Tremor

We report a cohort of 21 patients (12 females and nine males), with a mean age of 42.4 years, who developed tremor after receiving fluoxetine at a mean dose of 25.7 mg per day. The mean latency period for tremor appearance was 54.3 days. Severity was found to be mild. In all patients, tremor was postural, with P<0.0005, compared to patients with rest tremor and P<0.05 compared to action/intention-tremor patients. The frequency range was 6–12 Hz/s. After fluoxetine was discontinued, tremor disappeared in 10 patients after a mean latency period of 35.5 days. In the remaining 11 patients, tremor persisted up to the end of the observation period (a mean of 449 days). We believe that this tremor phenomenon is due to the involvement of the red nucleus and the inferior olivary nucleus through their projections to the thalamus and the spinal cord.

Peripheral pain and ataxic tremor can appear suddenly following thalamic stroke and can significantly alter a patient&#39;s psychological, social, and physical functioning. The present paper reports the case of a 70-year-old Caucasian female who sustained an acute left posterior cerebral artery infarction involving the thalamus and left mesiotemporal regions. She subsequently developed Central Poststroke Pain and ataxic movement of her right arm and hand in addition to a significant right-side claudication. She was treated over 16 weeks (6 weeks of EMG biofeedback and 10 weeks of psychotherapy) with a combination of EMG biofeedback, progressive muscle relaxation, behavioral pain coping skills training, Forced Use Therapy, and Cognitive Behavioral Therapy 7 years after her initial cerebral accident. The case demonstrates the utility of biofeedback when combined as part of a comprehensive treatment program to address the multiple complications associated with thalamic stroke.

The involuntary, rhythmic movements of the soft palate is called “Palatal Tremor (Myoclonus)”. The disease could be studied in two subgroups according to its etiology: Essential and secondary. These two subgroups could be differentiated by their clinical features and also a lesion in Guillain-Mollaret region is expected in secondary type. A “clic” noise is heard by the patient in essential type; whereas in secondary type, instead of a “clic” noise, nystagmus, dysarthria and ataxia accompanying to palatal tremor could be detected with physical examination. The diagnosis can easily be made with a good anamnesis and careful inspection, but clinicians order repetitive scanings and wrong treatments are given to the patients. The case presented in this paper is an example to
this situation. We would like to emphasize the importance of anamnesis and examination and also we would like to underline that rare diseases are still being misdiagnosed.