34 research outputs found
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Embarrassment in essential tremor : prevalence, clinical correlates and therapeutic implications
Background: Embarrassment is a commonly described feature of essential tremor (ET) but has not been the focus of clinical research. Objective: To estimate the prevalence, identify susceptible patient groups, and quantify the therapeutic correlates of reported embarrassment. Methods: A total of 106 ET cases from a population-based sample and 349 ET cases from a clinical sample were asked, "Does your tremor often embarrass you?" Results: In the clinical sample, the prevalence of embarrassment was high (58.2%). Even in those ET cases with no head tremor and mild arm tremor, nearly one-half (29/61 [47.5%]) reported embarrassment. While the prevalence of embarrassment was lower in the population-based sample, it was not negligible (18.9%). Embarrassment was associated with younger age of onset (p = 0.003) and women were nearly twice as likely as men to report embarrassment (OR = 1.85, p = 0.01). Independent of tremor severity, embarrassment nearly doubled the odds of using tremor medication (OR = 1.86, p = 0.01). Conclusions: Embarrassment may be a source of disability in ET. Even among clinic patients with mild tremor, nearly one-half reported embarrassment. We identified a number of patient characteristics linked to embarrassment. Embarrassment alone (i.e., independent of tremor severity) was responsible for a doubling of tremor medication usage. The majority of clinical trials do not assess the therapeutic effects of medication on embarrassment. These trials may benefit from scaled assessments of level of embarrassment
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Intention tremor in essential tremor : prevalence and association with disease duration
Scholarly attention only recently has been focused on intention tremor (IT) in essential tremor (ET).1, 2 Therefore, little has been written on its prevalence or clinical correlates. The association between IT and disease duration also remains unsettled. This question has pathophysiological implications. Studies have indicated metabolic and structural changes in the ET cerebellum.3, 4 If ET were a disease of progressive cerebellar dysregulation, one would expect more IT in patients with disease of longer duration. We assessed the prevalence and clinical correlates of IT and determined whether there was an association between IT and disease duration
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How are we doing with the treatment of essential tremor (ET)? persistence of patients with ET on medication : data from 528 patients in three settings
Background: The pharmacological treatment of essential tremor (ET) is not optimal. There are only two first-line medications and troublesome side effects are common. It is not uncommon for patients to simply stop taking medication. Yet, no published data substantiate or quantify this anecdotal impression. Objectives: To determine, amongst patients with ET who were prescribed medication for tremor, what proportion are still taking medication and what proportion have stopped? Methods: Five hundred and twenty-eight patients with ET from three distinct study settings (clinical, brain donors, population) were interviewed. Results: A clear pattern that emerged across settings was that the proportion of patients with ET who had stopped medication was sizable and consistently similar (nearly one-third): 31.4% (clinical), 24.3% (brain donors), 30.0% (population), 29.8% (overall). A similarly high proportion of cases with severe tremor had stopped their medication: 31.9% (clinical), 36.4% (brain donors). For the four most commonly used medications (propranolol, primidone, diazepam, topiramate), one-half or more of the treated patients had stopped the medication; amongst the less commonly used medications, the proportion who stopped was even higher. Conclusions: Nearly one of every three patients with ET who had been prescribed medication for tremor had discontinued pharmacotherapy. Even more revealing was that a similar proportion of cases with severe tremor had stopped medication. These data make tangibly evident that there is a sizable population of patients with ET who are untreated and disabled, and underscore the inadequacy of current pharmacotherapeutic options for this common neurological disease
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Action tremor of the legs in essential tremor : prevalence, clinical correlates, and comparison with age-matched controls
The hallmark feature of essential tremor (ET) is action tremor of the arms. Leg tremor may also occur yet it has not been the central focus of previous studies. Its prevalence has only rarely been reported, its clinical correlates have yet to be explored. Our aims were to report the prevalence and analyze the clinical correlates of leg action tremor in patients with ET and, given the propensity for normal elderly individuals to manifest mild limb tremors, compare the prevalence with that in age-matched controls. Kinetic leg tremor rated ā„1 occurred in 28/63 (44.4%) ET cases and in only 9/63 (14.3%) controls (p < 0.001); moderate leg tremor occurred in 14.3% of cases. Leg tremor severity modestly correlated with disease duration (r = 0.31, p = 0.02). However, the severity and laterality of leg tremor did not correlate with those of arm tremor. The pathophysiological implications of this finding deserve further exploration
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Higher blood harmane (1-methyl-9H-pyrido[3,4-b]indole) concentrations correlate with lower olfactory scores in essential tremor
