Search strategy and selection criteria
Introduction
Epidemiology
Tremor subtypes
London [6] (n = 100) | Olmsted County [74] (n = 200) | |
---|---|---|
Total patients with tremor | 58 (58%) | 51 (25.5%) |
Patients with severe tremor | 15 (15%) | 6 (3%) |
Arm tremor | 56 (56%) | 47 (23.5%) |
Bilateral arm tremor | 36 (36%) | not reported |
Leg tremor | 10 (10%) | 12 (6%) |
Head tremor | 9 (9%) | 7 (3.5%) |
trunk tremor | 7 (7%) | not reported |
Pathophysiology of tremor
Assessment of tremor
Medical treatment
Study | n* | study design | intervention(s) | tremor assessment | patients with tremor reduction (%) | patients with improved functional status (%) | adverse effects (n) |
---|---|---|---|---|---|---|---|
Koller, 1984 [52] | 3 | double-blind placebo-controlled crossover | propranolol (not specified) isoniazid (po.) 1200mg/d ethanol (iv.) 50ml of 10% solution | writing tasks, patient self assessment, clinical examination, accelerometry | no effect | hepatitis while on isoniazid treatment (1) | |
Sabra et al. 1982 [80] | 4 | case reports | isoniazid (po.) 400 to 1200mg/d | clinical examination | 4 (100%) | 4 (100%) | abnormal liver function tests (1) |
Duquette et al. 1985 [32] | 12 | open label | isoniazid (po.) 500–1000mg/d | patient self assessment, clinical examination, blinded evaluation of video tapes | 10 (83%) | 0 | drowsiness, dysphagia, increased bronchial secretions (6) abnormal liver function tests (2) fatigue (2) |
Morrow et al. 1985 [67] | 5 | open label | isoniazid (po.) 700–1200 mg/d | clinical examination | 4 (80%) | 4 (80%) | increased weakness (2) drowsiness (1) |
Francis et al. 1986 [38] | 5 | open label | isoniazid (po.) 1200 mg/d | clinical examination, polarised light goniometry | 4 (80%) | 0 | anorexia and nausea (3) |
Hallet et al. 1985 [44] | 6 | double-blind placebo-controlled crossover | isoniazid (po.) 1200 mg/d | self-rating scales, accelerometry, blinded evaluation of video tapes | 6 (100%) | 0 | None |
Bozek et al. 1987 [16] | 8 | double-blind placebo-controlled crossover | isoniazid (po.) 12 or 20 mg/kg | clinical examination, accelerometry, blinded evaluation of video tapes | 6 (75%) | 4 (50%) | somnolence (3) ** |
Sechi et al. 1989 [86] | 7 | single-blind placebo controlled | carbamazepine (po.) 400 or 600 mg/d | clinical tremor rating scale, accelerometry | 7 (100%) | not reported | none reported |
Rice et al. 1997 [78] | 16 | double-blind placebo-controlled crossover | ondansetron (iv.) 8 mg (single dose) | nine-hole peg-test, writing tasks, patient self assessment | 12 (75%) | not reported | short-lasting foot dystonia (1) |
Gbadamosi et al. 2001 [39] | 14 | open label | ondansetron (iv.) 8 mg (single dose) | nine-hole peg-test, writing tasks, patient self assessment | no effect | none reported | |
Aisen et al. 1991 [2] | 6 | open label | Gluthetimide 750 to 1250 mg | blinded functional assessment by occupational therapist, computer-aided tracking tasks | 5 (83%) | 5 (83%) | sedation (4) |
Clifford, 1983 [21] | 8 | open label | Δ9-THC (po.) 5 to 15 mg | clinical examination | 5 (63%) | 2 (25%) | none |
Zajicek et al. 2003 [103] | 365† | double-blind randomized placebo controlled | cannabis extract (po.) Δ9-THC (po.) | patient self assessment | no effect | cannabis extract: adverse events in 12 Δ9-THC: adverse events in18 placebo: adverse events in 20 | |
Wade et al. 2004 [92] | 13‡ | double-blind randomized placebo controlled | cannabis extract (po.) | visual analogue scale symptom reduction | no effect | cannabis extract:$ 112 adverse events in 80 patients placebo:$ 53 adverse events in 80 patients | |
