Louis Elan D
Continuum (Minneap Minn). 2019 Aug;25(4):959-975. doi: 10.1212/CON.0000000000000748.
Tremor may be defined as an involuntary movement that is rhythmic (ie, regularly recurrent) and oscillatory (ie, rotating around a central plane) and may manifest in a variety of ways; accordingly, tremor has a rich clinical phenomenology. Consequently, the diagnosis of tremor disorders can be challenging, and misdiagnoses are common. The goal of this article is to provide the reader with straightforward approaches to the diagnosis and treatment of tremors.
Focused ultrasound thalamotomy of the ventral intermediate nucleus of the thalamus is an emerging and promising therapy for the treatment of essential tremor.
The evaluation should start with a detailed tremor history followed by a focused neurologic examination, which should attend to the many subtleties of tremor phenomenology. Among other things, the history and examination are used to establish whether the primary tremor is an action tremor (ie, postural, kinetic, or intention tremor) or a resting tremor. The clinician should then formulate two sets of diagnoses: disorders in which action tremor is the predominant tremor versus those in which resting tremor is the predominant tremor. Among the most common of the former type are essential tremor, enhanced physiologic tremor, drug-induced tremor, dystonic tremor, primary writing tremor, orthostatic tremor, and cerebellar tremor. Parkinson disease is the most common disorder of resting tremor. This article details the clinical features of each of these disorders, as well as those of additional tremor disorders.
震颤可定义为一种不自主运动，具有节律性（即有规律地反复出现）和振荡性（即围绕中心平面旋转），且可能有多种表现形式；因此，震颤具有丰富的临床现象学特征。相应地，震颤障碍的诊断可能具有挑战性，误诊很常见。本文的目的是为读者提供诊断和治疗震颤的直接方法。
丘脑腹中间核的聚焦超声丘脑切开术是一种新兴且有前景的治疗特发性震颤的方法。
评估应从详细的震颤病史开始，随后进行针对性的神经系统检查，该检查应关注震颤现象学的诸多细微之处。除其他外，病史和检查用于确定原发性震颤是动作性震颤（即姿势性、运动性或意向性震颤）还是静止性震颤。然后临床医生应制定两组诊断：以动作性震颤为主的疾病与以静止性震颤为主的疾病。在前一种类型中最常见的是特发性震颤、生理性震颤增强、药物性震颤、肌张力障碍性震颤、原发性书写震颤、直立性震颤和小脑性震颤。帕金森病是最常见的静止性震颤疾病。本文详细介绍了这些疾病以及其他震颤疾病的临床特征。
