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Background Objectives Methods Results Conclusion There are few published data on the prevalence, pattern of anatomic distribution and predictors of various cranial tremors (eg, head, voice, jaw) in essential tremor (ET). Given the high levels of diagnostic misclassification in ET, data on observed clinical patterns would be valuable.To assess the prevalence, pattern of anatomic distribution and predictors of occurrence of cranial tremors in ET.ET cases who enrolled in two studies (respective n's = 301 and 175, total n = 476) underwent a detailed clinical assessment, which included a videotaped neurological examination. A senior movement disorders neurologist reviewed the examination and coded a range of cranial tremors as present or absent.The proportion of cases with any cranial tremor was 57.1% (Study 1) and 73.7% (Study 2). The following patterns emerged: (1) Head only and head + voice were the most commonly observed anatomical distribution of tremor. (2) Jaw tremors were rare, and face and tongue tremors, exceedingly rare. (3) There was a general layering‐on of tremor from head to head + voice to head + voice + jaw in more advanced cases. (4) Women were more likely to have head tremors than men, although there was no sex predilection tremor in other locations. (5) The likelihood of cranial tremor increased with greater tremor severity and age but was unrelated to tremor duration.We observed and quantified several patterns in the expression of cranial tremors in ET. Data on such patterns may assist clinicians and researchers in assigning diagnoses. [ABSTRACT FROM AUTHOR]

Background: Head tremor is common in dystonia syndromes and difficult to treat. Deep brain stimulation (DBS) is a therapeutic option in medically‐refractory cases. In most DBS‐centers, the globus pallidus internus (GPi) is targeted in patients with predominant dystonia and the ventrointermediate nucleus of the thalamus (Vim) in predominant tremor. The aim of the study was to evaluate the effect of GPi‐ versus Vim‐DBS in dystonic or essential head tremor. Methods: All patients with dystonia or essential tremor (ET) (n = 381) who underwent DBS surgery at our institution between 1999 and 2020 were screened for head tremor in our database according to predefined selection criteria. Of the 33 patients meeting inclusion criteria tremor and dystonia severity were assessed at baseline, short‐ (mean 10 months) and long‐term follow‐up (41 months) by two blinded video‐raters. Results: Twenty‐two patients with dystonic head tremor received either GPi‐ (n = 12) or Vim‐stimulation (n = 10), according to the prevailing clinical phenotype. These two groups were compared with 11 patients with ET, treated with Vim‐stimulation. The reduction in head tremor from baseline to short‐ and long‐term follow‐up was 60–70% and did not differ significantly between the three groups. Conclusions: GPi‐DBS effectively and sustainably reduced head tremor in idiopathic dystonia. The effect was comparable to the effect of Vim‐DBS on head tremor in dystonia patients with predominant limb tremor and to the effect of Vim‐DBS on head tremor in ET. [ABSTRACT FROM AUTHOR]

Head tremor usually requires bilateral deep brain stimulation of ventralis intermedius nucleus of thalamus. Ablation of VIM nucleus (VIM thalamotomy) is applied for limb tremor unilaterally because of serious complications from bilateral thalamotomy. Therefore, effects of thalamotomy on head tremor have been rarely reported. We report a successful long‐term outcome of head tremor with combined unilateral VIM thalamotomy and contralateral VIM‐DBS simultaneously. The patient was a 49‐year‐old man with head and bilateral hand tremors. His Fahn‐Tolosa‐Marin Tremor Rating Scale scores (head tremor score, range 8‐0, higher scores indicate greater severity) before and after the surgery were 8 and 0, respectively. Only transient tongue numbness was confirmed as a surgical complication. At the final follow‐up (36 months), the patient was completely free from tremor of the head and bilateral hands. Combined thalamotomy and DBS can be an alternative treatment option for head tremor. [ABSTRACT FROM AUTHOR]

