Myoclonus or tremor in orthostatism: An under‐recognized cause of unsteadiness in Parkinson's disease
Identifieur interne : 002946 ( Main/Corpus ); précédent : 002945; suivant : 002947Myoclonus or tremor in orthostatism: An under‐recognized cause of unsteadiness in Parkinson's disease
Auteurs : Smaranda Leu-Semenescu ; Emmanuel Roze ; Marie Vidailhet ; André-Pierre Legrand ; Jean-Marc Trocello ; Valérie Cochen ; Sophie Sangla ; Emmanuelle ApartisSource :
- Movement Disorders [ 0885-3185 ] ; 2007-10-31.
English descriptors
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. © 2007 Movement Disorder Society
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DOI: 10.1002/mds.21651
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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. © 2007 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Smaranda Leu‐Semenescu MD</name><affiliations><json:string>Department of Neurology, Saint‐Antoine Hospital, AP‐HP, Paris, France</json:string></affiliations></json:item><json:item><name>Emmanuel Roze MD</name><affiliations><json:string>Department of Neurology, Saint‐Antoine Hospital, AP‐HP, Paris, France</json:string><json:string>CNRS UMR 7102, Pierre et Marie Curie–Paris 6 University, Paris, France</json:string></affiliations></json:item><json:item><name>Marie Vidailhet MD</name><affiliations><json:string>Department of Neurology, Saint‐Antoine Hospital, AP‐HP, Paris, France</json:string><json:string>INSERM U679, Pierre et Marie Curie–Paris 6 University, Paris, France</json:string></affiliations></json:item><json:item><name>André‐Pierre Legrand PhD</name><affiliations><json:string>Quantum Physics Laboratory, ESPCI, Paris, France</json:string></affiliations></json:item><json:item><name>Jean‐Marc Trocello MD</name><affiliations><json:string>Department of Neurology, Saint‐Antoine Hospital, AP‐HP, Paris, France</json:string><json:string>Department of Physiology, Saint‐Antoine Hospital, AP‐HP, Paris, France</json:string><json:string>INSERM U732, Pierre et Marie Curie–Paris 6 University, Paris, France</json:string></affiliations></json:item><json:item><name>Valérie Cochen MD</name><affiliations><json:string>Department of Neurology, Saint‐Antoine Hospital, AP‐HP, Paris, France</json:string><json:string>INSERM U679, Pierre et Marie Curie–Paris 6 University, Paris, France</json:string></affiliations></json:item><json:item><name>Sophie Sangla MD</name><affiliations><json:string>Department of Neurology, Saint‐Antoine Hospital, AP‐HP, Paris, France</json:string></affiliations></json:item><json:item><name>Emmanuelle Apartis MD, PhD</name><affiliations><json:string>Department of Physiology, Saint‐Antoine Hospital, AP‐HP, Paris, France</json:string><json:string>INSERM U732, Pierre et Marie Curie–Paris 6 University, Paris, France</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>unsteadiness</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>orthostatic tremor</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>myoclonus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>neurophysiology</value></json:item></subject><articleId><json:string>MDS21651</json:string></articleId><language><json:string>eng</json:string></language><abstract>Patients with Parkinson's disease (PD) often complain of unsteadiness. 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Patients with slow tremor and myoclonus improved on levodopa and sometimes benefited further when clonazepam was added. 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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. © 2007 Movement Disorder Society</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>unsteadiness</term></item><item><term>orthostatic tremor</term></item><item><term>myoclonus</term></item><item><term>Parkinson's disease</term></item><item><term>neurophysiology</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>article category</head><item><term>Research Article</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2006-12-22">Received</change><change when="2007-06-05">Registration</change><change when="2007-10-31">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/78C41FDAD4BF63FC5706D668BF45B1986DA9CA87/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1531-8257</doi><issn type="print">0885-3185</issn><issn type="electronic">1531-8257</issn><idGroup><id type="product" value="MDS"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="MOVEMENT DISORDERS">Movement Disorders</title><title type="subtitle">Official Journal of the Movement Disorder Society</title><title type="short">Mov. 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href="file:MDS.MDS21651.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="1"></count><count type="tableTotal" number="2"></count><count type="referenceTotal" number="32"></count><count type="wordTotal" number="4370"></count></countGroup><titleGroup><title type="main" xml:lang="en">Myoclonus or tremor in orthostatism: An under‐recognized cause of unsteadiness in Parkinson's disease</title><title type="short" xml:lang="en">Myoclonus or Tremor in Orthostatism in PD</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Smaranda</givenNames><familyName>Leu‐Semenescu</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af1 #af2"><personName><givenNames>Emmanuel</givenNames><familyName>Roze</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af1 #af3"><personName><givenNames>Marie</givenNames><familyName>Vidailhet</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af4"><personName><givenNames>André‐Pierre</givenNames><familyName>Legrand</familyName><degrees>PhD</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af1 #af5 #af6"><personName><givenNames>Jean‐Marc</givenNames><familyName>Trocello</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af1 #af3"><personName><givenNames>Valérie</givenNames><familyName>Cochen</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au7" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Sophie</givenNames><familyName>Sangla</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au8" creatorRole="author" affiliationRef="#af5 #af6" corresponding="yes"><personName><givenNames>Emmanuelle</givenNames><familyName>Apartis</familyName><degrees>MD, PhD</degrees></personName><contactDetails><email>emmanuelle.apartis@sat.aphp.fr</email></contactDetails></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="FR" type="organization"><unparsedAffiliation>Department of Neurology, Saint‐Antoine Hospital, AP‐HP, Paris, France</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="FR" type="organization"><unparsedAffiliation>CNRS UMR 7102, Pierre et Marie Curie–Paris 6 University, Paris, France</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="FR" type="organization"><unparsedAffiliation>INSERM U679, Pierre et Marie Curie–Paris 6 University, Paris, France</unparsedAffiliation></affiliation><affiliation xml:id="af4" countryCode="FR" type="organization"><unparsedAffiliation>Quantum Physics Laboratory, ESPCI, Paris, France</unparsedAffiliation></affiliation><affiliation xml:id="af5" countryCode="FR" type="organization"><unparsedAffiliation>Department of Physiology, Saint‐Antoine Hospital, AP‐HP, Paris, France</unparsedAffiliation></affiliation><affiliation xml:id="af6" countryCode="FR" type="organization"><unparsedAffiliation>INSERM U732, Pierre et Marie Curie–Paris 6 University, Paris, France</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">unsteadiness</keyword><keyword xml:id="kwd2">orthostatic tremor</keyword><keyword xml:id="kwd3">myoclonus</keyword><keyword xml:id="kwd4">Parkinson's disease</keyword><keyword xml:id="kwd5">neurophysiology</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>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. © 2007 Movement Disorder Society</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Myoclonus or tremor in orthostatism: An under‐recognized cause of unsteadiness in Parkinson's disease</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Myoclonus or Tremor in Orthostatism in PD</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Myoclonus or tremor in orthostatism: An under‐recognized cause of unsteadiness in Parkinson's disease</title></titleInfo><name type="personal"><namePart type="given">Smaranda</namePart><namePart type="family">Leu‐Semenescu</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Saint‐Antoine Hospital, AP‐HP, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Emmanuel</namePart><namePart type="family">Roze</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Saint‐Antoine Hospital, AP‐HP, Paris, France</affiliation><affiliation>CNRS UMR 7102, Pierre et Marie Curie–Paris 6 University, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Marie</namePart><namePart type="family">Vidailhet</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Saint‐Antoine Hospital, AP‐HP, Paris, France</affiliation><affiliation>INSERM U679, Pierre et Marie Curie–Paris 6 University, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">André‐Pierre</namePart><namePart type="family">Legrand</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Quantum Physics Laboratory, ESPCI, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jean‐Marc</namePart><namePart type="family">Trocello</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Saint‐Antoine Hospital, AP‐HP, Paris, France</affiliation><affiliation>Department of Physiology, Saint‐Antoine Hospital, AP‐HP, Paris, France</affiliation><affiliation>INSERM U732, Pierre et Marie Curie–Paris 6 University, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Valérie</namePart><namePart type="family">Cochen</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Saint‐Antoine Hospital, AP‐HP, Paris, France</affiliation><affiliation>INSERM U679, Pierre et Marie Curie–Paris 6 University, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Sophie</namePart><namePart type="family">Sangla</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Saint‐Antoine Hospital, AP‐HP, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Emmanuelle</namePart><namePart type="family">Apartis</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Department of Physiology, Saint‐Antoine Hospital, AP‐HP, Paris, France</affiliation><affiliation>INSERM U732, Pierre et Marie Curie–Paris 6 University, Paris, France</affiliation><description>Correspondence: Department of Physiology, Saint‐Antoine Hospital, 184, rue du Faubourg Saint‐Antoine, 75571 Paris cedex 12, France</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2007-10-31</dateIssued><dateCaptured encoding="w3cdtf">2006-12-22</dateCaptured><dateValid encoding="w3cdtf">2007-06-05</dateValid><copyrightDate encoding="w3cdtf">2007</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">1</extent><extent unit="tables">2</extent><extent unit="references">32</extent><extent unit="words">4370</extent></physicalDescription><abstract 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. © 2007 Movement Disorder Society</abstract><subject lang="en"><genre>Keywords</genre><topic>unsteadiness</topic><topic>orthostatic tremor</topic><topic>myoclonus</topic><topic>Parkinson's disease</topic><topic>neurophysiology</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title><subTitle>Official Journal of the Movement Disorder Society</subTitle></titleInfo><titleInfo type="abbreviated"><title>Mov. Disord.</title></titleInfo><genre type="Journal">journal</genre><subject><genre>article category</genre><topic>Research Article</topic></subject><identifier type="ISSN">0885-3185</identifier><identifier type="eISSN">1531-8257</identifier><identifier type="DOI">10.1002/(ISSN)1531-8257</identifier><identifier type="PublisherID">MDS</identifier><part><date>2007</date><detail type="volume"><caption>vol.</caption><number>22</number></detail><detail type="issue"><caption>no.</caption><number>14</number></detail><extent unit="pages"><start>2063</start><end>2069</end><total>7</total></extent></part></relatedItem><identifier type="istex">78C41FDAD4BF63FC5706D668BF45B1986DA9CA87</identifier><identifier type="DOI">10.1002/mds.21651</identifier><identifier type="ArticleID">MDS21651</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2007 Movement Disorder Society</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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