MOVEMENT DISORDERS: TREMOR

MOVEMENT DISORDERS:TREMOR

Edited by

Leslie J. Findley

Consultant Neurologist, Regional Centre for Neurology and Neurosurgery,Oldchurch Hospital, Romford, and Harold Wood Hospital, Romford, Essex;

Visiting Consultant Neurologist, Queen Elizabeth Military Hospital,Woolwich, London; and Research Neurologist, MRC Neuro-Otology Unit,

Institute ofNeurology, The Nat ional Hospital, Queen Square, London

and

Rudy Capildeo

Consultant Neurologist , Regional Centre for Neurology and Neurosurgery,Oldchurch Hospital, Romford; and

Consultant Neurologist, Basi/don and Orsett Hospitals, Essex

MMACMILLAN

© The contributors 1984 Softcover reprint of the hardcover 1st edition 1984 978-0-333-35040-9

All rights reserved. No part of this publication may be reproduced ortran smitted , in any form or by any means , without permission .

First pub lished 1984 byThe Scientific and Medical DivisionTHE MACMILLAN PRESS LTDLondon and BasingstokeAssociated companies in Auckland , Delhi, Dublin , Gaborone , Hamburg ,Harare, Hong Kong , Johannesburg, Kuala Lumpur, Lagos, Manzini ,Melbourne, Mexico City , Nairobi, New York, Singapore and Tokyo

ISBN 978-1-349-06759-6 ISBN 978-1-349-06757-2 (eBook)DOI 10.1007/978-1-349-06757-2

Contents

Contributors ix

Preface xv

SECTION 1 GENERAL ASPECTS 1Classification of tremor 3

R. Capildeo and 1. J. Findley2 Definition, analysis and genesis of tremor 15

M. A. Gresty and 1. J. Findley3 Differential diagnosis of motor disorders by tremor analysis 27

H-I. Freund, H Hefter, V. Hamberg and K. Reiners4 Origins of normal and pathological tremor 37

C. D. Marsden5 Pharmacological differentiation of tremor 85

S. Fahn6 Pathology of tremor 95

A . Marshall

SECTION 2 NEUROPHYSIOLOGY OF TREMOR 1257 Physiological and enhanced physiological tremor 127

R. R. Young8 Segmental reflex, muscle mechanical and central mechanisms

underlying human physiological tremor 135J. H J. Allum

9 Muscle spindle discharge patterns in tremor and clonus 157K.-E. Hagbarth

10 Rebound excitation as the physiological basis for tremor: abiophysical study of the oscillatory properties of mammaliancentral neurones in vitro 165

R. R. LUnas11 Animals models of physiological , essential and parkinsonian-like

tremors 183Y. Lamarre

12 Determinants of tremor rate 195H. -J. Freund, H Hefter, V. Hamberg and K. Reiners

v

vi Contents

SECTION 3 ESSENTIAL TREMOR 20513 Essential tremor: introductory remarks 207

L. J. Findley14 Epidemiology of essential tremor 211

I. Rautakorpi, R. J. Marttila and U. K. Rinne15 Problems in the diffe rential diagnosis of essential tremor 219

P. Salisachs and L. J. Findley16 Beta-adrenoceptor involvement in tremor production: possible

defects in essential tremor 225S. Kilfeather, A . Massarella, P. Turner and L. J. Findley

17 Essential tremor: treatment with beta-adrenoceptor blocking drugs 245J. F. Wilson, R . W. Marshall and A . Richens

18 o,L-Propranolol and n-propranolol in essential tremor 261S. Calzetti and L. J. Findley

19 Primidone in essential tremor 271L. J. Findley, S. Calzetti and L. Cleeves

SECTION 4 THE TREMORS OF PARKINSON'S DISEASE 28320 Parkinson's disease complex-restyling an old overcoat! 285

R . Capildeo21 Tremor and rhythmical involuntary movements in Parkinson's disease 295

L. J. Findley and M. A . Gresty22 Neurochemical basis of parkinsonian tremor 305

P. Jenner and C. D. Marsden23 Assessment of resting tremor in Parkinson's disease 321

M. A. Gresty, R . McCarthy and L. J. Findley24 Medical treatment of tremor in Parkinson's disease 331

J. A . Obeso and J. M Martinez Lage25 Surgical treatment of tremor 339

J. Andrew

SECTION 5 CEREBELLAR TREMOR 35326 Cerebellar tremor: clinical aspects 355

S. Fahn27 Motor control in cerebellar tremor 365

P. Rondot and N. Bathien28 Treatment of cerebellar tremor 377

N.J. Legg

SECTION 6 TREMORS IN PERIPHERAL NEUROPATHY 38729 Tremor associated with peripheral neuropathy 389

