Myoclonus or Tremor in Orthostatism : An Under-Recognized Cause of Unsteadiness in Parkinson's Disease
Identifieur interne : 000350 ( France/Analysis ); précédent : 000349; suivant : 000351Myoclonus or Tremor in Orthostatism : An Under-Recognized Cause of Unsteadiness in Parkinson's Disease
Auteurs : Smaranda Leu-Semenescu [France] ; Emmanuel Roze [France] ; Marie Vidailhet [France] ; André-Pierre Legrand [France] ; Jean-Marc Trocello [France] ; Valérie Cochen [France] ; Sophie Sangla [France] ; Emmanuelle Apartis [France]Source :
- Movement disorders [ 0885-3185 ] ; 2007.
Descripteurs français
- Pascal (Inist)
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Abstract
Patients with Parkinson's disease (PD) often complain of unsteadiness. This can occur as the result of various neurological dysfunctions, including changes in postural adjustments, loss of postural reflexes, axial akinesia and rigidity, freezing and/or postural hypotension. In some cases these symptoms remain unexplained, and rare cases of unsteadiness have been attributed to tremor on standing. To delineate this condition, we investigated 11 consecutive PD patients with unexplained unsteadiness because of tremor on standing, seen in our department over a 6-year period. All the patients had detailed clinical and electrophysiological investigations based on surface polygraphic electromyographic recordings. Four patients had fast orthostatic tremor (13-18 Hz), one had intermediate orthostatic tremor (8-9 Hz), and three had slow orthostatic tremor (4-6 Hz). The remaining 3 patients had orthostatic myoclonus, a condition that has not previously been reported in PD. Patients with fast tremor improved on clonazepam. Patients with slow tremor and myoclonus improved on levodopa and sometimes benefited further when clonazepam was added. These observations show the usefulness of neurophysiological investigations for diagnosing and treating unexplained unsteadiness in Parkinson's disease.
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type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>INSERM U732, Pierre et Marie Curie-Paris 6 University</s1><s2>Paris</s2><s3>FRA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Cochen, Valerie" sort="Cochen, Valerie" uniqKey="Cochen V" first="Valérie" last="Cochen">Valérie Cochen</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Neurology, Saint-Antoine Hospital, AP-HP</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>INSERM U679, Pierre et Marie Curie-Paris 6 University</s1><s2>Paris</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Sangla, Sophie" sort="Sangla, Sophie" uniqKey="Sangla S" first="Sophie" last="Sangla">Sophie Sangla</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Neurology, Saint-Antoine Hospital, AP-HP</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Apartis, Emmanuelle" sort="Apartis, Emmanuelle" uniqKey="Apartis E" first="Emmanuelle" last="Apartis">Emmanuelle Apartis</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Physiology, Saint-Antoine Hospital, AP-HP</s1><s2>Paris</s2><s3>FRA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>INSERM U732, Pierre et Marie Curie-Paris 6 University</s1><s2>Paris</s2><s3>FRA</s3><sZ>5 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><settlement type="city">Paris</settlement></placeName></affiliation></author></analytic><series><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Myoclonus</term><term>Nervous system diseases</term><term>Neurophysiology</term><term>Orthostatism</term><term>Parkinson disease</term><term>Tremor</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Pathologie du système nerveux</term><term>Myoclonie</term><term>Tremblement</term><term>Maladie de Parkinson</term><term>Orthostatisme</term><term>Neurophysiologie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Patients with Parkinson's disease (PD) often complain of unsteadiness. This can occur as the result of various neurological dysfunctions, including changes in postural adjustments, loss of postural reflexes, axial akinesia and rigidity, freezing and/or postural hypotension. In some cases these symptoms remain unexplained, and rare cases of unsteadiness have been attributed to tremor on standing. To delineate this condition, we investigated 11 consecutive PD patients with unexplained unsteadiness because of tremor on standing, seen in our department over a 6-year period. All the patients had detailed clinical and electrophysiological investigations based on surface polygraphic electromyographic recordings. Four patients had fast orthostatic tremor (13-18 Hz), one had intermediate orthostatic tremor (8-9 Hz), and three had slow orthostatic tremor (4-6 Hz). The remaining 3 patients had orthostatic myoclonus, a condition that has not previously been reported in PD. Patients with fast tremor improved on clonazepam. Patients with slow tremor and myoclonus improved on levodopa and sometimes benefited further when clonazepam was added. These observations show the usefulness of neurophysiological investigations for diagnosing and treating unexplained unsteadiness in Parkinson's disease.</div></front></TEI><affiliations><list><country><li>France</li></country><settlement><li>Paris</li></settlement></list><tree><country name="France"><noRegion><name sortKey="Leu Semenescu, Smaranda" sort="Leu Semenescu, Smaranda" uniqKey="Leu Semenescu S" first="Smaranda" last="Leu-Semenescu">Smaranda Leu-Semenescu</name></noRegion><name sortKey="Apartis, Emmanuelle" sort="Apartis, Emmanuelle" uniqKey="Apartis E" first="Emmanuelle" last="Apartis">Emmanuelle Apartis</name><name sortKey="Apartis, Emmanuelle" sort="Apartis, Emmanuelle" uniqKey="Apartis E" first="Emmanuelle" last="Apartis">Emmanuelle Apartis</name><name sortKey="Cochen, Valerie" sort="Cochen, Valerie" uniqKey="Cochen V" first="Valérie" last="Cochen">Valérie Cochen</name><name sortKey="Cochen, Valerie" sort="Cochen, Valerie" uniqKey="Cochen V" first="Valérie" last="Cochen">Valérie Cochen</name><name sortKey="Legrand, Andre Pierre" sort="Legrand, Andre Pierre" uniqKey="Legrand A" first="André-Pierre" last="Legrand">André-Pierre Legrand</name><name sortKey="Roze, Emmanuel" sort="Roze, Emmanuel" uniqKey="Roze E" first="Emmanuel" last="Roze">Emmanuel Roze</name><name sortKey="Roze, Emmanuel" sort="Roze, Emmanuel" uniqKey="Roze E" first="Emmanuel" last="Roze">Emmanuel Roze</name><name sortKey="Sangla, Sophie" sort="Sangla, Sophie" uniqKey="Sangla S" first="Sophie" last="Sangla">Sophie Sangla</name><name sortKey="Trocello, Jean Marc" sort="Trocello, Jean Marc" uniqKey="Trocello J" first="Jean-Marc" last="Trocello">Jean-Marc Trocello</name><name sortKey="Trocello, Jean Marc" sort="Trocello, Jean Marc" uniqKey="Trocello J" first="Jean-Marc" last="Trocello">Jean-Marc Trocello</name><name sortKey="Trocello, Jean Marc" sort="Trocello, Jean Marc" uniqKey="Trocello J" first="Jean-Marc" last="Trocello">Jean-Marc Trocello</name><name sortKey="Vidailhet, Marie" sort="Vidailhet, Marie" uniqKey="Vidailhet M" first="Marie" last="Vidailhet">Marie Vidailhet</name><name sortKey="Vidailhet, Marie" sort="Vidailhet, Marie" uniqKey="Vidailhet M" first="Marie" last="Vidailhet">Marie Vidailhet</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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