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Prominent Bilateral Hand Tremor in Hashimoto's Encephalopathy: A Video Demonstration.

ABSTRACT: Hashimoto's encephalopathy often presents with neuropsychiatric manifestations including seizures and movement disorders.We describe a patient who presented with bilateral hand tremor and mild cognitive defects that fulfilled the criteria for a diagnosis of Hashimoto's encephalopathy. There was a rapid response to glucocorticoid therapy with relapse following treatment withdrawal.Recently published clinical criteria for the diagnosis of Hashimoto's encephalopathy include seizures, myoclonus, hallucinations, or stroke-like episodes but do not include tremor. Our case had mild cognitive dysfunction and a coarse tremor as the predominant clinical features, which probably represent mild disease.

SUBMITTER: Ramcharan K

PROVIDER: S-EPMC5075043 | biostudies-other | 2016

REPOSITORIES: biostudies-other

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Prominent Bilateral Hand Tremor in Hashimoto's Encephalopathy: A Video Demonstration.

Ramcharan Kanterpersad K Hosein Nadeem N Teelucksingh Joel David JD Rampersad Fidel F Teelucksingh Surujpal S

Tremor and other hyperkinetic movements (New York, N.Y.) 20161012

<h4>Background</h4>Hashimoto's encephalopathy often presents with neuropsychiatric manifestations including seizures and movement disorders.<h4>Case report</h4>We describe a patient who presented with bilateral hand tremor and mild cognitive defects that fulfilled the criteria for a diagnosis of Hashimoto's encephalopathy. There was a rapid response to glucocorticoid therapy with relapse following treatment withdrawal.<h4>Discussion</h4>Recently published clinical criteria for the diagnosis of H ...[more]

PMID: 27790384

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Project description:Essential tremor (ET) patients often experience hand tremor that impairs daily activities. Non-invasive electrical stimulation of median and radial nerves in the wrist using a recently developed therapy called transcutaneous afferent patterned stimulation (TAPS) has been shown to provide symptomatic tremor relief in ET patients and improve patients' ability to perform functional tasks, but the duration of tremor reduction is unknown. In this single-arm, open-label study, fifteen ET patients performed four hand tremor-specific tasks (postural hold, spiral drawing, finger-to-nose reach, and pouring) from the Fahn-Tolosa-Marin Clinical Rating Scale (FTM-CRS) prior to, during, and 0, 30, and 60 min following TAPS. At each time point, tremor severity was visually rated according to the FTM-CRS and simultaneously measured by wrist-worn accelerometers. The duration of tremor reduction was assessed using (1) improvement in the mean FTM-CRS score across all four tasks relative to baseline, and (2) reduction in accelerometer-measured tremor power relative to baseline for each task. Patients were labeled as having at least 60 min of therapeutic benefit from TAPS with respect to each specified metric if all three (i.e., 0, 30, and 60 min) post-therapy measurements were better than that metric's baseline value. The mean FTM-CRS scores improved for at least 60 min beyond the end of TAPS for 80% (12 of 15, p = 4.6e-9) of patients. Similarly, for each assessed task, tremor power improved for at least 60 min beyond the end of TAPS for over 70% of patients. The postural hold task had the largest reduction in tremor power (median 5.9-fold peak reduction in tremor power) and had at least 60 min of improvement relative to baseline beyond the end of TAPS therapy for 73% (11 of 15, p = 9.8e-8) of patients. Clinical ratings of tremor severity were correlated to simultaneously recorded accelerometer-measured tremor power (r = 0.33-0.76 across the four tasks), suggesting tremor power is a valid, objective tremor assessment metric that can be used to track tremor symptoms outside the clinic. These results suggest TAPS can provide reductions in upper limb tremor symptoms for at least 1 h post-therapy in some patients, which may improve patients' ability to perform tasks of daily living.

Project description:BackgroundOral Medication administration is one of the paramount nursing procedures, where nurses must pay their utmost commitment. The vital aims are to reduce medication errors and ensure patient safety. The objectives of this study were to evaluate whether the nursing students could learn and retain the basic guidelines for oral medication administration when they are taught using a video-assisted teaching method compared with the lecture-demonstration method and to assess the students' attitudes towards the two types of teaching methods.MethodsThis study was conducted as a quasi-experimental study with a pre and post-test design. Forty-five students in the first year of the bachelor's degree in nursing programme participated. All the participants completed a self- administered questionnaire, including socio demographic data and questions of oral medication administration. Subsequently, participants were randomly assigned to two groups. Oral medication administration procedure was taught using two different teaching methods. Finally, the post-test knowledge scores of both groups were assessed and analysed using the paired-sample t-test.ResultsThe results revealed that there was no significant difference in terms of age, gender and type of residence of students in the two groups. When comparing the pre-test mean score and post-test mean score using paired sample t-test, there was a statistically significant difference in both video demonstration group (t = - 4.533, p < 0.001) and lecture-demonstration group (t = - 4.208, p < 0.001). Almost all the students obtained good knowledge scores regardless of the method used in teaching oral medication administration. However, when comparing post-test scores of both groups using an independent sample t-test, it was identified that there was no significant difference between the two groups. Therefore, it was difficult to identify which method was effective than the other. According to the student feedback obtained at the end of the study, 67% of them preferred to have more video demonstrations in their skills classes.ConclusionThe results of this study suggested that oral medication administration can be effectively taught using lecture-demonstration and video-demonstration teaching methods.

Dataset Information

Prominent Bilateral Hand Tremor in Hashimoto's Encephalopathy: A Video Demonstration.

Publications

Prominent Bilateral Hand Tremor in Hashimoto's Encephalopathy: A Video Demonstration.

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