Somatosensory temporal discrimination threshold does not discriminate between patients with essential and dystonic head tremor

Czech version

Authors: P. Hollý ¹; T. Duspivová ^1,2; D. Kemlink ¹; O. Ulmanová ¹; J. Rusz ^1,3; R. Krupička ²; R. Jech ¹; E. Růžička ¹
Authors‘ workplace: Neurologická klinika a Centrum klinických neurověd 1. LF UK a VFN v Praze ¹; Katedra biomedicínské informatiky, Fakulta biomedicínského inženýrství, ČVUT v Praze ²; Katedra teorie obvodů, Fakulta elektrotechnická, ČVUT v Praze ³
Published in: Cesk Slov Neurol N 2022; 85(2): 163-167
Category: Original Paper
doi: https://doi.org/10.48095/cccsnn2022163

Overview

Aim: The aim of this study was to evaluate the utility of the somatosensory temporal discrimination threshold (STDT) examination in patients with head tremor to differentiate between patients with essential tremor (ET) and dystonic head tremor in cervical dystonia (CD). Patients and methods: 42 patients with head tremor (21 ET and 21 CD patients) and 20 healthy controls (HC) were examined. Patient examination consisted of medical history (onset of symptoms, family history, and effect of alcohol) and scales that objectively assessed head and upper limb tremor, severity of CD and severity of ataxia. All subjects were examined by STDT. This is a method based on determining the shortest interval in which an individual recognizes two tactile stimuli as temporally separated. Results: No significant differences were found between ET and CD patients in medical history data. On rating scales, the two groups of patients differed significantly, with ET patients having a higher severity of upper limb tremor and CD patients having a higher degree of dystonia (P < 0.0001). Both groups of patients had a higher degree of ataxia, significantly more in patients with ET (P = 0.0008). STDT values were significantly higher in patients with ET vs. HC (P = 0.0067). We did not find major differences when comparing groups of patients with ET and CD. Conclusion: In patients with head tremor, abnormally elevated STDT values were observed in patients with ET but not in CD, probably due to impaired somatosensory stimulus processing mechanisms and time perception attributed to cerebellar involvement. However, we did not find a significant difference in the STDT values when comparing the examined groups of patients.

Keywords:

essential tremor – Cerebellum – somatosensory temporal discrimination threshold – dystonic tremor – head tremor

Sources

1. Louis ED, Ottman R, Hauser WA. How common is the most common adult movement disorder? estimates of the prevalence of essential tremor throughout the world. Mov Disord 1998; 13(1): 5–10. doi: 10.1002/ mds.870130 105.

2. Louis ED, Ferreira JJ. How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor. Mov Disord 2010; 25(5): 534–541. doi: 10.1002/ mds.22838.

3. Louis ED, Thawani SP, Andrews HF. Prevalence of essential tremor in a multiethnic, community-based study in northern Manhattan, New York. N.Y. Neuroepidemiology 2009; 32(3): 208–214. doi: 10.1159/ 000195691.

4. Bhatia KP, Bain P, Bajaj N et al. Consensus statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord 2018; 33(1): 75–87. doi: 10.1002/ mds.27121.

5. Elble RJ. Diagnostic criteria for essential tremor and differential diagnosis. Neurology 2000; 54 (11 Suppl 4): S2–S6.

6. Louis ED. When do essential tremor patients develop head tremor? Influences of age and duration and evidence of a biological clock. Neuroepidemiology 2013; 41(2): 110–115. doi: 10.1159/ 000351698.

7. Lenka A, Bhalsing KS, Jhunjhunwala KR et al. Are patients with limb and head tremor a clinically distinct subtype of essential tremor? Can J Neurol Sci 2015; 42(3): 181–186. doi: 10.1017/ cjn.2015.23.

8. Hardesty DE, Maraganore DM, Matsumoto JY. Increased risk of head tremor in women with essential tremor: longitudinal data from the Rochester Epidemiology Project. Mov Disord 2004; 19(5): 529–533. doi: 10.1002/ mds.20096.

