Background: Jaw tremors in essential tremor (ET) rarely represent anything other than a cosmetic concern.

Phenomenology Shown: A case of an ET patient whose jaw tremor was severe enough to result in cracked teeth.

Educational Value: It behooves treating clinicians to be aware of the full spectrum of this movement disorder

Hernandez, Nora C.

Louis, Elan D.

Tremor and Other Hyperkinetic Movements

English

PubMed

Background: Jaw tremors in essential tremor (ET) rarely represent anything other than a cosmetic concern. Phenomenology Shown: A case of an ET patient whose jaw tremor was severe enough to result in cracked teeth. Educational Value: It behooves treating clinicians to be aware of the full spectrum of this movement disorder.</p

Nora C. Hernandez

Elan D. Louis

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Jaw Tremor Resulting in Broken Teeth: On the Essential Tremor Spectrum

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Video AbstractsJaw Tremor Resulting in Broken Teeth: On the Essential Tremor SpectrumNora C. Hernandez1& Elan D. Louis1,2,3,*1Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA, 2Department of Chronic Disease Epidemiology, Yale School of PublicHealth, Yale University, New Haven, CT, USA, 3Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, NewHaven, CT, USAAbstractBackground: Jaw tremors in essential tremor (ET) rarely represent anything other than a cosmetic concern.Phenomenology Shown: A case of an ET patient whose jaw tremor was severe enough to result in cracked teeth.Educational Value: It behooves treating clinicians to be aware of the full spectrum of this movement disorder.Keywords: Essential tremor, clinical, jaw tremor, teethCitation: Hernandez NC, Louis ED. Jaw tremor resulting in broken teeth: on the essential tremor spectrum. Tremor Other Hyperkinet Mov. 2015; 5. doi:10.7916/D8T15339* To whom correspondence should be addressed. E-mail: elan.louis@yale.eduEditor: Julian Benito-Leon, Hospital “12 de Octubre”, SpainReceived: October 5, 2015 Accepted: October 15, 2015 Published: November 2, 2015Copyright: ’ 2015 Hernandez et al. This is an open-access article distributed under the terms of the Creative Commons Attribution–Noncommercial–No Derivatives License, whichpermits the user to copy, distribute, and transmit the work provided that the original authors and source are credited; that no commercial use is made of the work; and that the work is notaltered or transformed.Funding: Dr. Louis has received research support from the National Institutes of Health: NINDS R01 NS042859 (principal investigator), NINDS R01 NS39422 (principal investigator),NINDS R01 NS086736 (principal investigator), NINDS R01 NS073872 (principal investigator), NINDS R01 NS085136 (principal investigator) and NINDS R01 NS088257 (principalinvestigator).Financial Disclosures: None.Conflict of Interest: The authors report no conflict of interest.Ethics Statement: All patients that appear on video have provided written informed consent; authorization for the videotaping and for publication of the videotape was provided.Cranial tremors, including head, voice, and jaw tremors, can occurin patients with essential tremor (ET), often becoming more prevalentwith longer disease duration.1 Jaw tremor has been estimated to occurin 7.5–18.0% of ET patients, with prevalence related to the method ofcase ascertainment.2 The tremor more often occurs when the mouth isopen (e.g., during speech) rather than closed. While the tremor mayrange from mild to severe, it is rare for jaw tremor to representanything other than a cosmetic concern. We are unaware of anydocumented cases of jaw tremor producing bodily injury. We nowreport an 86-year-old female diagnosed with ET in her early 70s; hersymptoms had begun at age 71. In August 2015, she was enrolled andconsented to be a participant in a clinical research study approved bythe Yale University Ethics Committee. At that time, she reported nofamily history of ET. By history, the tremor involved her arms, head,jaw, and voice, with marked jaw tremor being a major issue. Onexamination, there was mild postural tremor and moderate-to-severekinetic tremor of both arms, with head and voice tremors. There wasalso a prominent jaw tremor. Additional history was as follows: by2014, her jaw tremor had become so severe that she described herteeth as clicking continuously, at times forcefully striking against oneanother. The first catastrophic event occurred in September 2014. Herjaw movements had become severe and she broke her first right upperVideo 1. Tremor of the Jaw Is Evident during Speech and SustainedPhonation. The patient is treated with primidone 250 mg/day, which hasresulted in a substantial (i.e., 50%) reduction in her jaw tremor.Freely available onlineTremor and Other Hyperkinetic Movementshttp://www.tremorjournal.orgThe Center for Digital Research and ScholarshipColumbia University Libraries/Information Services1bicuspid tooth; a crown was introduced as a result of this. A secondepisode occurred soon after when she broke that crown and heradjacent canine tooth, for which she required a bridge. After thatepisode, she was placed on primidone, eventually reaching a dose of250 mg/day, with a consequent marked (.50%) reduction in jawtremor (Video 1). Such severe jaw tremor is a rare occurrence inpatients with ET. Nevertheless, it behooves clinicians to be aware ofthe full spectrum of this disorder and of the potential consequences ofcranial tremors in ET patients.References1. Louis ED, Gerbin M, Galecki M. Essential tremor 10, 20, 30, 40: clinicalsnapshots of the disease by decade of duration. Eur J Neurol 2013;20:949–954,doi:http://dx.doi.org/10.1111/ene.12123.2. Louis ED, Rios E, Applegate LM, Hernandez NC, Andrews HF. Jawtremor: prevalence and clinical correlates in three essential tremor casesamples. Mov Disord 2006;21:1872–1878, doi:http://dx.doi.org/10.1002/mds.21069.Hernandez NC, Louis ED Broken Teeth in Essential TremorTremor and Other Hyperkinetic Movementshttp://www.tremorjournal.orgThe Center for Digital Research and ScholarshipColumbia University Libraries/Information Services2

Jaw Tremor Resulting in Broken Teeth: On the Essential Tremor Spectrum

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