The Spectrum of Non-Parkinsonian Tremor: A Registry at a Tertiary Care Teaching Institute (original) (raw)
Related papers
Journal of Clinical Neuroscience, 2002
This study statistically evaluated a set of commonly measured tremor parameters to determine their individual and combined ability to discriminate between essential tremor (ET) and Parkinsonian tremor (PT). Accelerometer and surface electromyographic (EMG) records of moderate to severe upper limb tremor in 20 patients with ET and 22 patients with PT were used to quantitatively compare tremor amplitude, frequency and pattern of muscle bursting in two resting and three non resting postures. The group statistics showed significant differences between ET and PT with respect to tremor frequency in all five postures, tremor amplitude at rest and muscle bursting patterns. Discriminant function analysis showed that no single parameter or combination of parameters was able to correctly classify all patients. Frequency was much more discriminating than amplitude or muscle bursting patterns in all limb postures. The best amplitude discrimination was obtained when the hand and forearm were both fully supported. Muscle bursting patterns were poorly discriminating and did not assist in correct classification of single patients. Group statistics confirmed a highly significant biological difference between the two tremor types. Optimal classification of single PT (86% correct) and ET (95% correct) patients was obtained using frequency and two selected amplitude parameters from the resting limb. Limb posture was an important variable in optimising the discriminative ability of tremor studies. The implications for routine tremor studies are summarised. &
Essential tremor: predictors of disease progression in a clinical cohort
Journal of Neurology, Neurosurgery & Psychiatry, 2006
To examine the utility of baseline factors to predict disease progression among a clinical cohort of patients diagnosed with essential tremor. Measures: Tremor Rating Scale (TRS). Methods: A clinical series of 128 consecutive patients diagnosed with essential tremor was included for study. 45 (35%) patients had at least one follow-up exam (mean = 3.6 years). Baseline predictive factors examined included age, age at onset of symptoms, disease duration, sex, handedness, total tremor rating score, asymmetric tremor ratings, location of initial tremor onset, use of drugs for movement disorders, ETOH responsiveness of tremor, association of head or neck tremor, history of depression, familial history of essential tremor, Parkinson's disease, Alzheimer's disease and other movement disorders. Results: On average, the TRS total score increased by ,1 point per year before the first visit to the clinic and by about 2 points per year during the observed study period. The increase of 2 points per year during the observed study period represented an approximate 12% annual change from the mean TRS total score at the first clinic visit. Significant (p,0.05) predictive factors associated with increased tremor severity at the initial clinic visit included older age, longer disease duration, use of movement disorder drugs and the presence of voice tremor (r = 0.24, 0.27, 0.25, 0.19). The major factors associated with an increase in tremor severity from the initial clinic visit to the last follow up included asymmetrical tremor ratings, unilateral initial tremor onset and longer follow-up duration (r = 0.32, 0.31, 0.30). Multivariate regression analysis accounted for about 17-30% of the variance in tremor ratings (p,0.05). Conclusion: Essential tremor is a slow, progressive disease. The rate of disease progression and the factors associated with disease progression may vary throughout the disease course.
Neurology India, 2004
No Indian studies have focused on the clinical aspects of tremor. To study the distribution of various etiological types of tremor disorders at a Movement Disorders clinic of a large, tertiary care hospital in India and to study the clinical characteristics of essential tremor [ET]. Prospective cross-sectional study at a tertiary care specialty clinic. Patients presenting with tremor as the chief complaint, with no features suggestive of parkinsonism, cerebellar disorder or acute central nervous system disorder, were included. Patients were classified into different etiological categories from detailed history. All patients diagnosed as ET, were further interrogated for a detailed family history and examined for characteristics of tremor. These patients were then classified into 'definite', 'probable' and 'possible' ET. One hundred and six patients (mean age 44.4 + 15.1 years) were examined during the study period. ET (59.4%) and dystonic tremor (21.7%) were ...
Non-motor features of essential tremor, Updated review of evolving aspects
Sohag Medical Journal, 2021
Essential tremor (ET) is defined as an action tremor syndrome with a duration of more than three years in both upper limbs with or without tremor in other areas and with no other neurological signs. ET's non-motor characteristics add to the evidence of clinical variability in ET, a disease with a wide range of pathological and etiological characteristics. Problems in frontal-executive function, comparable to Parkinson's disease (PD), were one of the most common patterns of cognitive affection in ET. ET individuals who started tremor after the age of 65 were 64 to 70% more likely than control subjects to develop dementia, but ET cases who started tremor before the age of 65 have an equal chance to develop dementia as controls. Depression rates were considerably higher in ET than controls and more severe depression is found. A strong evidence linking anxiety and ET. Many studies have documented sleep disturbances in ET.
Lack of association between essential tremor and Parkinson's disease
Annals of Neurology, 1988
Four aspects of a possible association between essential tremor (ET) and Parkinson's disease (PD) were investigated (1) the frequency of extrapyramidal signs in ET; (2) the frequency of concurrent ET and PD (i.e., monosymptomatic postural tremor for 5 or more years prior to onset of PD); (3) the frequency of E T in the families of PD patients; and (4) the frequency of PD in families of ET patients. Two hundred and thirty-seven ET patients (137 in London and 100 in Chicago) were evaluated. One hundred patients with PD and 100 normal control subjects were also investigated. Mild extrapyramidal signs occurred in only 4.5% of ET patients and were consistent with those found in normal aging. Only 3% of PD patients gave a history of uncomplicated ET. There was no difference in the frequency of a family history of PD between ET patients, a group of PD patients, and control subjects. Frequency of a family history of ET was higher among PD patients than control subjects, although the difference was not statistically significant. These data indicate that there is no association or genetic link between ET and PD.