B. T. Shahani

30 Tremor in peripheral neuropathyI. S. Smith , P. Furness and P. K. Thomas

Contents vii

399

SECTION 7 TREMULOUS AND TREMOR·LIKE MOVEMENTSOF THE EYES 407

31 Mechanisms of ocular oscillations 409D. S. Zee and L. M. Optican

32 Pendular nystagmus (ocular myoclonus) and related somatic tremors :their pharmacological modification and treatment 421

J. J. Ell, L. J. Findley and M. A . Gresty

SECTION 8 DIVERSETREMULOUS STATES 42933 Atypical tremors, rare tremors and unclassified tremors 431

S. Fahn34 Drug-induced tremor 445

R . M. Pinder35 Tremor in relation to certain other movement disorders 463

R. R. Young

SECTION 9 SIGNIFICANCE OF TREMOR IN THE ONTOGENYOF THE NERVOUS SYSTEM 473

36 Possible role of tremor in the organisation of the nervous system 475R. R. LUnas

Glossary of terms 479

Index 487

Contributors

1. H. 1. AllumBrain Research Institute,University of Zurich; andHNO Klinik,Kantonsspital ,CH-4031 Basel,Switzerland

J. AndrewDepartment of Neurosu rgery ,The Middlesex Hospital ,Mortimer Street,London WI; andRegional Centre for Neurology and Neurosurge ry,Oldchurch Hospital,Romford,Essex

N. BathienCentre Hospitalier Sainte-Ann e,Faculte de Medecine Cochin Port-Royal,Service de Neurologie,1 Rue Cabanis,75674 Paris ,France

S . CalzettiIstituto di Clinica Neurologica ,Via del Quartiere 4,1-43100 Parma,Italy; andMRC Neuro-Otology Unit ,Institute of Neurology ,The National Hospital ,Queen Square ,London WCIN 3BG

R. CapildeoRegional Centre for Neurology and Neurosurgery,Oldchu rch Hospital,Romford,Essex

Lynn CleevesRegional Centre for Neurology and Neurosurger y,Oldchurch Hospital,Romford,Essex

ix

x Contributors

J. 1. EllMRC Neuro-Otology Unit,Institute of Neurology,The National Hospital,Queen Square,London WCIN 3BG

S.FahnDepartment of Neurology,College of Physicians and Surgeons,Columbia University,New York; andThe Neurological Institute,710 West 168th Street,New York,NY 10032 ,USA

1. 1. FindleyRegional Centre for Neurology and Neurosurgery ,Oldchurch Hospital ,Romford,Essex; andMRC Neuro-Otology Unit,Institute of Neurology ,The National Hospital,Queen Square ,London WC1N 3BG

H.-J. Freund,Medizinische Einrichtungen der Universitat Dusseldorf,Neurologische Klinik,Morrenstrasse 5,4000 Dusseldorf 1,West Germany

P. FurnessInstitute of Neurology ,The National Hospital,Queen Square,London WC1N 3BG

M. A. GrestyMRC Neuro-Otology Unit,Institute of Neurology,The National Hospital,Queen Square ,London WClN 3BG

K.-E. HagbarthDepartment of Clinical Neurophysiology,University Hospital,S-751 85 Uppsala,Sweden

Contributors xi

H. HefterMedizinische Einrichtungen der Universitat Dusseldorf,Neurologische Klinik ,Morrenstrasse 5 ,4000 Diisseldorf I ,West Germany

V . HombergMedizinische Einrichtungen der Universitat Diisseldorf,Neurologische Klinik,Morrenstrasse 5,4000 Dusseldorf 1,West Germany

P. JennerUniversity Department of Neurology,Institute of Psychiatry and King's College Hospital Medical School,De Crespigny Park ,Denmark Hill,London SE5 8AF

S. KilfeatherDepartment of Clinical Pharmacology,St Bartholomew's Hospital Medical College,London EC1A 7BE

Y. LamarreCentre de Recherche en Sciences Neurologiques,Faculte de Medecine,Universite de Mont real,CP 6128 A, Montreal,Quebec,H3C 317,Canada

N.1. LeggRoyal Postgraduate Medical School,Hammersmith Hospital,Ducane Road ,London W12 OHS

R. R. LlinasDepartment of Physiology and Biophysics,New York University Medical Center,School of Medicine,550 First Avenue,New York,NY 10016,USA

Rosaleen McCarthyDepartment of Psychology,The National Hospital,Queen Square ,London WC1N 3BG

xii Contributors

C. D. MarsdenUniversity Department of Neurology ,Institute of Psychiatry and King's Col1ege Hospital Medical School,De Crespigny Park ,Denmark Hill,London SE5 BAF

Ann Marshal1Department of Neuropathology,Regional Centre for Neurology and Neurosu rgery,Oldchu rch Hospital,Romford,Essex

R. W. MarshallDepartment of Pharmacology and Therapeutics,Welsh National School of Medicine,Heath Park,Cardiff CF4 4XN

1. M. Martinez LageDepartment de Neurologia,Clinica Universitaria,Facultad de Medicina ,Universidad de Navarra,Pamplona,Spain