9. Louis ED, Ford B, Frucht S. Factors associated with increased risk of head tremor in essential tremor: a community- based study in northern Manhattan. Mov Disord 2003; 18(4): 432–436. doi: 10.1002/ mds.10395.

10. Defazio G, Gigante AF, Abbruzzese G et al. Tremor in primary adult-onset dystonia: prevalence and associated clinical features. J Neurol Neurosurg Psychiatry 2013; 84(4): 404–408. doi: 10.1136/ jnnp-2012-303782.

11. Albanese A, Bhatia KP, Bressman SB et al. Phenomenology and classification of dystonia: a consensus update. Mov Disord 2013; 28(7): 863–873. doi: 10.1002/ mds.25475.

12. Erro R, Rubio- Agusti I, Saifee TA et al. Rest and other types of tremor in adult-onset primary dystonia. J Neurol Neurosurg Psychiatry 2014; 85(9): 965–968. doi: 10.1136/ jnnp-2013-305876.

13. Jedynak CP, Bonnet AM, Agid Y. Tremor and idiopathic dystonia. Mov Disord 1991; 6(3): 230–236. doi: 10.1002/ mds.870060307.

14. Albanese A, Sorbo FD. Dystonia and tremor: The clinical syndromes with isolated tremor. Tremor Other Hyperkinet Mov (N Y) 2016; 6: 319. doi: 10.7916/ D8X34XBM.

15. Rivest J, Marsden CD. Trunk and head tremor as isolated manifestations of dystonia. Mov Disord 1990; 5(1): 60–65. doi: 10.1002/ mds.870050115.

16. Tinazzi M, Fasano A, Di Matteo A et al. Temporal discrimination in patients with dystonia and tremor and patients with essential tremor. Neurology 2013; 80(1): 76– 84. doi: 10.1212/ WNL.0b013e31827b1a54.

17. Antelmi E, Erro R, Rocchi L et al. Neurophysiological correlates of abnormal somatosensory temporal discrimination in dystonia. Mov Disord 2017; 32(1): 141–148. doi: 10.1002/ mds.26804.

18. Lee MS, Lee MJ, Conte A et al. Abnormal somatosensory temporal discrimination in Parkinson‘s disease: Pathophysiological correlates and role in motor control deficits. Clin Neurophysiol 2018; 129(2): 442–447. doi: 10.1016/ j.clinph.2017.11.022.

19. Tinazzi M, Fiorio M, Fiaschi A et al. Sensory functions in dystonia: insights from behavioral studies. Mov Disord 2009; 24(10): 1427–1436. doi: 10.1002/ mds.22490.

20. Conte A, Ferrazzano G, Manzo N et al. Somatosensory temporal discrimination in essential tremor and isolated head and voice tremors. Mov Disord 2015; 30(6): 822–827. doi: 10.1002/ mds.26163.

21. Conte A, Ferrazzano G, Belvisi D et al. Somatosensory temporal discrimination in Parkinson‘s disease, dystonia and essential tremor: Pathophysiological and clinical implications. Clin Neurophysiol 2018; 129(9): 1849–1853. doi: 10.1016/ j.clinph.2018.05.024.

22. Albanese A, Asmus F, Bhatia KP et al. EFNS guidelines on diagnosis and treatment of primary dystonias. Eur J Neurol 2011; 18(1): 5–18. doi: 10.1111/ j.1468- 1331.2010.03042.x.

23. Goetz CG, Tilley BC, Shaftman SR et al. Movement Disorder Society-sponsored revision of the Unified Parkinson‘s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 2008; 23(15): 2129–2170. doi: 10.1002/ mds.22 340.

24. Elble R, Comella C, Fahn S et al. Reliability of a new scale for essential tremor. Mov Disord 2012; 27(12): 1567– 1569. doi: 10.1002/ mds.25162.

