Clinical Neuroscience

[Differentiation of parkinsonian and essential tremor by the use of electrophysiological methods]

GERTRÚD Tamás, FELYÉR Dénes, MAGYAR András, PÁLVÖLGYI László, TAKÁTS Annamária, SZIRMAI Imre, KAMONDI Anita

JULY 10, 2004

Clinical Neuroscience - 2004;57(07-08)

[Objective - Tremor is one of the most common movement disorders. Different tremors are induced by central and/or peripheral oscillators. The motor cortex plays a significant role in the generation of parkinsonian tremor but its function in essential tremor is not clear. We examined the effect of motor cortex activation on parkinsonian and essential tremor during movement of the contralateral hand. Our aim was to study the role of interhemispheric motor connections in genesis of different tremors. Patients and methods - We recorded the tremor of nine Parkinson patients and seven patients suffering from essential tremor using accelerometry. After Fast Fourier-transformation of digitized tremor signal we measured the power changes at the peak frequency after flash triggered movement (FM) and self-paced movement (SPM). For control we used flash signal without movement. Results - Peak frequency of parkinsonian and essential tremor was not different. The power decrease of parkinsonian tremor was significant during flash triggered and self-paced movement compared to the effect of flash (pFlash-FM=0.0008; pFlash-SPM=0.002), changes during the different movement protocols were not different (pFM-SPM=0.33). During self-paced movement parkinsonian tremor became significantly smaller than essential tremor (p<0.05). The effect of movement was not significant on the power of essential tremor (p=0.42), probably due to high standard deviation of individual data. Conclusions - Voluntary movement of the contralateral hand decreases parkinsonian tremor suggesting that its generator can be inhibited via the activation of the motor cortex. The diverse reaction of essential tremor may reflect various connections between its generator system and the motor areas, therefore it is not a separate disease entity.]

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[Introduction - Nontraumatic intracerebral haemorrhage accounts for 10 to 15% of all cases of stroke. Patients and method - In our study hypertensive striatocapsular haemorrhages were divided into six types on the basis of arterial territories: posterolateral, lateral, posteromedial, middle, anterior and massive (where the origin of the hemorrhage can not be defined due to the extensive damage of the striatocapsular region) type. We analysed laboratory data, clinical presentations and risk factors as alcoholism, smoking and hypertension of 111 cases. The size of the hematoma, midline shift and severity of ventricular propagation were measured on the acute CT-scan. The effect on the 30-day clinical outcome of these parameters were examined Results and conclusion - According to our results, the most important risk factor of hypertensive intracerebral haemorrhage was chronic alcoholism. Blood cholesterol, triglyceride levels and coagulation status had no effect on the prognosis, but high blood glucose levels Significantly worsen the clinical outcome. In our study, lateral striatocapsular haemorrhage was the most common while middle one was the least common type. The overall mortality is 42%, but differs by the type. The 30-day outcome significantly depends on the type of the haemorrhage, the initial level of consiousness, the size of the haematoma, the severity of ventricular propagation, the midline shift and the blood glucose levels. The clinical outcome proved to be the best in the anterior type, good in the posteromedial and lateral types. The prognosis of the massive type is poor. In our study, the classes and the mortality of the striatocapsular haemorrhages was different from the literature data. The higher mortality in our cohort could be due to the longer follow-up and the severe accompanying diseases of our patients.]

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