Clinical And Transcranial Magnetic Stimulation Study In Essential Tremor And Parkinson's Disease

Objective:To compare the clinical characteristics between essential tremor(ET) andParkinson's disease(PD).Methods:We prospectively evaluated 98 consecutive patients of ET and 78 patients of PDwith a detailed questionnaire that includes sex, age of admission, age of onset,duration between the first symptoms and the admission, whether there is aggravatefactor, family history of tremor, affect degree on the daily life, the rate of head tremor,type of the limb tremor and the effect of the alcohol test and medicine. The Chi-squareand t-test were employed for statistical analysis.Results:1. There is no difference in sex among ET and PD groups, P=0.147.2. The admission age of ET(52.22±22.53 years old) is lower than the PD's(59.36±17.04 years old), P＜0.05.3. The onset age of ET (43.08±18.18 years old) is earlier than PD's (54.31±16.99years old),P＜0.001. Most of ET are in the period of onset age that occupy 20～39and 50～59 years old (61.22%), showing there is double-hump in the onset age ofET.4. From the first symptoms to admission, ET is 14.04±11.39 years, PD is 4.33±3.02 years, obvious difference between 2 groups, P＜0.001.5. 97.96% of the ET and 94.87% of the PD patients have the special aggravatefactors, there is no difference between 2 groups.6. The positive family history of ET (48.98%) is obvious higher than that of PD(17.95%), P=0.000. 7. 84 of 98 ET patients complained the limb tremor affected the daily life, 62patients were affected slightly accompanying 73.81%, 79.49% of PD were heavilyaffected, there is obvious difference, P=0.000.8. 38.78% of ET patients have head tremor, but 2.56% of PD patients have headtremor, there is obvious difference, P=0.000.9. There is different type of limb tremor, with obvious difference, P=0.000. Posturetremor is appearing in ET, and rest tremor in PD.10. 64 of ET have the alcohol test, and 58 patients (90.63%) were reported to decreasetremor. 78 of ET were effective with the treatment of arotinolol.Conclusion:There are many differences between ET and PD, supporting they are twodifferent diseases. Objective:Studying the differentiating effects of motor evoked potential (MEP) and corticalsilent period (CSP) between Parkinson's disease (PD) and essential tremor (ET),supporting the evidence that differentiate these two kinds of diseases early.Methods:47 essential tremor patients, 43 Parkinson's disease patients, and 30 controlswere included in this study. Measure the motor evoked potential including relaxedmotor threshold (RMT), amplitude of MEP, cortical latency (CL), central motorconductive time (CMCT), cortical silent period (CSP) as the guide of motor corticalexcitement. The one-way ANOVA and t-test were employed for statistical analysis.Results:1. There is no difference in RMT, MEP amplitude, CL, CMCT and CSP between thetwo side of the control groups.2. There is no difference in RMT, MEP amplitude, CL, CMCT and CSP between thetwo side of the ET groups.3. In PD groups, RMT is obviously lower, MEP amplitude is obviously higher andCL, CMCT and CSP is obviously shorter in contralateral side compared to theipsilateral of the more serious symptoms.4. In ipsilateral side, RMT is obviously lower, CMCT is obviously shorter in PDcompared to the ET and controls, there is no difference in MEP amplitude and CL.There is no difference in ET and controls.5. In contralateral side, RMT is obviously lower, MEP amplitude is obviously higherand CL, CMCT and CSP is obviously shorter in PD compared to the ET and controls. There is no difference in ET and controls.Conclusion:There are differences in the motor evoked potential and CSP between ET and PD.It can used as a way to differentiate these two diseases. The motor cortical excitementis higher in PD, but is normal in ET, showing the pathogenesis is different. Objective:Studying the therapeutic effects of low frequency repetitive transcranial magneticstimulation in essential tremor (ET) and Parkinson's disease (PD).Methods:We evaluate 47 ET patients and 43 PD patients with the scale of TRS, UPDRSand Hoehn & Yahr, choose contralateral primary motor cortex (M1) of the moreserious part of the limb as the stimulus target, by applying with 0.5Hz, 90%RMT, 20pulses per sequence, train interal 5 seconds, 60 sequences, total 1200 pulses for 5secutive days. Before and after the rTMS treatment, we evaluated the patients bymotor evoked potential, central silent period (CSP) and evaluated the clinical scale,analysis the correlation between MEP, CSP and the clinical scale.Results:1. After rTMS treatment, ET groups' clinical scale TRS, TRSⅠ, TRSⅡ,TRSⅢarereduced. ET groups' RMT of the contralateral serious limb increased greatly aftertreatment. There is no difference in contralateral MEP amplitude, CL, CMCT,CSP and ipsilateral RMT, MEP amplitude, CL, CMCT, CSP before and aftertreatment.2. After rTMS treatment, PD groups' clinical scale UPDRS, UPDRSⅠ, UPDRSⅡ,UPDRSⅢ, Hoehn & Yahr are reduced. PD groups' contralateral RMT of theserious limb increased greatly, contralateral MEP amplitude is reduced,contralateral CL, CMCT and CSP is prolonged greatly after treatment. There isno difference in ipsilateral RMT, MEP amplitude, CL, CMCT and CSP beforeand after treatment. 3. There is no correlation between contralateral, ipsilateral MEP, CSP of moreserous limb and course of disease, clinical scale in ET and PD.Conclusions:The low frequency rTMS is efficient to relieve the clinical symptoms of ET andPD. rTMS affects the cerebellum-thalamus-cortical loop in ET. rTMS of theprefrontal cortex may induced the release of the endogenous dopamine to increase theintercortical inhibition and increase the blood flood to the focal brain in PD.