25. Gayraud D, Viallet F. Evaluation of cervical dystonia. Usefulness of rating scales: the TWSTRS scale. Rev Neurol (Paris) 2008; 164 (12 Suppl): F263–F274. doi: 10.1016/ S0035-3787(08)75127-0.

26. Schmitz-Hubsch T, du Montcel ST, Baliko L et al. Scale for the assessment and rating of ataxia: development of a new clinical scale. Neurology 2006; 66(11): 1717–1720. doi: 10.1212/ 01.wnl.0000219042.60538.92.

27. Tinazzi M, Frasson E, Bertolasi L. Temporal discrimination of somesthetic stimuli is impaired in dystonic patients. Neuroreport 1999; 10(7): 1547–1550. doi: 10.1097/ 00001756-199905140-00028.

28. Ganos C, Ferre ER, Marotta A et al. Cortical inhibitory function in cervical dystonia. Clin Neurophysiol 2018; 129(2): 466–472. doi: 10.1016/ j.clinph.2017.11.020.

29. Sadnicka A, Daum C, Cordivari C et al. Mind the gap: temporal discrimination and dystonia. Eur J Neurol 2017; 24(6): 796–806. doi: 10.1111/ ene.13293.

30. Bradley D, Whelan R, Kimmich O et al. Temporal discrimination thresholds in adult-onset primary torsion dystonia: an analysis by task type and by dystonia phenotype. J Neurol 2012; 259(1): 77–82. doi: 10.1007/ s00415- 011-6125-7.

31. Conte A, Defazio G, Hallett M et al. The role of sensory information in the pathophysiology of focal dystonias. Nat Rev Neurol 2019; 15(4): 224–233. doi: 10.1038/ s41582- 019-0137-9.

32. Quartarone A, Hallett M. Emerging concepts in the physiological basis of dystonia. Mov Disord 2013; 28(7): 958–967. doi: 10.1002/ mds.25532.

33. Hutchinson M, Kimmich O, Molloy A et al. The endophenotype and the phenotype: temporal discrimination and adult-onset dystonia. Mov Disord 2013; 28(13): 1766– 1774. doi: 10.1002/ mds.25676.

34. Scontrini A, Conte A, Defazio G et al. Somatosensory temporal discrimination in patients with primary focal dystonia. J Neurol Neurosurg Psychiatry 2009; 80(12): 1315–1319. doi: 10.1136/ jnnp.2009.178236.

35. Kaji R, Bhatia KP, Graybiel AM. Pathogenesis of dystonia: is it of cerebellar or basal ganglia origin? J Neurol Neurosurg Psychiatry 2018; 89(5): 488–492. doi: 10.1136/ jnnp-2017-316250.

36. Deuschl G, Wenzelburger R, Loffler K et al. Essential tremor and cerebellar dysfunction clinical and kinematic analysis of intention tremor. Brain 2000; 123(Pt 8): 1568– 1580. doi: 10.1093/ brain/ 123.8.1568.

37. Benito-Leon J, Labiano-Fontcuberta A. Linking essential tremor to the cerebellum: clinical evidence. Cerebellum 2016; 15(3): 253–262. doi: 10.1007/ s12311-015-0741-1.

38. Bares M, Husarova I, Lungu OV. Essential tremor, the cerebellum, and motor timing: towards integrating them into one complex entity. Tremor Other Hyperkinet Mov (N Y) 2012; 2: tre-02-93-653-1.

39. Manganelli F, Dubbioso R, Pisciotta C et al. Somatosensory temporal discrimination threshold is increased in patients with cerebellar atrophy. Cerebellum 2013; 12(4): 456–459. doi: 10.1007/ s12311-012-0435-x.

40. Bares M, Apps R, Avanzino L et al. Consensus paper: decoding the contributions of the cerebellum as a time machine. from neurons to clinical applications. Cerebellum 2019; 18(2): 266–286. doi: 10.1007/ s12311-018-0979-5.