Pattamon Panyakaew, Warongporn Phuenpathom, Roongroj Bhidayasiri, Mark Hallett
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Comprehensive tremor examinations involve the assessment of tremor in different conditions (rest, action or mixed, position or task-specific), distribution of tremor (upper limb, lower limb, head, jaw), positive signs for functional tremor (FT) if suspected (distractibility, entrainment, co-contraction), and associated neurological signs including parkinsonism, dystonic posture, cerebellar/brainstem signs, neuropathy, and cognitive impairment. A pivotal feature in this step is to determine any distinct feature of a specific isolated or combined tremor syndrome. In this review, we propose an algorithm to assess upper limb tremors. Ancillary testing should be performed if clinical evaluation is unclear. The choice of investigation depends on the types of tremors considered to narrow down the spectrum of etiology (Axis 2). Laboratory blood tests are considered for acute onset and acute worsening of tremors, while structural neuroimaging is indicated in unilateral tremors with acute onset, nonclassical presentations, and a combination of neurological symptoms. Neurophysiological study is an important tool that aids in distinguishing between tremor and myoclonus, etiology of tremor and document specific signs of FT. 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引用次数: 0
摘要
由于震颤综合征的表型复杂且相互重叠,因此震颤患者的诊断方法极具挑战性。震颤评估的第一步是确定震颤运动并排除震颤拟态。第二步是根据历史线索和重点检查得出的震颤特征对震颤综合征进行分类(轴 1)。全面的震颤检查包括评估不同条件下的震颤(静止、动作或混合、体位或任务特异性)、震颤分布(上肢、下肢、头部、下颌)、疑似功能性震颤(FT)的阳性体征(分心、夹带、共收缩)以及相关的神经系统体征,包括帕金森病、肌张力障碍姿势、小脑/脑干体征、神经病变和认知障碍。这一步骤的关键特征是确定特定的孤立性或合并性震颤综合征的任何明显特征。在本综述中,我们提出了一种评估上肢震颤的算法。如果临床评估不明确,则应进行辅助检查。检查项目的选择取决于震颤的类型,以缩小病因范围(轴 2)。实验室血液检查适用于急性发病和急性恶化的震颤,而结构性神经影像学检查则适用于急性发病、非典型表现和合并神经症状的单侧震颤。神经生理学研究是一种重要工具,有助于区分震颤和肌阵挛、震颤的病因以及记录 FT 的特殊体征。根据震颤的病因和患者的残疾情况,治疗主要以对症治疗为主。
Bedside clinical assessment of patients with common upper limb tremor and algorithmic approach
The diagnostic approach for patients with tremor is challenging due to the complex and overlapping phenotypes among tremor syndromes. The first step in the evaluation of tremor is to identify the tremulous movement and exclude the tremor mimics. The second step is to classify the tremor syndrome based on the characteristics of tremor from historical clues and focused examination (Axis 1). Comprehensive tremor examinations involve the assessment of tremor in different conditions (rest, action or mixed, position or task-specific), distribution of tremor (upper limb, lower limb, head, jaw), positive signs for functional tremor (FT) if suspected (distractibility, entrainment, co-contraction), and associated neurological signs including parkinsonism, dystonic posture, cerebellar/brainstem signs, neuropathy, and cognitive impairment. A pivotal feature in this step is to determine any distinct feature of a specific isolated or combined tremor syndrome. In this review, we propose an algorithm to assess upper limb tremors. Ancillary testing should be performed if clinical evaluation is unclear. The choice of investigation depends on the types of tremors considered to narrow down the spectrum of etiology (Axis 2). Laboratory blood tests are considered for acute onset and acute worsening of tremors, while structural neuroimaging is indicated in unilateral tremors with acute onset, nonclassical presentations, and a combination of neurological symptoms. Neurophysiological study is an important tool that aids in distinguishing between tremor and myoclonus, etiology of tremor and document specific signs of FT. Treatment is mainly symptomatic based depending on the etiology of the tremor and the patient’s disabilities.
期刊介绍:
Asian Biomedicine: Research, Reviews and News (ISSN 1905-7415 print; 1875-855X online) is published in one volume (of 6 bimonthly issues) a year since 2007. [...]Asian Biomedicine is an international, general medical and biomedical journal that aims to publish original peer-reviewed contributions dealing with various topics in the biomedical and health sciences from basic experimental to clinical aspects. The work and authorship must be strongly affiliated with a country in Asia, or with specific importance and relevance to the Asian region. The Journal will publish reviews, original experimental studies, observational studies, technical and clinical (case) reports, practice guidelines, historical perspectives of Asian biomedicine, clinicopathological conferences, and commentaries
Asian biomedicine is intended for a broad and international audience, primarily those in the health professions including researchers, physician practitioners, basic medical scientists, dentists, educators, administrators, those in the assistive professions, such as nurses, and the many types of allied health professionals in research and health care delivery systems including those in training.