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January 01, 2013; 80 (1) Article

Temporal discrimination in patients with dystonia and tremor and patients with essential tremor

Michele Tinazzi, Alfonso Fasano, Alessandro Di Matteo, Antonella Conte, Francesco Bove, Tommaso Bovi, Alessia Peretti, Giovanni Defazio, Mirta Fiorio, Alfredo Berardelli
First published December 12, 2012, DOI: https://doi.org/10.1212/WNL.0b013e31827b1a54
Michele Tinazzi
From the Department of Neurological, Psychological, Morphological and Motor Sciences (M.T., A.D.M., T.B., A.P., M.F.), University of Verona, Verona; Department of Neurology (A.F., F.B.), Catholic University, Rome; AFaR–Associazione per la Ricerca Biomedica Fatebenefratelli (A.F.), Rome; Neuromed Institute (IRCSS) (A.C., A.B.), Pozzilli (IS); Department of Neurosciences and Sensory Organs (G.D.), School of Motor Sciences, "Aldo Moro" University of Bari, Bari; and Department of Neurology and Psychiatry (A.B.), Sapienza University of Rome, Italy.
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Alfonso Fasano
From the Department of Neurological, Psychological, Morphological and Motor Sciences (M.T., A.D.M., T.B., A.P., M.F.), University of Verona, Verona; Department of Neurology (A.F., F.B.), Catholic University, Rome; AFaR–Associazione per la Ricerca Biomedica Fatebenefratelli (A.F.), Rome; Neuromed Institute (IRCSS) (A.C., A.B.), Pozzilli (IS); Department of Neurosciences and Sensory Organs (G.D.), School of Motor Sciences, "Aldo Moro" University of Bari, Bari; and Department of Neurology and Psychiatry (A.B.), Sapienza University of Rome, Italy.
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Alessandro Di Matteo
From the Department of Neurological, Psychological, Morphological and Motor Sciences (M.T., A.D.M., T.B., A.P., M.F.), University of Verona, Verona; Department of Neurology (A.F., F.B.), Catholic University, Rome; AFaR–Associazione per la Ricerca Biomedica Fatebenefratelli (A.F.), Rome; Neuromed Institute (IRCSS) (A.C., A.B.), Pozzilli (IS); Department of Neurosciences and Sensory Organs (G.D.), School of Motor Sciences, "Aldo Moro" University of Bari, Bari; and Department of Neurology and Psychiatry (A.B.), Sapienza University of Rome, Italy.
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Antonella Conte
From the Department of Neurological, Psychological, Morphological and Motor Sciences (M.T., A.D.M., T.B., A.P., M.F.), University of Verona, Verona; Department of Neurology (A.F., F.B.), Catholic University, Rome; AFaR–Associazione per la Ricerca Biomedica Fatebenefratelli (A.F.), Rome; Neuromed Institute (IRCSS) (A.C., A.B.), Pozzilli (IS); Department of Neurosciences and Sensory Organs (G.D.), School of Motor Sciences, "Aldo Moro" University of Bari, Bari; and Department of Neurology and Psychiatry (A.B.), Sapienza University of Rome, Italy.
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Francesco Bove
From the Department of Neurological, Psychological, Morphological and Motor Sciences (M.T., A.D.M., T.B., A.P., M.F.), University of Verona, Verona; Department of Neurology (A.F., F.B.), Catholic University, Rome; AFaR–Associazione per la Ricerca Biomedica Fatebenefratelli (A.F.), Rome; Neuromed Institute (IRCSS) (A.C., A.B.), Pozzilli (IS); Department of Neurosciences and Sensory Organs (G.D.), School of Motor Sciences, "Aldo Moro" University of Bari, Bari; and Department of Neurology and Psychiatry (A.B.), Sapienza University of Rome, Italy.
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Tommaso Bovi
From the Department of Neurological, Psychological, Morphological and Motor Sciences (M.T., A.D.M., T.B., A.P., M.F.), University of Verona, Verona; Department of Neurology (A.F., F.B.), Catholic University, Rome; AFaR–Associazione per la Ricerca Biomedica Fatebenefratelli (A.F.), Rome; Neuromed Institute (IRCSS) (A.C., A.B.), Pozzilli (IS); Department of Neurosciences and Sensory Organs (G.D.), School of Motor Sciences, "Aldo Moro" University of Bari, Bari; and Department of Neurology and Psychiatry (A.B.), Sapienza University of Rome, Italy.
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Alessia Peretti
From the Department of Neurological, Psychological, Morphological and Motor Sciences (M.T., A.D.M., T.B., A.P., M.F.), University of Verona, Verona; Department of Neurology (A.F., F.B.), Catholic University, Rome; AFaR–Associazione per la Ricerca Biomedica Fatebenefratelli (A.F.), Rome; Neuromed Institute (IRCSS) (A.C., A.B.), Pozzilli (IS); Department of Neurosciences and Sensory Organs (G.D.), School of Motor Sciences, "Aldo Moro" University of Bari, Bari; and Department of Neurology and Psychiatry (A.B.), Sapienza University of Rome, Italy.
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Giovanni Defazio
From the Department of Neurological, Psychological, Morphological and Motor Sciences (M.T., A.D.M., T.B., A.P., M.F.), University of Verona, Verona; Department of Neurology (A.F., F.B.), Catholic University, Rome; AFaR–Associazione per la Ricerca Biomedica Fatebenefratelli (A.F.), Rome; Neuromed Institute (IRCSS) (A.C., A.B.), Pozzilli (IS); Department of Neurosciences and Sensory Organs (G.D.), School of Motor Sciences, "Aldo Moro" University of Bari, Bari; and Department of Neurology and Psychiatry (A.B.), Sapienza University of Rome, Italy.
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Mirta Fiorio
From the Department of Neurological, Psychological, Morphological and Motor Sciences (M.T., A.D.M., T.B., A.P., M.F.), University of Verona, Verona; Department of Neurology (A.F., F.B.), Catholic University, Rome; AFaR–Associazione per la Ricerca Biomedica Fatebenefratelli (A.F.), Rome; Neuromed Institute (IRCSS) (A.C., A.B.), Pozzilli (IS); Department of Neurosciences and Sensory Organs (G.D.), School of Motor Sciences, "Aldo Moro" University of Bari, Bari; and Department of Neurology and Psychiatry (A.B.), Sapienza University of Rome, Italy.
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Alfredo Berardelli
From the Department of Neurological, Psychological, Morphological and Motor Sciences (M.T., A.D.M., T.B., A.P., M.F.), University of Verona, Verona; Department of Neurology (A.F., F.B.), Catholic University, Rome; AFaR–Associazione per la Ricerca Biomedica Fatebenefratelli (A.F.), Rome; Neuromed Institute (IRCSS) (A.C., A.B.), Pozzilli (IS); Department of Neurosciences and Sensory Organs (G.D.), School of Motor Sciences, "Aldo Moro" University of Bari, Bari; and Department of Neurology and Psychiatry (A.B.), Sapienza University of Rome, Italy.
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Citation
Temporal discrimination in patients with dystonia and tremor and patients with essential tremor
Michele Tinazzi, Alfonso Fasano, Alessandro Di Matteo, Antonella Conte, Francesco Bove, Tommaso Bovi, Alessia Peretti, Giovanni Defazio, Mirta Fiorio, Alfredo Berardelli
Neurology Jan 2013, 80 (1) 76-84; DOI: 10.1212/WNL.0b013e31827b1a54

