{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T12:53:46Z","timestamp":1740142426830,"version":"3.37.3"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"10","license":[{"start":{"date-parts":[[2024,10,13]],"date-time":"2024-10-13T00:00:00Z","timestamp":1728777600000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Patients often exhibit very severe or disabling forms of tremor that cannot be clearly characterized.<\/jats:p><jats:p>\n          Objective\u2003To present a series of 37 cases of tremor considered unclassifiable. Patients diagnosed with essential tremor according to criteria of the International Parkinson Disease and Movement Disorder Society (IPDMDS), who had been previously studied, were included as controls. All patients underwent a battery of tests between 2019 and 2022, which enabled us to compare them.<\/jats:p><jats:p>\n          Methods\u2003Relevant demographic and clinical information were collected. The following tools were applied: the Mini-Mental State Examination (MMSE); the Hospital Anxiety and Depression Scale (HADS); the Fahn-Tolosa-Mar\u00edn Tremor Rating Scale (TRS); and the Quality of Life in Essential Tremor (QUEST). A simple brain magnetic resonance imaging (MRI) scan was performed for all patients. The categorical variables were compared using the Chi-squared test and the t-test with Fisher correction if appropriate, and the quantitative variables were compared through the two-tailed Student t-test. Values of p \u2264 0.01 were considered statistically significant.<\/jats:p><jats:p>\n          Results\u2003The cases presented higher scores on the anxiety and depression subscales of the HADS than the controls (p \u2264 0.006 and 0.000 respectively). In all domains of the TRS, the cases scored significantly higher, as well as in the QUEST. History of enolism was higher among the controls, and history of orthostasis and rest tremor was higher among the cases (p \u2264 0.000). Cerebellar atrophy was present in every patient in the case group, and in 24 subjects in the control group. Dystonia was observed in 7 subjects in the case group, and in none of the patients in the control group.<\/jats:p><jats:p>\n          Conclusion\u2003There are patients with unclassifiable and extremely disabling tremors who respond poorly to the pharmacological therapy options.<\/jats:p>","DOI":"10.1055\/s-0044-1790196","type":"journal-article","created":{"date-parts":[[2024,10,13]],"date-time":"2024-10-13T22:31:11Z","timestamp":1728858671000},"page":"1-5","source":"Crossref","is-referenced-by-count":0,"title":["Severe and unclassifiable tremor"],"prefix":"10.1055","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4496-6654","authenticated-orcid":false,"given":"Marcos","family":"Serrano-Due\u00f1as","sequence":"additional","affiliation":[{"name":"Pontificia Universidad Cat\u00f3lica del Ecuador, Facultad de Medicina, Quito, Ecuador."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,10,13]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1002\/mds.27121","article-title":"Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society","volume":"33","author":"K P Bhatia","year":"2018","journal-title":"Mov Disord"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"684835","DOI":"10.3389\/fneur.2021.684835","article-title":"Tremor Syndromes: An Updated Review","volume":"12","author":"A Lenka","year":"2021","journal-title":"Front Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1002\/mds.870131303","article-title":"Consensus statement of the Movement Disorder Society on Tremor","volume":"13","author":"G Deuschl","year":"1998","journal-title":"Mov Disord"},{"issue":"03","key":"ref4","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1007\/s12311-018-0994-6","article-title":"Revisiting the Clinical Phenomenology of \u201cCerebellar Tremor\u201d: Beyond the Intention Tremor","volume":"18","author":"A Lenka","year":"2019","journal-title":"Cerebellum"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"107628","DOI":"10.1016\/j.clineuro.2023.107628","article-title":"Essential tremor and the scales: Quality of life in essential tremor, the Fahn-Tolosa-Marin Tremor Rating Scale; and, the Bain and Findley Clinical Tremor Rating Scale","volume":"226","author":"M Serrano-Due\u00f1as","year":"2023","journal-title":"Clin Neurol Neurosurg"},{"key":"ref6","first-page":"37","volume-title":"Origins of normal and pathological tremor","author":"C D Marsden","year":"1984"},{"issue":"03","key":"ref7","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-mental state\u201d. 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