Fox et al. 2004 [37] | 14 | double-blind randomized placebo controlled crossover | cannabis extract (po.) | tremor rating scale | no effect | cannabis extract: adverse events in 10 placebo: adverse events in 2 |
Surgical treatment
Study | n* | patient characteristics** | lesion site | follow-up | tremor and disability assessment | patients with tremor reduction (%)§ | patients with improved functional status (%)§ | patients with permanent adverse effects (n) |
---|---|---|---|---|---|---|---|---|
Cooper, 1960a [25] | 2 | disabling intention tremor | VL | 3 to 12 mo | clinical examination | 2 (100%) | not reported | none |
Cooper, 1960b [24] | 6 | disabling intention tremor | unilateral (n = 5) or bilateral (n = 1) VL | Not specifically reported | clinical examination, assessment of filmed tremor | 5 (83%) | not reported | increase of contralateral hemiparesis (1) |
Krayenbühl et al. 1962 [54] | 4 | disabling bilateral intention tremor | unilateral (n = 3) or bilateral (n = 1) VL | 3 weeks to 6 mo | clinical examination | 4 (100%) | 4 (100%) | none |
Broager and Fog, 1962 [18] | 4 | severe intention tremor | unilateral VL | 1 to 6 mo | clinical examination | 4 (100%) | 2 (50%) | generalized seizure (1) mental change (1) |
Cooper et al. 1967 [26] | 32 | disabling bilateral intention tremor | unilateral or bilateral VL | 12 to 96 mo | clinical examination | 27 (85%) | not reported | increase of contralateral hemiparesis (2) |
Samra et al. 1970 [81] | 25 | disabling bilateral arm intention tremor | unilateral or bilateral VL | not specifically reported | clinical examination, assessment of filmed tremor | 22 (88%) | not reported | increase of contralateral hemiparesis (1) |
Riechert and Richter, 1972 [79] | 29 | disabling intention (n = 29) and postural (n = 18) tremor | unilateral (n = 28) or bilateral (n = 1) VL | not specifically reported | clinical examination, patient self assessment questionnaires | 29 (100%) | “two thirds” of patients | increase of leg paresis (2) |
Arsalo et al. 1973 [10] | 26 | disabling bilateral intention tremor | unilateral VL and subthalamus | 3 to 97 mo | clinical examination | 21 (80%) | not reported | subdural haematoma (1) |
Andrew et al. 1974 [8] | 4 | disabling postural (n = 2) and intention (n = 4) tremor | unilateral VIM | 6 to 36 mo | clinical examination | 4 (100%) | not reported | hemiplegia (1) |
Van Manen, 1974 [91] | 4 | severe intention tremor | unilateral VL | 3 to 86 mo† | clinical examination | 2 (50%) | not reported | not reported separately for MS subgroup |
Hauptvogel et al. 1975 [45] | 11 | severe intention tremor | unilateral (n = 10) or bilateral (n = 1) VL | 15 to 86 mo | clinical examination | 7 (63%) | 4 (36%) | not reported |
Mundinger and Kuhn 1982 [68] | 84 | severe action tremor | ZI, VOP | 36 to 120 mo | clinical examination filmed tremor patient self assessment questionnaire | 70 (83%) | not reported | not specifically reported |
Speelman and van Manen, 1984 [89] | 11 | severe intention tremor | unilateral VL | 3 weeks to 132 mo | clinical tremor and functional rating scales | 8 (73%) | 0 (0%) | hemiparesis (4) micturition disturbance (2) speech disorder (1) |
Kandel and Hondcarian, 1985 [51] | 20 | severe intention tremor | unilateral (n = 15) or bilateral (n = 5) VL (ZI, FF) | 12 to 120 mo | not reported | 14 (70%) | not reported | none |
