystonic Tremor. In: Grimaldi, G., Manto, M. (eds) Mechanisms and Emerging Therapies in Tremor Disorders. Contemporary Clinical Neuroscience. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4027-7_11

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