IRCCS Neuromed, Via Atinense, 18, Pozzilli (IS), 86077, Italy.
Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, Rome, 00185, Italy.
J Neural Transm (Vienna). 2024 Aug;131(8):941-952. doi: 10.1007/s00702-024-02784-0. Epub 2024 May 14.
Subtle parkinsonian signs, i.e., rest tremor and bradykinesia, are considered soft signs for defining essential tremor (ET) plus.
Our study aimed to further characterize subtle parkinsonian signs in a relatively large sample of ET patients from a clinical and neurophysiological perspective.
We employed clinical scales and kinematic techniques to assess a sample of 82 ET patients. Eighty healthy controls matched for gender and age were also included. The primary focus of our study was to conduct a comparative analysis of ET patients (without any soft signs) and ET-plus patients with rest tremor and/or bradykinesia. Additionally, we investigated the asymmetry and side concordance of these soft signs.
In ET-plus patients with parkinsonian soft signs (56.10% of the sample), rest tremor was clinically observed in 41.30% of cases, bradykinesia in 30.43%, and rest tremor plus bradykinesia in 28.26%. Patients with rest tremor had more severe and widespread action tremor than other patients. Furthermore, we observed a positive correlation between the amplitude of action and rest tremor. Most ET-plus patients had an asymmetry of rest tremor and bradykinesia. There was no side concordance between these soft signs, as confirmed through both clinical examination and kinematic evaluation.
Rest tremor and bradykinesia are frequently observed in ET and are often asymmetric but not concordant. Our findings provide a better insight into the phenomenology of ET and suggest that the parkinsonian soft signs (rest tremor and bradykinesia) in ET-plus may originate from distinct pathophysiological mechanisms.
细微的帕金森症状，如静止性震颤和运动迟缓，被认为是定义特发性震颤（ET）伴发症的软性体征。
本研究旨在从临床和神经生理学角度进一步描述相对较大的 ET 患者样本中的细微帕金森症状。
我们使用临床量表和运动技术评估了 82 名 ET 患者的样本。还纳入了 80 名性别和年龄匹配的健康对照者。我们研究的主要重点是对无任何软性体征的 ET 患者和伴有静止性震颤和/或运动迟缓的 ET 伴发症患者进行对比分析。此外，我们还研究了这些软性体征的不对称性和侧别一致性。
在伴发帕金森软性体征的 ET 患者（样本的 56.10%）中，临床观察到静止性震颤的占 41.30%，运动迟缓的占 30.43%，静止性震颤和运动迟缓同时存在的占 28.26%。有静止性震颤的患者比其他患者有更严重和更广泛的动作性震颤。此外，我们观察到动作性震颤和静止性震颤之间存在正相关。大多数 ET 伴发症患者的静止性震颤和运动迟缓存在不对称性。通过临床检查和运动学评估均证实这些软性体征之间没有侧别一致性。
静止性震颤和运动迟缓在 ET 中经常观察到，且通常不对称但不具有一致性。我们的研究结果提供了对 ET 现象学的更深入了解，并表明 ET 伴发症中的帕金森软性体征（静止性震颤和运动迟缓）可能源自不同的病理生理机制。
