Provocation of Parkinsonian tremor.
Classical Parkinsonian rest tremor typically fluctuates over time and can be provoked by stressful situations. We quantified and compared the influence of different provocation methods on classical rest tremor severity. The effect of counting backwards from 100, tapping of the contralateral foot and a Stroop test on the Unified Parkinson's Disease Rating Scale (UPDRS) III rest tremor scores and the accelerometrically measured tremor amplitudes (total power) were analyzed in 18 patients with Parkinson's disease and a Type I tremor. Each of the three provocation methods increased the UPDRS III rest tremor score by 1-2 and the total power by 1-2 orders of magnitude compared with baseline (P < 0.001). The maximal effect was reached on average after 2-3 minutes of provocation. The effects were not significantly different. Provocations clearly influence the result of clinical rest tremor ratings, with the kind of provocation being of minor importance. We therefore suggest that each assessment of Parkinsonian rest tremor should include a systematic provocation and this should be formally included in future versions of the UPDRS.
Raethjen
Jan
J
Department of Neurology, University of Kiel, Schittenhelmstr. 10, Kiel, Germany.
Austermann
Kristina
K
Department of Neurology, University of Kiel, Schittenhelmstr. 10, Kiel, Germany.
Witt
Karsten
K
Department of Neurology, University of Kiel, Schittenhelmstr. 10, Kiel, Germany.
Zeuner
Kirsten E
KE
Department of Neurology, University of Kiel, Schittenhelmstr. 10, Kiel, Germany.
Papengut
Frank
F
Department of Neurology, University of Kiel, Schittenhelmstr. 10, Kiel, Germany.
Deuschl
Günther
G
Department of Neurology, University of Kiel, Schittenhelmstr. 10, Kiel, Germany.
D000328:Adult; D000368:Aged; D018491:Dopamine Agonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D012720:Severity of Illness Index; D014202:Tremor / Q000175:diagnosis / Q000453:epidemiology*
D018491:Dopamine Agonists; D007980:Levodopa