Peripherally Induced Tremor And Parkinsonism

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There are several disorders that have been reported to result from trauma to the peripheral nervous system. These include tremor, dystonia, segmental myoclonus, hemifacial spasm, and in some cases parkinsonism. Among 146 patients with peripherally induced movement disorders, 28 had tremor with or without parkinsonism (81). Eleven patients had tremor-dominant parkinsonism. Clinical features included rest and action tremor, and bradykinesia and rigidity in those with parkinsonism. Onset of movement disorder was temporally related to the injury, and was within 2-5 months after injury. Injuries varied from whiplash to sprain, dental procedure, fracture, overuse, or surgery. Patients had the injury in various areas including arm, neck, lumbar region, and teeth. A majority of patients had injuries in the arms. The condition seemed to spread to the other parts of the body beyond the initial site of injury, and it is unclear if any of them may have had predisposition to parkinsonism, and the trauma in some way has led to the earlier onset of parkinsonism (81). F-Dopa PET scans showed a reduction in F-Dopa uptake suggesting that some patients with peripherally induced parkinsonism may be predisposed to develop the disorder because of a subclinical dopaminergic degeneration.

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