Elan D Louis1. 1. G.H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY 10032, USA. EDL2@columbia.edu
Abstract
BACKGROUND: Essential tremor (ET) is a chronic, progressive neurological disease. Head (neck) tremor may eventually develop in as many as 30-60% of patients, yet it is unclear why. Is its appearance merely a function of advancing disease duration? Alternatively, is patient age a primary factor? The latter would argue for the presence of a biological clock that is important for the expression of this clinical feature of ET. METHODS: A total of 363 ET patients were enrolled in a cross-sectional, clinical-epidemiological study. Each ET patient underwent a 20-min videotaped neurological examination which included an assessment of the presence/absence of head tremor. RESULTS: Head tremor was present on examination in 140 (38.6%) patients. Young patients, even with longer-duration tremor, rarely had head tremor: 2/27 (7.4%) patients<40 years old with tremor duration≥10 years had head tremor versus 121/283 (42.8%) older patients (>60 years old) with tremor duration≥10 years (p<0.001). In a multivariate logistic regression analysis, while head tremor was associated with age (p<0.001) it was not independently associated with tremor duration (p=0.26); interestingly, it was associated with gender in that model (p<0.001). With the exception of 1 patient, head tremor did not begin before the age of 36. CONCLUSIONS: Data suggest that the appearance of head tremor in ET depends on a biological factor that is intrinsic to the patient (i.e. age) and is not a clear consequence of advancing disease duration.
BACKGROUND: Essential tremor (ET) is a chronic, progressive neurological disease. Head (neck) tremor may eventually develop in as many as 30-60% of patients, yet it is unclear why. Is its appearance merely a function of advancing disease duration? Alternatively, is patient age a primary factor? The latter would argue for the presence of a biological clock that is important for the expression of this clinical feature of ET. METHODS: A total of 363 ET patients were enrolled in a cross-sectional, clinical-epidemiological study. Each ET patient underwent a 20-min videotaped neurological examination which included an assessment of the presence/absence of head tremor. RESULTS:Head tremor was present on examination in 140 (38.6%) patients. Young patients, even with longer-duration tremor, rarely had head tremor: 2/27 (7.4%) patients<40 years old with tremor duration≥10 years had head tremor versus 121/283 (42.8%) older patients (>60 years old) with tremor duration≥10 years (p<0.001). In a multivariate logistic regression analysis, while head tremor was associated with age (p<0.001) it was not independently associated with tremor duration (p=0.26); interestingly, it was associated with gender in that model (p<0.001). With the exception of 1 patient, head tremor did not begin before the age of 36. CONCLUSIONS: Data suggest that the appearance of head tremor in ET depends on a biological factor that is intrinsic to the patient (i.e. age) and is not a clear consequence of advancing disease duration.
Authors: Aristide Merola; Alok K Dwivedi; Aasef G Shaikh; Tamour Khan Tareen; Gustavo A Da Prat; Marcelo A Kauffman; Jennie Hampf; Abhimanyu Mahajan; Luca Marsili; Joseph Jankovic; Cynthia L Comella; Brian D Berman; Joel S Perlmutter; Hyder A Jinnah; Alberto J Espay Journal: J Neurol Date: 2019-04-26 Impact factor: 4.849
Authors: Priyesh N Patel; Edmond K Kabagambe; Jennifer C Starkweather; Matthew Keller; Zaki A Ahmed; Simone C Gruber; Jordan S Akins; C Gaelyn Garrett; David O Francis Journal: Laryngoscope Date: 2018-11-13 Impact factor: 3.325