Focal limb dystonia and tremor: Clinical update. (March 2020)

• Record Type: Journal Article
• Authors: Murgai, Aditya Ashok; Jog, Mandar
• Is Part Of: Toxicon. Volume 176(2020)
• Page Start: 10
• Page End: 14
• Publication Date: 2020-03
• Subjects: Dystonia -- Tremor -- Electrophysiology; Toxins -- Periodicals; Venom -- Periodicals; 615.9
• DOI: 10.1016/j.toxicon.2020.01.004
• Languages: English
• ISSNs: 0041-0101

Abstract

Abstract: The association between tremor and dystonia has been known for many decades. Dystonic tremor is seen in the body part affected with dystonia. Tremor and dystonia can also co-exist in different body parts. Subtle dystonic posturing can be missed in patients with upper limb tremor and these patients are often misdiagnosed as essential tremor. Careful clinical examination and electrophysiology may help in differentiating classical essential tremor from dystonic tremor. Writer's cramp, a common focal hand dystonia can mimic primary writing tremor when the dystonic posturing is subtle. Oral medications have limited therapeutic efficacy. Botulinum toxin is considered as first line therapy for focal limb dystonia and is also effective in the treatment of tremor. Surgical options are reserved for cases refractory to medical therapy. In this review, we summarize the current state of knowledge of focal limb dystonia and tremor with a focus on underlying neurophysiology in these conditions. Highlights: Dystonic tremor is jerky and irregular, may show sensory trick and presence of null point. Dystonic tremor is often misdiagnosed as essential tremor. Botulinum toxin is the mainstay treatment for focal limb dystonia and is also effective in dystonic tremor.