Abstract Details

Title Evalualuation of Tremor in Childhood Electrophysiologically Influences Prognosis and Outcome

Topic Child Neurology and Developmental Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-029

Objective To evaluate childhood " tremor" electrophysiologically differentiating phenomenology from many entities influencing therapy and outcome.

Background Tremor in children and adolescents in many forms accounts for 15-20% of referrals in some series. Essential tremor is most common however new criteria regarding essential tremor requires further clarification when applied to children. Utilizing non invasive electrophysiological recordings other non-essential tremors may be defined that resemble essential tremor clinically. Differential diagnosis may be expanded when consideration is given to atypical presentations of childhood tremor. Since tremor frequently co exists with other movement disorders, separation of the tremor component may require more specific studies studies.

Design/Methods Ten patients ages 4-18 years were enrolled in a NIH NINDS IRB approved study that included clinical evaluation, neuroimaging and electrophysiological recordings. EMG electrodes were placed on the bilateral flexor carpi radialis ( FCR) and extensor carpi radialis (ECR) muscles. Bandpass filter for EMG was 10-200 Hz. Monoaxial accelerometers were placed on the dorsum of the hands bilaterally for detection of hand tremor. Monoaxial acclerometers were placed on the middle fingers bilaterally for detection of finger tremor. Band pass filter was set at 10-50 Hz. The effect of weighting using 1 lb magnets on the hands was evaluated . Finger weighting utilized 1/2 lb weights.

Results

Data analysis revealed diagnoses that included physiological tremor, enhanced physiological tremor, functional tremor, drug induced tremor; dystonic tremor, myoclonus, myoclonic tremor, cerebellar tremor and parkinsonian tremor , the latter five mimicking essential tremor.Differnetiation off a central component from a peripheral component allowed for more precise diagnosis.

Conclusions Previously we reported a smaller series of patients with childhood tremor, This enlarged series defines specifically other entities and while clinical evaluation remains paramount the elucidation of dystonic tremor, myoclonic tremor, cerebellar tremor and parkinsonian tremor using electrophysiology confirmed specific diagnoses that informed therapy and outcome.

Authors/Disclosures
Bennett L. Lavenstein, MD, FAAN PRESENTER	No disclosure on file
Mark Hallett, MD, FAAN (National Institutes of Health)	Dr. Hallett has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Hallett has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurocrine. Dr. Hallett has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Brainsway. Dr. Hallett has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for VoxNeuro. Dr. Hallett has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for QuantalX. Dr. Hallett has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Hallett has received intellectual property interests from a discovery or technology relating to health care. Dr. Hallett has received publishing royalties from a publication relating to health care. Dr. Hallett has received publishing royalties from a publication relating to health care. Dr. Hallett has received publishing royalties from a publication relating to health care. Dr. Hallett has received publishing royalties from a publication relating to health care. Dr. Hallett has received personal compensation in the range of $500-$4,999 for serving as a Speaker with International Parkinson and Movement Disorder Society. Dr. Hallett has a non-compensated relationship as a Past-President with Functional Neurological Disorder Society that is relevant to AAN interests or activities.
	No disclosure on file
	No disclosure on file

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