Gigante A F, Berardelli A, Defazio G
Department of Basic Medical Sciences, Neurosciences and Sense Organs, 'Aldo Moro' University of Bari, Bari, Italy.
Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
Eur J Neurol. 2016 May;23(5):935-9. doi: 10.1111/ene.12966. Epub 2016 Feb 24.
Tremor in dystonia has been described as a postural or kinetic abnormality. In recent series, however, patients with idiopathic adult-onset dystonia also displayed rest tremor.
The frequency and distribution of rest tremor were studied in a cohort of 173 consecutive Italian patients affected by various forms of idiopathic adult-onset dystonia attending our movement disorder clinic over 8 months.
Examination revealed tremor in 59/173 patients (34%): 12 patients had head tremor, 34 patients had arm tremor, whilst 13 patients presented tremor in both sites. Head tremor was postural in all patients, whereas arm tremor was postural/kinetic in 28 patients, only at rest in one and both postural/kinetic and at rest in 18 patients. Patients with tremor were more likely to have segmental/multifocal dystonia. Patients who had rest tremor (either alone or associated with action tremor) had a higher age at dystonia onset and a greater frequency of dystonic arm involvement than patients with action tremor alone or without tremor.
Both action and rest tremor are part of the tremor spectrum of adult-onset dystonia and are more frequently encountered in segmental/multifocal dystonia. The higher age at dystonia onset and the greater frequency of arm dystonia in patients with rest tremor may have pathophysiological implications and may account, at least in part, for the previous lack of identification of rest tremor as one possible type of tremor present in dystonia.
肌张力障碍中的震颤被描述为姿势性或运动性异常。然而，在最近的系列研究中，特发性成人起病肌张力障碍患者也表现出静止性震颤。
在8个月期间，对连续就诊于我们运动障碍门诊的173例患有各种形式特发性成人起病肌张力障碍的意大利患者进行队列研究，以探讨静止性震颤的频率和分布情况。
检查发现173例患者中有59例（34%）存在震颤：12例患者有头部震颤，34例患者有手臂震颤，13例患者在两个部位均出现震颤。所有患者的头部震颤均为姿势性，而28例患者的手臂震颤为姿势性/运动性，1例仅在静止时出现，18例在姿势性/运动性及静止时均出现。有震颤的患者更易出现节段性/多灶性肌张力障碍。与仅出现动作性震颤或无震颤的患者相比，出现静止性震颤（单独出现或与动作性震颤并存）的患者肌张力障碍起病年龄更大，肌张力障碍累及手臂的频率更高。
动作性震颤和静止性震颤均为成人起病肌张力障碍震颤谱的一部分，且在节段性/多灶性肌张力障碍中更常见。静止性震颤患者肌张力障碍起病年龄较大且手臂肌张力障碍频率较高，这可能具有病理生理学意义，并且至少可以部分解释既往为何未将静止性震颤视为肌张力障碍中可能存在的一种震颤类型。
