Department of Neurological Surgery, University of Virginia, Charlottesville.
Department of Neurology, University of Virginia, Charlottesville.
JAMA. 2014 Mar 5;311(9):948-54. doi: 10.1001/jama.2014.1397.
Tremor, defined as a rhythmic and involuntary movement of any body part, is the most prevalent movement disorder, affecting millions of people in the United States. All adults have varying degrees of physiological tremor so it is imperative to distinguish physiological tremor from pathological tremor types. Tremor is not inherently dangerous, but it can cause significant disability at home and in the workplace. Common tremors like essential tremor and Parkinson disease tremor can be recognized by most clinicians at the early stages for the initiation of disease-specific medical therapies. Less common tremors, such as those induced by drugs or brain lesions, are also important to recognize because they may be more refractory to medical therapies and may require earlier referral to a neurological specialist. In patients with the most progressive and severe tremors that are resistant to medical therapies, surgical interventions are available and typically target deep brain regions with stimulation or lesioning. This Grand Rounds review describes the evaluation and evidence-based management of the most common tremors, essential tremor and Parkinson disease tremor.
震颤是一种身体任何部位的节律性和无意识的运动，是最常见的运动障碍，影响着美国数百万人。所有成年人都有不同程度的生理性震颤，因此必须将生理性震颤与病理性震颤类型区分开来。震颤本身并不危险，但它会导致患者在家庭和工作场所产生严重的残疾。像特发性震颤和帕金森病震颤这样的常见震颤，大多数临床医生在疾病早期就能识别出来，从而开始进行特定疾病的药物治疗。不太常见的震颤，如由药物或脑损伤引起的震颤，也很重要，因为它们可能对药物治疗更有抵抗力，可能需要更早地转介给神经科专家。对于那些对药物治疗有抵抗力的、最具进展性和最严重的震颤患者，可采用手术干预，通常通过刺激或破坏深部脑区来进行。本次大查房回顾描述了最常见的震颤（特发性震颤和帕金森病震颤）的评估和基于证据的管理。