Hitchcock et al. 1987 [48] | 30 | tremor | Thalamus | 24 mo | clinical examination functional rating scales | 50% | 25% | not reported |
Wester et al. 1990 [97] | 9 | severe intention tremor | unilateral VOA and VOP | 3 to 89 mo mean: 24 mo† | questionnaire sent to treating neurologist | 6 (66%) | 6 (66%) | hemiparesis (5) mental changes (3) dysphasia (3) dysarthria (2) subdural haematoma (1) |
Goldman et al. 1992 [43] | 2 | severe intention tremor unresponsive to medication | unilateral VL | 3 mo 34 mo | clinical tremor rating scale | 2 (100%) | 0 (0%) | dysarthria (1) |
Whittle and Haddow, 1995 [98] | 9 | severe rest, kinetic, postural or intention tremor | unilateral VL | 12 mo | clinical examination and evauation of video tapes | 9 (100%) | 2 (22%) | depression (2) |
Shahzadi et al. 1995 [87] | 33 | severe tremor | unilateral VIM | 3 to 120 mo | clinical examination ability to drink from a waterfilled cup | 22 (67%) | 17 (51%) | not reported |
Hooper and Whittle, 1998 [50] | 6 | severe postural (n = 4) or intention tremor (n = 2) | unilateral VL | 14 to 73 mo mean: 51 mo | Barthel Index | 1 (16%) | 1 (16%) | not reported |
Critchley and Richardson, 1998 [27] | 24 | disabling intention tremor | unilateral (n = 22) or bilateral (n = 2) VIM | mean: 26 mo | clinical tremor and functional rating scales | 18 (75%) | 2 (8%) | hemiparesis (1) seizure (2) MS relapse (3) dysarthria (1) |
Schuurman et al. 2000 [85] | 5 | severe arm tremor | unilateral VIM‡ | 6 mo | clinical tremor and functional rating scales | 5 (100%) | 0 (0%) | severe gait or balance disturbance (2) |
Niranjan et al. 2000 [72]*** | 3 | severe action tremor | unilateral VIM | 2 to 11 mo median 6 mo† | clinical tremor rating scale, patient self assessment of functional improvement | 3 (100%) | 3 (100%) | none |
Alusi et al. 2001 [4] | 11 | severe postural and intention tremor | unilateral VOP (n = 7), ZI (n = 3), STN (n = 1) | 12 mo | clinical tremor and functional rating scales | 11 (100%) | 7 (64%) | depression (3) seizures (2) hemiparesis (1) dysphasia (1) |
Matsumoto et al. 2001 [62] | 6 | severe tremor | unilateral VIM | 3 to 12 mo | clinical tremor and functional rating scales, novel movement analysis tool | 6 (100%) | 0 (0%) | MS relapse (2) |
Bittar et al. 2005 [15] | 10 | disabling postural and intention arm tremor | unilateral VOP (distal tremor), unilateral ZI (proximal tremor) or unilateral VOP and ZI (mixed tremor) | 12 to 50 mo: mean 16 mo | clinical tremor rating scale | not individually reported, overall improvement of mean tremor scores: postural: 78% intention: 72% | not reported | hemiparesis (3) seizures (1) |
Study | N* | patient characteristics | stimulation site | follow-up | tremor and disability assessment | patients with tremor reduction (%)§ | patients with improved functional status (%)§ | patients with permanent adverse effects (n) |
---|---|---|---|---|---|---|---|---|
Brice and McLellan, 1980 [17] | 2 | severe bilateral arm intention tremor | bilateral subthalamic | 5 mo 6 mo | clinical examination | 2 (100%) | 2 (100%) | ** |
Nguyen and Degos, 1993 [71] | 1 | severe unilateral distal postural arm tremor | unilateral VIM | 17 mo | clinical tremor and functional rating scales | 1 (100%) | 1 (100%) | not reported |
Siegfried and Lippitz, 1994 [88] | 9 | severe intention tremor | unilateral (n = 8) or bilateral (n = 1) VIM | not reported | not reported | 9 (100%) | not reported | not reported |
Benabid et al. 1996 [13] | 4 | severe arm tremor† | VIM† | ≥ 6 mo | clinical tremor rating scale | 0 (0%)‡ | no detailed report† | intracerebral haemorrhage (1) |
