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Neurophysiological investigations in patients with primary writing tremor

Authors

  • Nicola Modugno MD, PhD,

    1. Dipartimento di Scienze Neurologiche, Universitá di Roma La Sapienza, Roma, and Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
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  • Yusaku Nakamura MD,

    1. Dipartimento di Scienze Neurologiche, Universitá di Roma La Sapienza, Roma, and Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
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  • Sven Bestmann MD,

    1. Sobell Department of Neurophysiology. The Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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  • Antonio Curra MD, PhD,

    1. Dipartimento di Scienze Neurologiche, Universitá di Roma La Sapienza, Roma, and Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
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  • Alfredo Berardelli MD,

    Corresponding author
    1. Dipartimento di Scienze Neurologiche, Universitá di Roma La Sapienza, Roma, and Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
    • Dipartimento di Scienze Neurologiche, Universitá di Roma La Sapienza, Viale dell'Universitá 30, Rome, 00185 Italy
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  • John Rothwell PhD

    1. Sobell Department of Neurophysiology. The Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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Abstract

The pathophysiology of primary writing tremor (PWT) is still unknown: it has been classified as a focal form of essential tremor and as a tremulous form of writer's cramp. We studied cortical and spinal excitability in patients with PWT and compared the results with published data of patients with essential tremor, and writer's cramp. We used electrical stimulation of median and radial nerve to study reciprocal inhibition of forearm antagonist muscles and paired transcranial magnetic stimulation at short and long interstimulus intervals (ISIs) to assess intracortical excitability. Both studies were conducted on patients with PWT and on control subjects. The early (presynaptic) and late (disynaptic) phases of reciprocal inhibition were normal as was intracortical excitability at short and long ISIs. Our study suggests that the pathophysiology of PWT is different from that of writer's cramp and partially also from that of essential tremor. © 2002 Movement Disorder Society

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