University Hospitals and Cleveland VA Medical Center, Case Western Reserve University, Cleveland, OH, USA.
Department of Neurology, Emory University, Atlanta, Georgia, USA.
Parkinsonism Relat Disord. 2024 May;122:106068. doi: 10.1016/j.parkreldis.2024.106068. Epub 2024 Mar 22.
This review delves into the historical evolution and ongoing controversy surrounding the relationship between tremor and dystonia. The Dystonia Consensus Panel and the International Parkinson's and Movement Disorders Society's Tremor Taskforce have attempted to define these entities, but the complexity arises when patients have a combination of both dystonia and tremor. The term "dystonic tremor" has sparked diverse interpretations, with debates over its clinical features and the need for more objectively defined characteristics. Logistic regression analyses in a large cohort of dystonia patients identified determinants such as body region affected by dystonia, dystonia severity, age, and recruitment site, with unexpected associations emphasizing the subjectivity in detecting and classifying tremor. The study further discovered diverse prevalence of "dystonic tremor" based on different definitions, revealing substantial variability among investigators. The recently convened Dystonia-Tremor panel aimed to address these challenges by proposing a more uniform nomenclature, emphasizing precise and descriptive terms. Despite the complexity, instrumented measures, such as electromyography, temporal discrimination threshold, blink reflex, and trajectory shape analysis, seem to be useful in distinguishing between tremor and dystonia. The pathophysiology debate centers around the involvement of the cerebello-thalamo-cortical and basal ganglia-thalamo-cortical circuits. Evidence supports the role of both circuits in driving the pathophysiology of dystonic tremor, challenging the notion of a clear dichotomy. The review concludes by emphasizing the need for a nuanced understanding, highlighting the intricate interplay between tremor and dystonia, and the potential of instrumental measures in advancing diagnostic accuracy.
这篇综述深入探讨了震颤和肌张力障碍之间关系的历史演变和持续争议。肌张力障碍共识小组和国际帕金森病和运动障碍学会震颤工作组试图定义这些实体，但当患者同时存在肌张力障碍和震颤时，问题就变得复杂了。“肌张力障碍性震颤”一词引发了各种解释，其临床特征和更客观定义特征的必要性引发了争论。在一大群肌张力障碍患者的逻辑回归分析中，确定了一些决定因素，如受肌张力障碍影响的身体部位、肌张力障碍的严重程度、年龄和招募地点，这些意想不到的关联强调了在检测和分类震颤方面的主观性。该研究还发现，根据不同的定义，“肌张力障碍性震颤”的患病率存在差异，表明研究人员之间存在很大的差异。最近成立的肌张力障碍-震颤小组旨在通过提出更统一的命名法来应对这些挑战，强调精确和描述性的术语。尽管存在复杂性，但仪器测量，如肌电图、时间辨别阈值、眨眼反射和轨迹形状分析，似乎在区分震颤和肌张力障碍方面有用。病理生理学的争论集中在小脑-丘脑-皮质和基底节-丘脑-皮质回路的参与上。有证据支持这两个回路在驱动肌张力障碍性震颤的病理生理学方面的作用，这挑战了清晰二分法的概念。综述最后强调了需要更细致的理解，突出了震颤和肌张力障碍之间的复杂相互作用，以及仪器测量在提高诊断准确性方面的潜力。