Geny et al. 1996 [41] | 13 | severe postural tremor (n = 12), moderate intention tremor (n = 1) | unilateral VIM | 8 to 26 mo mean: 13 mo | clinical tremor and functional rating scales | 9 (69%) | 12 (92%) | MS relapse (3) |
Whittle et al. 1998 [99]*** | 5 | severe arm tremor | VL | not reported | not reported | not reported | not reported | not reported |
Hay, 1999 [46] | 1 | head and limb tremor | unilateral thalamus | 2 mo | not reported | 1 (100%) | not reported | not reported |
Montgomery et al, 1999 [66] | 14 | disabling arm tremor | unilateral VIM | variable | clinical tremor rating scale | 15 (100%) | not reported | MS relapse (1)# |
Schulder et al. 1999 [83] | 5 | severe bilateral postural and intention arm tremor | unilateral VIM | >6 mo | clinical tremor rating scale, patient self assessment of functional improvement | 5 (100%) | 3 (60%) | Ms relapse (2) |
Taha et al. 1999 [90] | 2 | bilateral limb, head or voice tremor† | bilateral VIM (bilateral DBS or unilateral DBS plus contralateral thalamotomy) | mean: 10 mo | clinical tremor rating scale | 2 (100%) | not reported | not reported separately for MS subgroup† |
Schuurman et al. 2000 [85] | 5 | severe arm tremor | unilateral or bilateral VIM | 6 mo | clinical tremor and functional rating scales | 3–5 (60–100%)$ | 0 (0%) | dysarthria (2) severe gait or balance disturbance (1) arm ataxia (1) |
2 | severe tremor | unilateral or bilateral VIM† | 3 to 24 mo, mean: 12 mo† | clinical tremor rating scales, assessment of video tapes | 2 (100%) | not reported | not reported separately for MS subgroup† | |
Matsumoto et al. 2001 [62] | 3 | severe tremor | unilateral VIM | 3 to 12 mo | clinical tremor and functional rating scales, novel movement analysis tool | 3 (100%) | 0 (0%) | none |
Hooper et al. 2002 [49] | 10 | disabling arm tremor | unilateral thalamus | 12 mo | clinical tremor and functional rating scales | 10 (100%) | 0 (0%) | intracerebral haemorrhage (2) generalized seizure (2) |
Nandi et al. 2002 [70] | 1 | severe bilateral postural and intention tremor | unilateral ZI | 12 mo | clinical examination | 1 (100%) | 1 (100%) | increased dystonic posturing of left foot impairing ambulation (1) |
Berk et al. 2002 [14] | 12 | disabling arm tremor | unilateral VIM | 12 mo | clinical tremor and functional rating scales, patient self assessment questionnaire | significant tremor reduction, not individually reported | no significant improvement | wound infection (2) |
Wishart et al. 2003 [102] | 4 | bilateral arm tremor | bilateral VL | 15 to 31 mo | clinical tremor rating scale | 4 (100%) | 4 (100%) | MS relapse (1) dysarthria (1) |
Schulder et al. 2003 [84] | 9 | disabling arm tremor | unilateral thalamus | 9 to 48 mo, | clinical tremor and functional rating scales, patient self assessment | 8 (88%) | 3 (33%) | MS relapse (3) |
Nandi et al. 2004 [69] | 10 | disabling arm tremor | unilateral (n = 6) or bilateral (n = 4) VOP and ZI | 3 to 23 mo | computer-aided tracking tasks | significant tremor reduction, not individually reported | not reported | seizure (1) dysarthria (1) wound infection (1) |
Bittar et al. 2005 [15]y | 10 | disabling postural and intention arm tremor | unilateral VOP (distal tremor), unilateral ZI (proximal tremor) or unilateral VOP and ZI (mixed tremor) | 3 to 23 mo: | clinical tremor rating scale | not individually reported, overall improvement of mean tremor scores: postural: 64% intention: 36% | not reported | monoparesis (1) |