Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
BMJ. 2019 Aug 5;366:l4485. doi: 10.1136/bmj.l4485.
Essential tremor is one of the most common movement disorders in adults and can affect both children and adults. An updated consensus statement in 2018 redefined essential tremor as an isolated action tremor present in bilateral upper extremities for at least three years. Tremor may also be present in other locations, commonly the neck or the vocal cords. Patients with additional neurologic symptoms are now categorized as "essential tremor plus." Additional clinical features associated with the condition include but are not limited to cognitive impairment, psychiatric disorders, and hearing loss. When treatment is needed, propranolol and primidone are considered first line treatments. Patients who are severely affected are often offered deep brain stimulation. Although the ventral intermediate nucleus of the thalamus is the traditional surgical target, the caudal zona incerta is also being studied as a possible superior alternative. Magnetic resonance imaging guided high intensity focused ultrasound is a newer surgical alternative that may be ideal for patients with substantial medical comorbidities. Current research explores novel oral treatments, chemodenervation, and noninvasive neuromodulation for treatment of essential tremor.
特发性震颤是成人中最常见的运动障碍之一，可影响儿童和成人。2018 年的一项更新共识将特发性震颤重新定义为至少存在 3 年的双侧上肢孤立性动作震颤。震颤也可能出现在其他部位，通常是颈部或声带。现在，伴有其他神经症状的患者被归类为“特发性震颤伴发”。与该疾病相关的其他临床特征包括但不限于认知障碍、精神障碍和听力损失。当需要治疗时，普萘洛尔和扑米酮被认为是一线治疗药物。病情严重的患者通常会接受深部脑刺激治疗。虽然丘脑腹侧中间核是传统的手术靶点，但尾状核下区也被作为一种可能的替代靶点进行研究。磁共振成像引导高强度聚焦超声是一种较新的手术替代方法，可能是合并大量合并症的患者的理想选择。目前的研究探索了新型口服治疗药物、化学神经切断术和非侵入性神经调节治疗特发性震颤。