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ABSTRACT

Objective: To investigate whether psychophysical techniques assessing temporal discrimination could help in differentiating patients who have tremor associated with dystonia or essential tremor.

Methods: We tested somatosensory temporal discrimination thresholds (TDT) and temporal discrimination movement thresholds (TDMT) in 39 patients who had tremor associated with dystonia or essential tremor presenting with upper-limb tremor of comparable severity and compared their findings with those from a group of 25 sex- and age-matched healthy control subjects.

Results: TDT was higher in patients who had tremor associated with dystonia than in those with essential tremor and healthy controls (110.6 ± 31.3 vs 63.1 ± 15.2 vs 62.4 ± 9.2; p < 0.001). Conversely, TDMT was higher in patients with essential tremor than in those with tremor associated with dystonia and healthy controls (113.7 ± 14.7 vs 103.4 ± 11.3 vs 100.4 ± 4.2; p < 0.001). Combining the 2 tests in a pattern for essential tremor (abnormal TDMT/normal TDT) and tremor associated with dystonia (normal TDMT/abnormal TDT) yielded a positive predictive value (PPV) of 86.7% and a negative predictive value (NPV) of 70.8% for diagnosing essential tremor and a PPV of 100.0% and NPV of 74.1% for diagnosing tremor associated with dystonia.

Conclusions: TDT and TDMT testing should prove a useful tool for differentiating tremor associated with dystonia and essential tremor. Our findings imply that the pathophysiologic mechanisms underlying tremor associated with dystonia differ from those for essential tremor.

Glossary

123I-FP-CIT SPECT=
123I-labeled N-(3-fluoropropyl)-2β-carbomethoxy-3β-(4-iodophenyl)nortropane SPECT;
ANOVA=
analysis of variance;
CI=
confidence interval;
cTBS=
continuous theta-burst stimulation;
ET=
essential tremor;
FCR=
flexor carpi radialis;
FDI=
first dorsal interosseous;
HC=
healthy control;
ISI=
interstimulus interval;
NPV=
negative predictive value;
PPV=
positive predictive value;
TAD=
tremor associated with dystonia;
TDMT=
temporal discrimination movement threshold;
TDT=
temporal discrimination threshold;
TRS=
Tremor Rating Scale

Footnotes

  • ↵* These authors contributed equally to this work.

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received May 1, 2012.
  • Accepted August 13, 2012.
  • © 2012 American Academy of Neurology
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