Physiological tremor Enhanced physiological tremor Essential tremor syndrome Dystonic tremor syndrome Parkinsonian tremor Cerebellar tremor Holmes tre

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1 Journal of the K. S. C. N. Vol. 1, No. 2 The Classification and Electrophysiological Evaluation of Tremor Man-Wook Seo, M.D. Department of Neurology, College of Medicine, Chonbuk National University - Abstract - Tremor is an approximately rhythmic, roughly sinusoidal involuntary movement. Despite nearly a century of modern clinical and laboratory investigations, no tremor is understood completely. Human tremors derive from different etiologies and thus, not suprisingly, the physiologies are diverse. Tremors may derive from mechanical oscillations, mechanical reflex oscillations, normal central oscillators, and pathologic central oscillators. However the definitive identification of oscillators for any tremor have not yet been established. Measuring tremor clinically is difficult because tremors behave in different and often complex ways. There are several different techniques for measuring tremor. One of most popular and sensitive methods use accelerometries. An excellent method consists of accelerometry and EMG combined with spectral analysis and weighting of the body part, which allows separation of tremors coming from mechanical reflex and central oscillators. Now times, increased power and speed of microprocessors enable clinical laboratories to quantify tremor and other aspects of motor disability with accuracy and precision not possible a decade ago. Key Words : Tremor, Pathophysiologic mechanisms, Electrophysiological tests 270 Journal of the K. S. C. N. 1999

2 Physiological tremor Enhanced physiological tremor Essential tremor syndrome Dystonic tremor syndrome Parkinsonian tremor Cerebellar tremor Holmes tremor Palatal tremor Neuropathic tremor Drug-induced and toxic tremor Psychogenic tremor Others 271

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4 Mechanical systems Graphic digitizing tablets Electromyography Long term EMG Fourier analysis of tremor Advanced methods of time series analysis Three-dimensional analysis of tremor curves Reflex testing Activation patterns of ballistic movements Single motor unit recording Median nerve SEPs, jerk-locked averaging and EEGs Magnetoencephalography Others 273

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14 11. Deuschl G, Bain P, Brin M, Ad Hoc Scientific committee. 17. Fahn S, Tolosa E, Marin C. Clinical rating scale for tremor. In disorders. Baltimore, MD: Williams & Wilkins, 1993: Bain PG Clinical measurement of tremor. Mov Disord 1998; 13(S3): Pullman SL. Spiral analysis: A new technique for measuring 10. Sabra AF, Hallett M, Action tremor with alternating activity in antagonist muscles. Neurology 1984;34: tural wrist tremors by magnetic stimulation of the motor cor- tex in patients with Parkinson s disease or essential tremor and in normal subjects mimicking tremor. Ann Neurol 1993 ; 33: Spieker S, Boose A, Breit s et al. Long-term measurement of tremor. Mov disord 1998;13(S3): New York, NY: Marcel Dekker, 1995; Consensus statement of the movement disorder society on tremor. Mov Disord 1998;13(S3): ;15(S): Elble RJ, Koller WC. Tremor. Baltimore, MD: Johns Hopkins, Rothwell JC. Physiology and anatomy of possible oscillators in the central nervous system. Mov Disord 1998;13(S3): Zimmermann R, Deuschl G, Hornig A, et al. Tremors in Parkinson s disease: symptom analysis and rating. Clin Neuropharmacol 1994;56: Bain PG, Findley LJ, Atchinson P, et al. Assessing tremor severity. J Neurol Neurosurg Psychiatry 1993;56: Jankovic J, Tolosa E, eds. Parkinson s disease and movement tremor with a digitizing tablet. Mov Disord ; 1 3 ( S 3 ) : Britton TC, Thompson PD, Day BL, et al. Modulation of pos- 13. Buckwell D, Gresty MA. Analysis of tremor waveforms. In: Finddley LJ, Koller WC, eds. Handbook of Tremor Disorders. 14. Gantert C, Honerkamp J, Timmer J, Analyzing the dynamics of hand tremor time series. Biol Cybern 1992;66: Jankovic J, Frost JJ. Quantitative assessment of parkinsonian and essential tremor: clinical application of triaxial accelerometry. Neurology 1981;31: Chen R, Ashby P, Lang AE. Stimulus-sensitive myoclonus in akinetic-rigid syndromes. Brain 1992;115: Deuschl G, Lucking CH. Physiology and clinical applications of hand muscle reflexes. EEG Clin Neurophysiol 1990 ; 41 S : , ;18:

