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We read with interest the recent article by Josephs et al.1 Like the experience at the Mayo Clinic, we have encountered patients with tremor-dominant Parkinson disease (PD), presenting with unilateral tremor, who have long and benign courses. Many of these patients have had minimal levodopa responsiveness except for modest improvement in segmental hypokinesia and perhaps tone. Several of these patients disabled by their tremor have now undergone subthalamic deep brain stimulation with near abolition of their tremor. We too believe that patients with tremor-dominant PD have long been ignored in the literature, often intermixed with those having rigid/akinetic disease in large series.
The question remains whether we are seeing a separate disease process, or just a variant of idiopathic PD. In general, tremor onset and tremor dominance in idiopathic PD confers benignity, while the absence of tremor often predicts a more rapidly progressive and debilitating disease.2 - 3 We consider tremor-dominant PD to be one end of a spectrum and use a formula for designating tremor-dominant, akinetic/rigid, and mixed subtypes.4 Almost all tremor-dominant PD patients have enough segmental or generalized hypokinesia, rigidity, and dopamine responsiveness to satisfy the CAPIT criteria for IPD.5
Correspondence: Dr Van Horn, UT Move, Department of Neurology, UTHSC-Houston Medical School, 6431 Fannin #7.044, Houston, TX 77030.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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The Rational Clinical Examination Make the Diagnosis: Parkinsonism
The Rational Clinical Examination Original Article: Does This Patient Have Parkinson Disease?
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