Background: Early theories for cervical dystonia, as promoted by Hassler, emphasized the role of the midbrain interstitial nucleus of Cajal. Focus then shifted to the basal ganglia, and it was further supported with the success of deep brain stimulation. Contemporary theories suggested the role of the cerebellum, but even more recent hypotheses renewed interest in the midbrain. Although the pretectum was visited on several occasions, we still do not know about the physiology of midbrain neurons in cervical dystonia.Methods: We analyzed the unique database of pretectal neurons collected in the 1970s and 1980s during historic stereotactic surgeries aimed to treat cervical dystonia. This database is valuable because such recordings could otherwise never be obtained from humans.Results: We found the following 3 types of eye or neck movement sensitivity: eye-only neurons responded to pure vertical eye movements, neck-only neurons were sensitive to pure neck movements, and the combined eye-neck neurons responded to eye and neck movements. There were the 2 neuronal subtypes: burst-tonic and tonic. The eye-neck or eye-only neurons sustained their activity during eccentric gaze holding. In contrast, the response of neck-only and eye-neck neurons exponentially decayed during neck movements.Conclusions: Modern quantitative analysis of a historic database of midbrain single units from patients with cervical dystonia might support novel hypotheses for normal and abnormal head movements. This data, collected almost 4 decades ago, must be carefully viewed, especially because it was acquired using a less sophisticated technology available at that time and the aim was not to address specific hypothesis, but to make an accurate lesion providing optimal relief from dystonia. © 2017 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Background Accelerometers and gyroscopes are used commonly in the assessment of hand tremor, but their validity in the assessment of head tremor has not been studied. We hypothesized that gyroscopy would be superior to accelerometry because head tremor is rotational motion, and gyroscopes record rotational motion, free of gravitational artifact. We also hypothesized a strong logarithmic relationship between 0 to 4-point tremor ratings and the transducer measures of tremor amplitude, similar to those previously reported for hand tremor. Methods Head tremor was recorded for 1 minute in each of the five head positions used in the Essential Tremor Rating Assessment Scale, using a triaxial accelerometer and triaxial gyroscope mounted at the vertex of the head. Mean and maximum 3-second burst displacement tremor and rotation tremor were computed by spectral analysis. The minimum detectable change for the transducers was estimated using the residual mean squared error from repeated-measures analysis of variance. Results Tremor displacement and rotation (T) were logarithmically related to tremor ratings (tremor rating score; TRS): log(T) = α TRS + β, where α ≈ 0.47 for displacement and ≈0.64 for rotation, and β ≈ −1.8 and −1.4. Tremor ratings correlated more strongly with gyroscopy (r = 0.83-0.87) than with accelerometry (r = 0.71-0.75). Minimum detectable change (percent reduction) was approximately 66% of the baseline geometric mean. Conclusions Gyroscopic transducers are superior to accelerometry for assessment of head tremor. Both measures of head tremor are logarithmically related to tremor ratings. The minimum detectable change of the transducer measures is comparable to those previously reported for hand tremor. [ABSTRACT FROM AUTHOR]

Idiopathic head tremor (IHT) syndrome is a recognized but poorly characterized movement disorder in English bulldogs (EBs). The data analyzed were collected via a detailed online questionnaire and video recordings. Thirty-eight percent of the population demonstrated IHT. The first presentation was early in life. There was no sex or neutered status predisposition. The condition disappeared with time in 50% of the cases. The direction of the head movement was vertical or horizontal. The number of episodes per day and the duration of the episodes were greatly variable. The majority of episodes occurred at rest. Most of the episodes were unpredictable. And there was no alteration of the mental status for most dogs during the episodes. Stress has been reported as a suspected trigger factor. IHT in EBs can be considered an idiopathic paroxysmal movement disorder. © 2013 International Parkinson and Movement Disorder Society [ABSTRACT FROM AUTHOR]

Background and purpose: The medical treatment available for patients with essential tremor (ET) is often inadequate. Furthermore, the efficacy of the medical treatments currently available for patients with ET of cranial nerve areas is less satisfactory than that of the medical treatments available for patients with ET involving the upper extremities. This pilot study was performed to evaluate whether zonisamide (ZNS) is effective in the treatment of patients with isolated head tremor. Methods: All subjects with isolated head tremor were randomly treated with either ZNS or propranolol. After a washout period, the subjects were switched to the alternative drug. Results: ZNS was found to be more effective in the treatment of patients with isolated head tremor than propranolol. No severe adverse effects were reported with either ZNS or propranolol. Conclusion: ZNS may be more useful than propranolol for the treatment of ET patients with head tremor. [ABSTRACT FROM AUTHOR]

Objectives: Essential tremor (ET) patients presenting tremor in the midline structures may be a distinct subtype of the syndrome. Therefore, we sought to explore the clinical manifestations, especially non-motor symptoms (NMS) of Chinese ET patients with midline tremor (MT)., Methods: In the cross-sectional study, we grouped 290 definite or probable ET patients based on their MT conditions. The NMS in ET patients were evaluated using the NMS scale (NMSS). NMS and other clinical correlates were then compared among subgroups with, and without MT., Results: We revealed that 39.0%, 27.6%, and 6.9% of the patients respectively had neck, voice, and facial tremors. With the accumulation of tremor in midline structures, NMS became more severe and prevalent. Logistic regression analyses revealed that factors such as: female gender (OR = 2.164, 95% CI: 1.307-3.583), having least or highest action arm tremor (OR = 2.512, 95% CI: 1.520-4.151), having higher score of sleep/fatigue domain (OR = 1.692, 95% CI: 1.004-2.850) and mood/apathy (OR = 1.926, 95% CI: 1.143-3.246) domain, to be independently associated with MT manifestation., Conclusions: Our study demonstrates the heterogeneity of symptoms in ET patients with MT, especially in prominent NMS. In addition, the discrepancy of NMS between patients with, and without MT provides novel insight into the underlying pathophysiology and therapeutic of ET., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)