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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (6): 1096-1102. doi: 10.19723/j.issn.1671-167X.2019.06.021

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Diagnostic value of tremor analysis in identifying the early Parkinson’s syndrome

Xiao-xuan LIU,Shuo ZHANG,Na LIU,A-ping SUN,Ying-shuang ZHANG,Dong-sheng FAN()   

  1. Department of Neurology, Peking University Third Hospital, Beijing 100191, China
  • Received:2019-01-04 Online:2019-12-18 Published:2019-12-19
  • Contact: Dong-sheng FAN E-mail:dsfan@sina.com.cn
  • Supported by:
    Supported by the Joint Project Fund of Peking University Health Science Center and Ulm University(PKU2017ZC001-2)

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Abstract:

Objective: To investigate the diagnostic value of tremor analysis in early stages of Parkinson’s syndrome, when the clinical symptoms of tremor onset are not unilaterally often able for a definite diagnosis to be made.Methods: We included 70 patients with unilateral tremor, under 45 years old and disease duration within 3 years enrolled in Peking University Third Hospital from January, 2014 to December 2015. We recorded clinical features, unified Parkinson’s disease rating scale (UPDRS)-Ⅲ, non-motor symptom (NMS) scores. Tremor analysis and transcranial sonography were performed for all the patients. Based on the results of tremor analysis, we arbitrarily divided the patients into 3 groups: (1) The patients with classical Parkinson’s syndrome manifestations on one side (25 cases); (2) The patients with classical Parkinson’s syndrome manifestations on both sides (15 cases); (3) The patients with no classical Parkinson’s syndrome manifestations (30 cases). The patients were monitored every 6 months to 3 years, until the final diagnosis was made.Results: There was no significant difference in age, gender distribution, Hamilton depression scale (HAMD) scores and H-Y scores among the three groups (P>0.05). The average UPDRS-Ⅲ motor scores of the three groups were significantly different (P=0.001), with 18.23, 18.79 and 14.67, respectively. The average scores of NMS were significantly different, with 15.81, 17.07 and 9.90, respectively (P<0.001). The positive rates of transcranial sonography (TCS) in the three groups were 48.0%, 60.0% and 26.67%, with no significant difference (P=0.702). After three years of follow-up, 35 patients (50%) met the diagnostic criteria of Parkinson’s disease of International Parkinson and Movement Disorder Society (MDS) in 2015, 19 patients (27.1%) met the criteria of idiopathic tremor, and 7 patients (10%) met the criteria of Parkinson’s plus syndrome. The sensitivity and specificity of tremor analysis for early diagnosis of Parkinson’s disease were 82.8% and 68.6%, respectively. Compared with TCS, the sensitivity and specificity of TCS were 65.7% and 62.9%. There were consistency (Kappa=0.568) and significant difference (P=0.031) between the two methods.Conclusion: Tremor analysis is sensitive and a superior way in identifying early Parkinson’s syndrome patients with tremor dominant manifestation. The combination of non-motor symptoms and transcranial sonography are also needed at diagnosis.

Key words: Parkinson disease, Tremor, Electromyogram

CLC Number: 

  • R742.5

Figure 1

The results of tremor analysis at rest in group 1 (with classical PD manifestations on one side) Acc, accelerometer; R, right. A 55-year-old man presented with unila-teral resting tremor for 9 months. Tremor analysis showed peak frequency was 5 Hz/s, and there was alternating contraction on the left side of electromyogram. Harmonic resonance was also observed."

Figure 2

The results of tremor analysis at rest in group 2 (with classical PD manifestations on both sides) Acc, accelerometer; R, right; L, left. A 60-year-old women presented with resting tremor of her left hand for 2 years. Tremor analysis showed the peak frequency was 5 Hz/s bilaterally, and there was alternating contraction on both sides of electromyogram. Harmonic resonance phenomenon was also observed."

Figure 3

The results of tremor analysis at rest in group 3 (with no classical PD manifestations) Acc, accelerometer; R, right; L, left. A 70-year-old man presented with postual tremor of his left hand for 10 months. There was no clear alternating contraction of electromyogram, some of which showed synchronous contraction, no harmonic resonance phenomenon."

Table 1

Comparison of demographic data"

Items Group 1 (n=25) Group 2 (n=15) Group 3 (n=30) Statistics P
Age of onset/years 61.27±9.85 60.86±9.95 64.63±9.59 F=1.118 0.333
Gender (M/F) 15/10 9/6 13/17 χ2=1.988 0.385
Disease course/months 11.08±4.0 11.93±7.05 17.33±10.05 F=5.189 0.008
UPDRS-Ⅲ 18.23±4.28 18.79±3.77 14.67±3.38 F=8.428 0.001
NMS 15.81±4.05 17.07±8.43 9.9±5.24 F=11.112 <0.001
HAMD 8.85±3.53 9.29±4.25 8.20±4.95 F=0.339 0.714
MMSE 26.58±1.68 26.5±1.70 27.83±1.32 F=5.997 0.004
NMS>2 7 (28.0) 9 (60.0) 6 (20.0) χ2=7.636 0.022
TCS (+) 12 (48.0) 9 (60.0) 8 (26.7) χ2=5.271 0.072
H-Y scale 1.21±0.68 1.07±0.58 0.63±0.52 F=6.955 0.002

Table 2

The results of tremor analysis in different groups"

Items Group 1 (n=25) Group 2 (n=15) Group 3 (n=30) Statistics P
Peak frequency/Hz
At rest
Tremor side 5.38±0.70 5.27±0.78 6.59±1.65 F=4.422 0.040
Non-tremor side 2.89±2.18 4.94±0.70 5.33±2.49 F =6.007 0.001
Posture
Tremor side 6.38±0.71 6.16±1.47 6.87±2.36 F =3.095 0.304
Non-tremor side 4.32±2.14 5.68±2.08 5.07±3.04 F =0.995 0.322
Tremor amplitude/μV
At rest
Tremor side 162.69±172.79 204.01±148.72 133.63±189.42 F =0.555 0.557
Non-tremor side 136.68±90.86 185.62±110.19 138.43±169.47 F =0.413 0.664
Posture
Tremor side 216.2±94.41 300.5±233.76 187.33±131.96 F =0.722 0.400
Non-tremor side 185.4±174 230.95±134.22 201.86±93.19 F =0.361 0.699
Alternative ratio
At rest
Tremor side 18 (72.0) 14 (93.3) 6 (20.0) χ2=29.307 <0.001
Posture
Tremor side 14 (56.0) 8 (53.3) 4 (13.3) χ2=12.776 0.002
Harmonic resonance
At rest
Tremor side 12 (48.0) 9 (60.0) 4 (13.3) χ2=12.042 0.002
Non-tremor side 7 (28.0) 6 (40.0) 2 (6.7) χ2=7.597 0.022
Posture
Tremor side 4 (16.0) 4 (26.7) 8 (26.7) χ2=1.037 0.595
Non-tremor side 2 (8.0) 4 (26.7) 4 (13.3) χ2= 2.707 0.258

Table 3

Comparison of the proportion of patients with PD between two methods after 3 years of follow-up study"

Items Tremor analysis (+) Tremor analysis (-) TCS (+) TCS (-) P
Group 1 (n=25) Group 2 (n=15) Group 3 (n=30)
PD 17 12 6 23 12
Non-PD 8 3 24 13 22 0.031
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