Clinical characteristics of essential tremor in Taiwan: an exploratory-comparative study
European Journal of Neurology, 2011
Summa BACk%ROUND: 99.5% of individuals with essential tremor (ET) who live in the community have mild tremor and do not attend clinics. Clinic-based studies of ET have not allowed investigators to characterize the full clinical spectrum of this disorder. In community-based studies of ET, the primary focus has been the prevalence rather than the clinical characteristics of ET. OBJECTIVE: To describe the clinical characteristics of ET as seen in a community-based study. METHODS: 73 subjects with ET, identified in a community-based study of ET in Washington Heights-Inwood, New York, underwent a standardized 84-item physicianadministered tremor interview and a 26-item videotaped tremor examination which included 12 bedside tests for ET. Two neurologists who specialized in movement disorders and who demonstrated cxcellent interrater agreement rated the seventy of tremor using a 0 to +3 clinical rating scale and assigned a total tremor score (range, 0-36) and a diagnosis of ET. RESULTS: Diagnoses in the 73 cases were: definite ET (18, 24.7%), probable ET (32,43.8%), and possible ET (23,31.5%). The mean total tremor score was 17.8 of 36. Thirty-six of 73 (49.3% j were asymptomatic, answering "no" to the question "do you often have shaking or tremor that you can't control?" Sixty-seven of 73 (91.8%) had not been prescribed medication for tremor. On average, subjects received tremor ratings of >+2 on only 5.4 of the 12 bedside tests for ET. Kinetic tremor was rated as more severe than postural tremor in 72 (98.6%) of 73 cases. CONCLUSIONS: We present the clinical findings of a group of largely untreated, unselected cases of ET that would not otherwise have come to neurologic attention. The tremor was mild, often asymptomatic, and not uniformly present throughout the examination. It was rarely treated. The kinetic component of the tremor was more severe than the postural component. These clinical data further our understanding of the clinical spectrum of ET.
Are Patients with Limb and Head Tremor a Clinically Distinct Subtype of Essential Tremor?
Background: Essential tremor (ET) is the most common tremor disorder in adults. In addition to upper limbs, the tremor in ET may also involve head, jaw, voice, tongue, and trunk. Though head tremor (HT) is commonly present in patients with ET, large comparative studies of ET patients with HT (HT+) and without HT (HT−) are few. Methods: To determine whether ET with HT is a distinct clinical subtype by comparing ET patients with and without HT, a chart review of 234 consecutive patients with ET attending the neurology clinics of the National Institute of Mental Health and Neurosciences, India, was done. A movement disorder specialist confirmed the diagnosis of ET in all patients using the National Institutes of Health collaborative genetic criteria. Results: HT was present in 44.4% of the patients. Comparison between HT+ and HT− showed that the HT+ group patients: (1) were older, (2) had later onset of tremor, (3) had unimodal distribution of age at onset with a single peak in the fifth decade, (4) had more frequent voice tremor, and (5) were more likely to have mild cervical dystonia. HT was part of presenting symptoms in nearly two thirds of the ET patients and in the rest it was detected during clinical examination. Conclusions: Several demographic and clinical variables suggest that ET patients with HT have a distinct clinical phenotype.
Knowledge gaps and research recommendations for essential tremor
Parkinsonism & related disorders, 2016
Essential tremor (ET) is a common cause of significant disability, but its etiologies and pathogenesis are poorly understood. Research has been hampered by the variable definition of ET and by non-standardized research approaches. The National Institute of Neurological Disorders and Stroke (USA) invited experts in ET and related fields to discuss current knowledge, controversies, and gaps in our understanding of ET and to develop recommendations for future research. Discussion focused on phenomenology and phenotypes, therapies and clinical trials, pathophysiology, pathology, and genetics. Across all areas, the need for collaborative and coordinated research on a multinational level was expressed. Standardized data collection using common data elements for genetic, clinical, neurophysiological, and pathological studies was recommended. Large cohorts of patients should be studied prospectively to collect bio-samples, characterize the natural history of the clinical syndrome including ...
Evaluation of a screening instrument for essential tremor
Movement Disorders, 2008
To evaluate a screening instrument for essential tremor (ET) consisting of a seven-item questionnaire and a spiral drawing. A total of 2,448 Danish twins aged 70 years or more and a second sample aged 60 years or more (n 5 1,684) from a population-based northern German cross-sectional study (PopGen ET) were screened for ET. Inclusion criteria were a previous diagnosis of ET, a positive answer to two or more questions of the questionnaire or a spiral rating >4 (range of scale 0-9). Three hundred thirteen of 380 positively screened and 321 negatively screened subjects were clinically examined. Definite or probable ET was diagnosed in 104 patients, possible in 86 and other tremors in 98 patients. The sensitivity of the screening instrument was 70.5%, the positive predictive value was 64.9%, the specificity was 68.2%, and the negative predic-tive value was 73.5%. Tremor severity correlated significantly with higher spiral scores and more positive items. More patients were identified by spiral drawing in all tremor groups. The interrater and intrarater reliability for spirals ranged from 0.7 to 0.8 using intraclass coefficient. A cluster analysis revealed that the questionnaire can be reduced to three items, about uncontrollable tremor in any body part, tremor while drinking or pouring and other family members with tremor, without loosing efficacy. We present an easy to use and reliable screening instrument that is effective to identify patients with ET but not able to exclude patients with other tremor forms.