title: Facial tremors in patients with and without parkinsonism.
abstract: Facial (lip and jaw) tremors can be an early sign of Parkinson's disease (PD), essential tremor and other parkinsonisms. Its response to acute dopaminergic therapy and further predictive clinical diagnosis has not been previously addressed. The aim of this study was to evaluate facial tremors response to acute dopaminergic therapy and further predictive value for clinical diagnosis. A retrospective review of medical records from patients with recent onset of facial tremor, with or without parkinsonism, submitted to acute levodopa challenge for clinical prediction of sustained long-term dopaminergic response was conducted. Twenty-eight out of 559 patients (5 %) had facial tremors, which responded to levodopa in 46 % of patients. Facial tremors response to acute levodopa challenge showed 92 % sensitivity and 93 % specificity to predict a final PD diagnosis. In PD patients, facial tremor magnitude of response to levodopa was not different from that of hand rest tremor (p = 0.8). Facial tremors, although infrequent, can be an early sign of PD. Positive response to acute levodopa challenge predicts long-term PD diagnosis.
authors.affiliation: Movement Disorders Section, Neuroscience Department, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, 1428, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Malco
authors.initials: M
authors.lastname: Rossi
authors.affiliation: Movement Disorders Section, Neuroscience Department, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, 1428, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Miguel
authors.initials: M
authors.lastname: Wilken
authors.affiliation: Movement Disorders Section, Neuroscience Department, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, 1428, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Pierre
authors.initials: P
authors.lastname: Morisset
authors.affiliation: Movement Disorders Section, Neuroscience Department, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, 1428, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Sofia
authors.initials: S
authors.lastname: Fariña
authors.affiliation: Movement Disorders Section, Neuroscience Department, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, 1428, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cerquetti
authors.affiliation: Movement Disorders Section, Neuroscience Department, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, 1428, Ciudad Autónoma de Buenos Aires, Argentina. mmerello@fleni.org.ar.|Argentine National Scientific and Technological Research Council (CONICET), Buenos Aires, Argentina. mmerello@fleni.org.ar.
authors.forename: Marcelo
authors.identifier: http://orcid.org/0000-0003-3383-8566
authors.initials: M
authors.lastname: Merello
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015259:Dopamine Agents / Q000627:therapeutic use; D005145:Face / Q000473:pathology*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D020734:Parkinsonian Disorders / Q000150:complications* / Q000188:drug therapy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014202:Tremor / Q000150:complications* / Q000188:drug therapy
chemical_list: D015259:Dopamine Agents; D007980:Levodopa
keywords: Chin; Facial; Jaw; Levodopa; Parkinson’s disease; Tremor