n Future Planning
5. EMG Study：
Electromyogram has been a specific tool to evaluate the nature of ET. We wish to put the SPECT image findings in comparison with the EMG data, for the unresolving problems of ET.
6. Medication：
SPECT scan may be a well tool to investigate the mechanisms of drugs that could alleviate the intensity of tremor. It could afford the objective images and data for the effective
medications.
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Appendix A Table 1
Table 1. Circumstances that activate various types of tremor Circumstance Tremor type
Resting Parkinsonian
Rubral*
Table 2 Differential Diagnosis of Tremor
1. Neurological diseases
Cerebellar tremor
Dystonia and dystonic tremors Enhanced physiologic tremor Isolated chin tremor
Isolated voice tremor Orthostatic tremor Palatal tremor Rubral tremor
Writer's tremor and other task-specific tremors
Pallidonigral degeneration Multiple system atrophy (MSA) Olivopontocerebellar atrophy (OPCA) Striatonigral degeneration
Progressive pallidal atrophy Huntington’s disease (HD) Benign hereditary chorea Fahr’s disease
Paroxysmal dystonic choreoathetosis (PDC) Ataxia-telangiectasia (AT)
Familial intention tremor and lipofuscinosis
Ramsay-Hunt syndrome (progressive myoclonic ataxia) Dystonia musculorum deformans
DOPA-responsive dystonia
Cervical dystonia (spasmodic torticollis) Meige syndrome
Task-specific tremors (writer’s or voice tremor) Space-occupying lesions of the brain
Peripheral neuropathies (e.g., Charcot-Marie-Tooth, Guillain-Barré, etc.)
2. Drug-induced tremors
Antidepressants, especially tricyclics Beta-agonists Withdrawal of drugs
3. Metabolic
B-12 deficiency Hyperthyroidism Hyperparathyroidism Hypocalcemia
Hyponatremia Kidney disease Liver disease
4. Toxic
Alcohol Arsenic Caffeine DDT Lead Nicotine Toluene
Withdrawal of alcohol, cocaine
5. Psychogenic tremor
Table 3 Drugs that may induce tremor.
Table 4 Classic distinguishing festures of PD and ET.
Table 5 Guidelines for identifying essential tremor
Table 5: Guidelines for identifying essential tremor
Core criteria
4. Bilateral action tremor of the hands and forearms (but not rest tremor)
5. Absence of other neurologic signs, except for cogwheel phenomenon (palpable tremor during manipulation of the patient's limbs) 6. May have isolated head tremor with no
abnormal posture
Secondary criteria
5. Long duration ( 3 years) 6. Family history
7. Beneficial response to ethanol
Table 6 . Tremor Scale
Score Symptom
0 Absent (no tremor or writing impairment
1
Slight and infrequently present (mild tramor, writing and drawing of spiral is minimally impaired)
2
Moderate; bothersome to most patients (writing and drawing of spiral moderately impaired)
3 Severe tremor(writing and drawing severely impaired)
4 Marked tremor (interferes with most activities)
Table 7
Table 8 Basic Data of 25 Patients
Table 9 CBF of ROIs
Table 10 CBF -Thalamus and Lesion side
Table 11 Basal ganglia CBF and lesion side
Exact Sig. [2*(1-tailed Sig.)] 0.1483 0.8180 R: right; L: left; BG: basal ganglia; OC: occipital;
Table 12 Cerebellum CBF and lesion side
R(Cm/OC) L(Cm/OC)
Mann-Whitney U 49 33
Wilcoxon W 64 243
Z -0.0679 -1.1549
p 0.9458 0.2481
Exact Sig. [2*(1-tailed Sig.)] 0.9738 0.2718 R: right; L: left; OC: occipital; Cm: cerebellum
Table 13 Tremor score and CBF (Th)
R(Th/OC) L(Th/OC) TREM SCORE
R(Th/OC) Correlation Coefficient 1.0000 0.1008 -0.0119
p . 0.6317 0.9550
N 25 25 25
L(Th/OC) Correlation Coefficient 0.1008 1.0000 -0.0357
p 0.6317 . 0.8656
N 25 25 25
TREM SCORE Correlation Coefficient -0.0119 -0.0357 1.0000
p 0.9550 0.8656 .
Exact Sig. [2*(1-tailed Sig.)] 0.3333 0.4004 R: right; L: left; OC: occipital; Th: thalamus;
Table 15 Patient’s age and CBF
Coefficient 1.0000 0.1008 -0.1513
p . 0.6317 0.4703
N 25 25 25
L(Th/OC) Correlation Coefficient 0.1008 1.0000 0.3500
p 0.6317 . 0.0864
N 25 25 25
年齡 Correlation Coefficient -0.1513 0.3500 1.0000
p 0.4703 0.0864 .
N 25 25 25
R: right; L: left; OC: occipital; Th: thalamus;
Table 16 發病時間 and CBF
發病時間 R(Th/OC) L(Th/OC)
發病時間
Correlation
Coefficient 1.0000 0.0163 0.2002
p . 0.9382 0.3372
N 25 25 25
R(Th/OC) Correlation Coefficient 0.0163 1.0000 0.1008
p 0.9382 . 0.6317
N 25 25 25
L(Th/OC) Correlation Coefficient 0.2002 0.1008 1.0000
p 0.3372 0.6317 .
N 25 25 25
R: right; L: left; OC: occipital; Th: thalamus;
Appendix B Figure 1
The prevalence of ET increasing with age.
Figure 2
Hand-writing of essential tremor patients.
Figure 3
Figure 4
Figure 5
Figure 6