R. J . MarttilaDepartment of Neurology,University ofTurku,SF-20520 Turku 52,Finland

A. Massarel1aDepartment of Clinical Pharmacology ,St Bartholomew's Hospital ,London ECIA 7BE

J . A. ObesoDepartment de Neurologia ,Clinica Universitaria,Facultad de Medicina,Universidad de Navarra,Pamplona,Spain

L. M. OpticanClinical Branch and Laboratory of Sensorimotor Research,National Institutes of Health,Bethesda , MD; andDepartments of Neurology and Ophthalmology,Johns Hopkins Hospital ,600 North Wolfe Street,Baltimore,MD 21205,USA

R. PinderScientific Development Group ,Organon,Oss,The Netherlands

1. RautakorpiDepartment of Neurology,University of Turku,SF-20520 Turku 52;andDepartment of Neurology ,Lappi Central Hospital ,SF-97145 Totonvaara,Finland

K. ReinersMedizinische Einrichtungen der Universitat Dusseldorf,Neurologische Klinik,Morrenstrasse 5,4000 Dusseldorf I ,West Germany

A. RichensDepartment of Pharmacology and Therapeutics,Welsh National School of Medicine,Heath Park,Cardiff CF4 4XN

U. K. RinneDepartment of Neurology,University of Turku ,SF-20520 Turku 52,Finland

P. RondotCentre Hospitalier Sainte-Anne,Faculte de Medecine Cochin Port-Royal,Service de Neurologie,I Rue Cabanis,75674 Paris,France

P. SalisachsMRC Neuro-Otology Unit,The National Hospital ,Queen Square,London WCIN 3BG; andServicio de Neurologia ,Residencia Sanitaria de la Seguridad Social,Badalona,Barcelona,Spain

Contributors xiii

xiv Contributors

B. T. ShahaniClinical Neurophysiology Laboratory,Department of Neurology,Massachusetts General Hospital and Harvard Medical School,Fruit Street,Boston ,MA 02114,USA

I. S. SmithDepartment of Clinical Neurophysiology,The National Hospital,Queen Square ,London WCIN 3BG

P. K. ThomasInstitute of Neurology ,The National Hospital,Queen Square ,London WCIN 3BG

P. TurnerDepartment of Clinical Pharmacology,St Bartholomew's Hospital,London ECIA 7BE

1. F. WilsonDepartment of Pharmacolog y and Therapeutics,Welsh National School of Medicine,Heath Park,Cardiff CF4 4XN

R. R. YoungMovement Disorder Clinic and Clinical Neurophysiology Laboratory,Department of Neurology,Massachusetts General Hospital and Harvard Medical School,Fruit Street,Boston ,MA 02114 ,USA

D.S .ZeeClinical Branch and Laboratory of Sensorimotor Research ,National Institutes of Health,Bethesda, MD; andDepartments of Neurology and Ophthalmology,Johns Hopkins Hospital ,600 North Wolfe Street,Baltimore ,MD 21205,USA

Preface

Tremor is a manifestation of normal or abnormal functioning of the nervoussystem. Although our knowledge of the causes of tremor is incomplete, it isapparent that all tremors involve a combination of peripheral and central mecha­nisms. These mechanisms are diverse in nature , including the passive mechanicalproperties of body appendages, oscillatory instabilities in both short and long'reflex' loops and intrinsic electrochemical instabilities in individual neurones andneuronal assemblages. Thus the study of tremors is of necessity a multidisciplinaryundertaking.

This book presents the views of specialists from various disciplines who sharea common interest in tremor phenomena. The participants joined in a 'workshop'whose aim was to forge an integrative approach to tremor research. The contri­butions represent individual approaches to the subject, written retrospectively andtempered by the discussions that took place.

The purpose of the book is to give a comprehensive, current account of the'state of the art' in tremor research. Sections are included dealing with techniquesof tremor analysis, normal and abnormal physiology, epidemiology, anatomicaland chemical pathology , behavioural neurology , pharmacology, and medical andsurgical treatment.

It was apparent to all participants that the initial and considerable difficultyconfronting discussion of tremor was semasiological. For this reason, a glossaryof definitions has been appended. The definitions in this glossary are not thosenecessarily adopted throughout the book but are based on a consensus view of theeditors, and of Professor David Marsden FRS and Dr Michael Gresty. The inten tionof the glossary is to provoke comment, criticism and further clarification of termsso that, eventually, we may arrive at a universally acceptable terminology .

The editors would like to acknowledge the help of Dr Michael Gresty inadvising on the scientific contributions to this volume and Professor David MarsdenFRS for his support and encouragement. The workshop was supported financiallyby a charitable grant from Sandoz Products Limited.

Spring 1984

xv

Leslie J. Findley and Rudy Capildeo