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Childhood head tremor
1University of Connecticut Department of Pediatrics, Connecticut Children's Medical Center, Hartford, USA. fdimari@ccmckids.org
Insights
This study followed four children with head tremor, finding it can stem from shuddering spells and family history. Some cases showed mild dystonia, with variable treatment responses and spontaneous remission suggesting a benign course.
Area of Science:
- Pediatric Neurology
- Movement Disorders
Background:
- Head tremor in children is a rare condition.
- Understanding its etiology, clinical presentation, and prognosis is crucial for diagnosis and management.
Observation:
- Four children (3 girls, 1 boy) aged 15 months to 11 years with head tremor were longitudinally studied.
- Onset occurred between 5-10 months, characterized by "yes-yes" or "no-no" movements, sometimes with chin deviation.
- Tremor worsened with upright posture and movement, absent during sleep; no voluntary suppression or sensation reported.
Findings:
- Three children had prior shuddering spells; two developed mild dystonic leg posturing during concentration.
- Neurological exams and investigations (MRI, CT, metabolic screening) were normal.
- Family history of tremor or infantile shuddering was noted in two families.
Implications:
- Head tremor in children may evolve from shuddering spells and be linked to family history and mild dystonia.
- Therapeutic responses to medications (beta-blockers, anticholinergics, etc.) were variable.
- Spontaneous remission observed suggests a generally benign prognosis for this condition.
Abstract:
We report here four children (three girls, one boy) with head tremor followed longitudinally, ages 15 months to 11 years, with follow-up over 1 to 8 years. Each demonstrated onset of head tremor between the ages of 5 and 10 months. In each case head tremor was characterized by a predominant "yes-yes" or "no-no" movement of the head. In two of the children the movement was slightly skewed with chin movement toward the shoulder. Oscillations were at a frequency of about 1 to 2 Hz. They were accentuated when sitting upright without head support, increased at times of movement, and dissipated while lying flat or sleeping. The children were unable to voluntarily suppress the action and did not experience any sensation of movement. Three of the children had shuddering spells prior to onset of head tremor. Two children have developed mild dystonic posturing of the legs when intently concentrating. Their general and neurologic examinations were normal. Normal investigations included brain magnetic resonance imaging and computed tomography, urine amino acids and organic acids screening, serum lactate, erythrocyte sedimentation rate, antinuclear antibodies, and ceruloplasmin and copper levels. A family history of tremor was present in two children, maternal epilepsy in one child, and infantile shuddering occurred in the father of one child. Therapy included trials of selective and nonselective beta-adrenergic blockers, alpha-adrenergic agonists, anticholinergics, anticonvulsants, and amantadine. One child responded well to both timolol and trihexyphenidyl. A second child responded moderately to primidone. Two have not been treated. Two have had head tremor spontaneously remit. We conclude from this small series of children with head tremor that it can evolve from a prior history of shuddering spells, occurs in the context of a positive family history of tremor, and can be accompanied by the development of a mild dystonia. Therapeutic response is variable to multiple agents. Spontaneous remission occurs, suggesting a benign course.