Dystonia with Tremors: A Clinical Approach

Dystonia commonly accompanies tremors but the prevalence of the association is controversial. Oppenheim had already described that tremors were associated with dystonic symptoms in “Dystonia Musculorum Deformans” in the early 20th century (Oppenheim et al, 1911, as cited in Jedynak et al., 1991). Yanagisawa analyzed idiopathic dystonia with electromyography and found that dystonia was associated with rhythmic activity in all of the patients (Yanagisawa & Goto, 1971). In a genetic and clinical population study on dystonia, 80% of the population had tremors for generalized dystonia (Larsson and Sjogren, 1966). Marsden reported that 14% of patients with generalized nonfamilial idiopathic dystonia presented with tremors (Marsden, 1974). In addition, 68% of patients with cervical dystonia had head tremors (Pal et al., 2000). However, Rondot examined 132 patients with cervical dystonia, which revealed rhythmic activity and upper limb tremors in 40% and 21% of the patients, respectively (Rondot et al., 1981, as cited in Jedynak et al., 1991). In a survey on writer`s cramp, hand tremors were reported in almost half of the subjects (Sheehy, 1982). In addition, Jankovic investigated 350 patients diagnosed with Essential tremor (ET), based on the presence of tremors in the head, hand, or voice in the absence of any other diseases that may cause tremors. Forty-seven percent of these subjects also had dystonia (Lou and Jankovic, 1991). Therefore, the prevalence of dystonia with tremors varies greatly depending on the reports.