Harmane (1-methyl-9H-pyrido[3,4-b]indole), a neurotoxin, may be an environmental risk factor for essential tremor (ET). Harmane and related chemicals are toxic to the cerebellum. Whether it is through this mechanism (cerebellar toxicity) that harmane leads to ET is unknown. Impaired olfaction may be a feature of cerebellar disease
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Dietary epidemiology of essential tremor: meat consumption and meat cooking pactices
Background/Aim: Harmane [1-methyl-9H-pyrido(3,4-b)indole] is a tremor-producing neurotoxin. Blood harmane concentrations are elevated in essential tremor (ET) patients for unclear reasons. Potential mechanisms include increased dietary harmane intake (especially through well-cooked meat) or genetic-metabolic factors. We tested the hypothesis that meat consumption and level of meat doneness are higher in ET cases than in controls. Methods: Detailed data were collected using the Lawrence Livermore National Laboratory Meat Questionnaire. Results: Total current meat consumption was greater in men with than without ET (135.3 Ā± 71.1 vs. 110.6 Ā± 80.4 g/day, p = 0.03) but not in women with versus without ET (80.6 Ā± 50.0 vs. 79.3 Ā± 51.0 g/day, p = 0.76). In an adjusted logistic regression analysis in males, higher total current meat consumption was associated with ET (OR = 1.006, p = 0.04, i.e., with 10 additional g/day of meat, odds of ET increased by 6%). Male cases had higher odds of being in the highest than lowest quartile of total current meat consumption (adjusted OR = 21.36, p = 0.001). Meat doneness level was similar in cases and controls. Conclusion: This study provides evidence of a dietary difference between male ET cases and male controls. The etiological ramifications of these results warrant additional investigation
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Elevated blood harmane (1-methyl-9H-pyrido[3,4-b]indole) concentrations in essential tremor
Essential tremor (ET) is a widespread late-life neurological disease. Genetic and environmental factors likely play an etiological role. Harmane (1-methyl-9H-pyrido[3,4-b]indole) is a potent tremor-producing neurotoxin. In 2002, we demonstrated elevated blood harmane concentrations in an initial sample of 100 ET cases compared to 100 controls. Between 2002 and 2007, we assembled a new and larger sample of ET cases and controls. We now attempt to replicate our previous findings. Cases and controls were frequency-matched on age, gender, and race. Blood harmane concentrations were quantified by high-performance liquid chromatography. Subjects comprised 150 ET cases and 135 controls (mean age 65.3 Ā± 15.5 vs. 65.5 Ā± 14.2 years, p = 0.94). Mean log blood harmane concentration was ā¼50% higher in cases than controls (0.50 Ā± 0.54 gā10/ml vs. 0.35 Ā± 0.62 gā10/ml, p = 0.038). In a logistic regression analysis, log blood harmane concentration was associated with ET (ORadjusted 1.56, 95% CI 1.01ā2.42, p = 0.04), and odds of ET was 1.90 (95% CI 1.07ā3.39, p = 0.029) in the highest versus lowest log blood harmane tertile. Log blood harmane was highest in ET cases with familial ET (0.53 Ā± 0.57 gā10/ml), intermediate in cases with sporadic ET (0.43 Ā± 0.45 gā10/ml) and lowest in controls (0.35 Ā± 0.62 gā10/ml) (test for trend, p = 0.026). Blood harmane appears to be elevated in ET. The higher concentrations in familial ET suggests that the mechanism may involve genetic factors
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Cancer and blood concentrations of the comutagen harmane in essential tremor
Blood concentrations of harmane, a tremor-producing neurotoxin, are elevated in essential tremor (ET). Harmane is also a comutagen. Using a case-control design, we compared the prevalence of cancer in ET cases vs. controls, and determined whether blood harmane concentrations are elevated among ET cases with cancer. 66/267 (24.7%) ET cases vs. 55/331 (16.6%) controls had cancer (adjusted OR 1.52, 95% CI 1.01 ā 2.30, P = 0.04). Among specific cancer types, colon cancer was more prevalent in ET cases than controls (2.6% vs. 0.6%, P = 0.04). Log blood harmane concentration was higher in ET cases vs. controls (P = 0.02) and in participants with vs. without cancer (P = 0.02). Log blood harmane concentration was highest in ET cases with cancer when compared with other groups (P = 0.009). These links between cancer and ET and between high blood harmane and cancer in ET deserve further study
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Older onset essential tremor : more rapid progression and more degenerative pathology
There are few data on rate of progression in essential tremor (ET). To quantify the rate of tremor progression in a cross-sectional sample of 348 ET cases in an epidemiological study; characterize the relationship between age of tremor onset and rate of tremor progression in that sample; and characterize the relationship between age of tremor onset, rate of tremor progression, and severity of underlying brain changes in 9 cases from a brain repository. Rate of tremor progression was defined as tremor severity divided by duration. The degeneration index = number of torpedoes per section divided by Purkinje cell linear density. In the epidemiological study, older age of tremor onset was associated with faster rate of tremor progression (P < 0.001). In the brain repository, older age of tremor onset was associated with higher degeneration index (P = 0.037), and higher degeneration index was associated with faster rate of tremor progression (P = 0.018). In a large clinical sample, older age of onset was associated with more rapid tremor progression. In a brain bank, older age of onset was associated with more degenerative pathology in the cerebellum. As in several neurodegenerative disorders, in older onset cases, it is possible that the disease advances more rapidly