title: Clinical features and nigrostriatal dysfunction in patients with combined postural and resting tremors.
abstract: BACKGROUND
  The characteristics of clinical features and nigrostriatal dopaminergic dysfunction in patients with combined postural and resting tremors have been less clearly reported.
  
  
  METHODS
  The present study examined 43 patients with a visible persistent bilateral postural tremor and a unilateral/bilateral resting tremor involving the hands and forearms. The patients had experienced tremors for more than 3 years, with no evidence of Parkinson's disease or other parkinsonian disorders. Visual and quantitative analyses of [18F] N-(3-fluoropropyl)-2beta-carbon ethoxy-3beta-(4-iodophenyl) nortropane (FP-CIT) PET in 36 patients were performed. Seventeen age-matched normal controls were also studied.
  
  
  RESULTS
  On visual analysis, 28 patients (78%) showed normal [18F] FP-CIT uptake and eight (22%) showed significantly reduced uptake, suggesting nigrostriatal dopaminergic neuronal degeneration. The reduced [18F] FP-CIT uptake was significantly associated with earlier age-at-onset of tremor and asymmetric presentation of resting tremor. On quantitative analysis, there were statistically significant differences in the [18F] FP-CIT uptake ratio in the posterior putamen between patients with reduced uptake (2.37 ± 1.83) and patients with normal uptake (6.39 ± 1.35) (P < 0.001). However, posterior putamen uptake levels in patients with normal [18F] FP-CIT uptake on visual analysis were similar to those in normal controls (7.22 ± 1.29) (P = 0.291).
  
  
  CONCLUSIONS
  The nigrostriatal dopaminergic dysfunction in patients with combined postural and resting tremors may be associated with earlier age-at-onset of tremor and asymmetric pattern of resting tremor, which might help to correctly diagnose patients with mixed tremors.
authors: Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, South Korea; Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors: Sooyeoun
authors: S
authors: You
authors: Mi-Jung
authors: MJ
authors: Kim
authors: Sung Reul
authors: SR
authors: Kim
authors: Mi Jung
authors: MJ
authors: Kim
authors: Minyoung
authors: M
authors: Oh
authors: Jae Seung
authors: JS
authors: Kim
authors: Sun Ju
authors: SJ
authors: Chung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D014202:Tremor / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D014326:Tropanes
chemical_list: D019275:Radiopharmaceuticals; D014326:Tropanes; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane
keywords: Essential tremor; Parkinson's disease; Postural tremor; Resting tremor; [(18)F] FP-CIT PET