Diagnosis and imaging of essential and other tremors

Researcher: Madelein van der Stouwe, MD, PhD

Thesis defense: 2015

Second promotor: Prof. Marina de Koning-Tijssen, MD, PhD

Collaborator: Prof. Nico Leenders, MD, PhD

Funding: UMCG

Everyone suffers from trembling hands from time to time. For instance, when you are nervous, such as during a speech, or after a few of cups of coffee. Some people tremble considerably more than others: they are not at all nervous, but tremble none the less. This can be related to several different tremor diagnoses, from the most common: essential tremor, to the most well known: tremor in Parkinson’s disease. It is important to distinguish one type from the other, as both prognosis and treatment vary substantially. The first part of this thesis investigates tremor diagnosis, in which consultation by a neurologist including the physical examination is of primary importance. We investigated 5 typical characteristics that point to certain tremors and established that these tests differentiate the different tremor syndromes quite well. Next, we focused on muscle investigation (EMG), and found that certain advanced techniques are of additional value in diagnosis. In the second part of this thesis, the focus shifts towards the most common form of tremor, essential tremor, and how it is generated in the brain. By using a combination of simultaneously recorded muscle investigation (EMG) and brain scans (fMRI), we were able to establish increased, abnormal activity in the little brain or cerebellum and the network it is a part of. The knowledge from this thesis is of immediate additional value in daily clinical practice on the one hand, while on the other hand it adds to our understanding of essential tremor.

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