Diagnosis and imaging of essential and other tremors

Everyone suffers from trembling hands from time to time. For instance, when you are nervous, such as during a speech, or after a few of cups of coffee. Some people tremble considerably more than others: they are not at all nervous, but tremble none the less. This can be related to several different tremor diagnoses, from the most common: essential tremor, to the most well known: tremor in Parkinson’s disease. It is important to distinguish one type from the other, as both prognosis and treatment vary substantially. The first part of this thesis investigates tremor diagnosis, in which consultation by a neurologist including the physical examination is of primary importance. We investigated 5 typical characteristics that point to certain tremors and established that these tests differentiate the different tremor syndromes quite well. Next, we focused on muscle investigation (EMG), and found that certain advanced techniques are of additional value in diagnosis. In the second part of this thesis, the focus shifts towards the most common form of tremor, essential tremor, and how it is generated in the brain. By using a combination of simultaneously recorded muscle investigation (EMG) and brain scans (fMRI), we were able to establish increased, abnormal activity in the little brain or cerebellum and the network it is a part of. The knowledge from this thesis is of immediate additional value in daily clinical practice on the one hand, while on the other hand it adds to our understanding of essential tremor

Social skills training for juvenile delinquents:Post-treatment changes

Objectives To examine the post-treatment effectiveness of an outpatient, individual social skills training for juvenile delinquents in the Netherlands and to conduct moderator tests for age, gender, ethnicity, and risk of reoffending. Methods The sample consisted of juveniles who received Tools4U, a social skills training with a parental component, as a penal sanction (N = 115). Propensity score matching was used to select a control group of juveniles receiving treatment as usual (TAU) of n = 108 juveniles (of a total of N = 354). Assessment of impulsivity, social perspective-taking, social problem-solving, critical reasoning, developmental task-related skills, and treatment integrity took place before and immediately after the treatment. Results Treatment integrity was found to be sufficient, so that treatment effects could be attributed to the Tools4U training. Tools4U was more effective than TAU in reducing impulsivity, cognitive distortions (self-centering and assuming the worst), and social perspective-taking deficits (hostile intent attribution). No treatment effects were found on adolescents’ social problem-solving skills, and only caretakers of girls showed improvement in parenting skills. Effects on developmental task-related skills were not in the expected direction: after Tools4U, juveniles reported significantly less social acceptance and self-worth than juveniles receiving TAU. Conclusions Tools4U showed generally small effects and no effects on protective factors, which might limit the long-term treatment effects on delinquency. Treatment effects may be improved by implementing additional techniques and improving the parental component for boys in particular

Tremor pathophysiology:lessons from neuroimaging

Contains fulltext : 226036.pdf (Publisher’s version ) (Closed access)PURPOSE OF REVIEW: We discuss the latest neuroimaging studies investigating the pathophysiology of Parkinson's tremor, essential tremor, dystonic tremor and Holmes tremor. RECENT FINDINGS: Parkinson's tremor is associated with increased activity in the cerebello-thalamo-cortical circuit, with interindividual differences depending on the clinical dopamine response of the tremor. Although dopamine-resistant Parkinson's tremor arises from a larger contribution of the (dopamine-insensitive) cerebellum, dopamine-responsive tremor may be explained by thalamic dopamine depletion. In essential tremor, deep brain stimulation normalizes cerebellar overactivity, which fits with the cerebellar oscillator hypothesis. On the other hand, disconnection of the dentate nucleus and abnormal white matter microstructural integrity support a decoupling of the cerebellum in essential tremor. In dystonic tremor, there is evidence for involvement of both cerebellum and basal ganglia, although this may depend on the clinical phenotype. Finally, in Holmes tremor, different causal lesions map to a common network consisting of the red nucleus, internal globus pallidus, thalamus, cerebellum and pontomedullary junction. SUMMARY: The pathophysiology of all investigated tremors involves the cerebello-thalamo-cortical pathway, and clinical and pathophysiological features overlap among tremor disorders. We draw the outlines of a hypothetical pathophysiological axis, which may be used besides clinical features and cause in future tremor classifications

Myoclonus-dystonia : distinctive motor and non-motor phenotype from other dystonia syndromes

Background: myoclonus-dystonia (M-D) due to a pathogenic variant of SGCE is an autosomal dominant inherited movement disorder. Apart from motor symptoms, psychiatric disorders are highly prevalent in patients with MD. Previous studies suggest, but never tested directly, that the type of psychiatric disorder differs between dystonia syndromes, probably related to disease specific pathology. Little is known about other non-motor symptoms (NMS) in M.D. Here, we systematically study NMS in M-D in direct comparison to other types of dystonia and healthy controls. Methods: Standardized questionnaires were used to assess type and severity of psychiatric co-morbidity, sleep problems, fatigue and quality of life. Results of M-D patients with a pathogenic variant of SGCE were compared to results of idiopathic cervical dystonia (CD) patients, dopa-responsive dystonia (DRD) patients with a pathogenic variant of GCH1 and controls. Results: We included 164 participants: 41 M-D, 51 CD, 19 DRD patients, 53 controls. Dystonia patients (M-D, CD and DRD) had an increased prevalence of psychiatric disorders compared to controls (56-74% vs. 29%). In M-D we found a significantly increased prevalence of obsessive-compulsive disorder (OCD) and psychosis compared to CD and DRD. All dystonia patients had more sleep problems (49-68% vs. 36%) and fatigue (42-73% vs. 15%) than controls. Compared to other dystonia subtypes, M-D patients reported less excessive daytime sleepiness and fatigue. Conclusion: Psychiatric comorbidity is frequent in all dystonia types, but OCD and psychosis are more common in M-D patients. Further research is necessary to elucidate underlying pathways

An Overview of Computational Approaches for Interpretation Analysis

It is said that beauty is in the eye of the beholder. But how exactly can we characterize such discrepancies in interpretation? For example, are there any specific features of an image that makes person A regard an image as beautiful while person B finds the same image displeasing? Such questions ultimately aim at explaining our individual ways of interpretation, an intention that has been of fundamental importance to the social sciences from the beginning. More recently, advances in computer science brought up two related questions: First, can computational tools be adopted for analyzing ways of interpretation? Second, what if the "beholder" is a computer model, i.e., how can we explain a computer model's point of view? Numerous efforts have been made regarding both of these points, while many existing approaches focus on particular aspects and are still rather separate. With this paper, in order to connect these approaches we introduce a theoretical framework for analyzing interpretation, which is applicable to interpretation of both human beings and computer models. We give an overview of relevant computational approaches from various fields, and discuss the most common and promising application areas. The focus of this paper lies on interpretation of text and image data, while many of the presented approaches are applicable to other types of data as well.Comment: Preprint submitted to Digital Signal Processin