15 19. Britton TC, Thompson PD, Day BL, et al. Rapid wrist movements in patients with essential tremor. The critical role of the second agonist burst. Brain 1994;117: Volkmann J, Joliot M, Mogilner A, et al. Central motor loop oscillations in parkinsonian resting tremor revealed by magnetoencephalography. Neurology 1996;46: Volkmann J. Oscillations of the human sensorimotor system as revealed by magnetoencephalography. Mov Disord ; 13(S3): Staude G, Wolf W, Ott M, et al. Tremor as a factor in prolonged reaction times of parkinsonian patients. Mov Disord 1995;10: Spaulding SJ, Hayes KC, Harburn KL. Periodicity in the Hoffmann reflex recovery curve. Exp Neurol 1987;98: McManis PG and Sharabrough FW. Orthostatic tremor: clini cal and electrophysiologic characteristics. Muscle Nerve 1993; 1998;16: Mercuri B, Berardelli A, Modugno N, et al. Reciprocal inhibition in forearm muscles in patients with essential tremor. Muscle Nerve 1998;21: Romeo S, Berardelli A, Pedace F, et al. Cortical excitability in patients with essential tremor. Muscle Nerve ; 2 1 : Koster B, Lauk M, Timmer J, et al. Central mechanisms in human enhanced physiological tremor. Neurosci Lett ; 241: Halliday AM, Redfearn JWT. An analysis of the frequencies of finger tremor in healthy subjects. J Physiol ; : Elble RJ, Randall JE. Motor-unit activity responsible for 8- to 12-Hz component of human physiological finger tremor. J Neurophysiol 1976;39: Ahrens RC. Skeletal muscle tremor and the influence of adrenergic drugs. J Asthma 1990;27: Sanes JN, Absence of enhanced physiological tremor in patients without muscle or cutaneous afferents. J Neurol Neurosurg Psychiatry 1985;48: Marshall J. Observations on essential tremor. J Neurol Neurosurg Psychiatry 1962;25: Elble RJ. Physiologic and essential tremor. N e u r o l o g y ; 36: Hallett M. Overview of human tremor physiology. M o v Disord 1998;13(S3): Boose A, Spieker S, Jentgens C, Dichgans J. Wrist tremor: investigation of agonist-antagonist interaction by means of long-term EMG recording and cross-spectral analysis. Electroencephalogr Clin Neurophysiol 1996;101: Elble RJ, Higgins C, Hughes L. Essential tremor entrains rapid voluntary movements. Exp Neurol 1994;126: Shahani BT. Tremor associated with peripheral neuropathy. In: Findley LJ, Capildeo R, eds. Movement disorders: tremor. London, Macmillan, 1984; Deuschl G, Lucking CH, Quintern J. Orthostatic tremor: clinical signs, pathophysiology and therapy, Z EEg-EMG ; 18: Rothwell JC, Taub MM, Marsden CD. Primary writing tremor. J Neurol Neurosurg Psychiatry 1979;42: Bain PG, findley LJ, Britton TC, et al. Primary writing tremor. Brain 1995;118: Heilman KM Orthostatic tremor. Arch Neurol ; 4 1 : Papa SM and Gershanik OS. Orthostatic tremor: an essential variant? Mov Disord 1988;3: FitzGerald PM and Jankovic J. Orthostatic tremor: an association with essential tremor. Mov Disord 1991;6: Thompson PD, Rothwell JC, Day BL, et al. The physiology of orthostatic tremor. Arch Neurol 1986;43: Britton TC, Thompson PD, Kamp w, et al. Primary orthostatic tremor: further observations in six cases. J Neurol 1992;239: : Sander Hw, Masdeu JC, Tavoulareas G, et al. Orthostatic tremor: an electrophysiological analysis. Mov Disord 1998;13: Uncini A, Onofri M, Basciani M. Orthostatic tremor; Report of two cases and an electrophysiological study. Acta Neurol Scan. 1989;79: Boroojerdi B, Ferbert A, Foltys H, et al. Evidence for a nonorthostatic origin of orthostatic tremor. J Neurol Neurosurg Psychiatry 1999;66: Brooks VB. The neural basis of motor control. Oxford University Press, New York. 51. Jedinak CP, Bonnet AM, Agid Y. Tremor and idiopathic dystonia. Mov Disord 1991;6: Deuschl G, Heinen G, Kleedorfer B, et al. Clinical and polymyographic investigation of spsmodic torticollis. J Neurol 1992;239: Deuschl G, Heinen F, Guschlbauer B, et al. Hand tremor in patients with spasmodic torticollis. Mov Disord 1997;12: Britton TC, Thompson PD, Day BL, et al. Modulation of postural tremors at the wrist by supramaximal electrical median nerve shocks in essential tremor, Parkinson s disease and normal subjects mimicking tremor. J Neurol Neurosurg Psychiatry ; 5 6 : Pascual-Leone A, Valls-Sole J, Toro C, et al. Resetting of essential tremor and postural tremor in Parkinson s disease with transcranial magnetic stimulation. Muscle Nerve ; 17: Bergman H, Raz AR, Feingold A, Nini A, et al. Physiology of MPTP tremor. Mov Disord 1998;13(S3): Elble RJ. Animal models of action tremor. Mov Disord 1998: 13(S3): Cardoso G, Jankovic J: Peripherally induced tremor and parkisonism. Arch Neurol 1995;52: Ferbert A, Gerwig M. Tremor due to stroke. Mov Disord 1993;8: Toro C, Pascual-Leone A, Deuschl G, et al. Cortical tremor: A common manifestation of cortical myoclonus. N e u r o l o g y 284 Journal of the K. S. C. N. 1999

16 1993;43: Terada K, Ikeda A, Mima T, Kimura M, et al. Familial cortical myoclonic tremor as a unique form of cortical reflex myoclonus. Mov Disord 1997 ; 12 : Takigawa T, Mina T, Saida K, et al. A case of cortical reflex myoclonus manifesting tremor. Rinsho Shinkeigaku 1997 ; 37 : Ikeda A, Kakigi T, Funai N, et al. Cortical tremor: a variant of cortical reflex myoclonus. Neurology 1990;40:

Pharmacotherapeutics Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee Univ

Pharmacotherapeutics Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee Univ Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee University College of Medicine & Hospital E mail : ycell2@yahoo.co.kr Abstract