Daphne Robakis1, Elan D Louis2. 1. Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA. 2. Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA. Electronic address: elan.louis@yale.edu.
Abstract
INTRODUCTION: Essential tremor (ET) is a common yet frequently misdiagnosed movement disorder. One contributing factor may be the dearth of studies that focus on the nuances of clinical phenomenology. A clinical feature that has received relatively little attention is head tremor. Indeed, there is no consensus regarding the predominant direction of head tremor in ET, and no study has examined the clinical correlates of directionality. METHODS: We identified 51 ET cases with head tremor enrolled in a clinical-epidemiological study of ET at Columbia University. Each had a videotaped neurological examination. Videotapes were viewed and coded by a movement disorders neurologist for head tremor direction ("no-no", "yes-yes", or mixed) and continuity (continuous, intermittent, or rare). Direction was correlated with a wide range of clinical features. RESULTS: Fourteen cases (27.5%) had "no-no" tremor, 9 (17.6%) had "yes-yes" tremor, and 28 (54.9%) had a mixed tremor. Mixed and "yes-yes" cases were older (p = 0.004) and had a longer tremor duration (p = 0.018) than "no-no" cases. Tremor severity (arms) was higher for mixed cases than for "yes-yes" and "no-no" cases (p = 0.04). More mixed cases had continuously present tremor while more "no-no" cases had rare head tremor (p < 0.001). CONCLUSIONS: Head tremor in ET seems to start as an infrequent tremor in one direction (esp. "no-no") and becomes more frequent while acquiring additional directionality and a mixed phenotype as the disease progresses. These findings add to our understanding of the clinical spectrum of ET.
INTRODUCTION: Essential tremor (ET) is a common yet frequently misdiagnosed movement disorder. One contributing factor may be the dearth of studies that focus on the nuances of clinical phenomenology. A clinical feature that has received relatively little attention is head tremor. Indeed, there is no consensus regarding the predominant direction of head tremor in ET, and no study has examined the clinical correlates of directionality. METHODS: We identified 51 ET cases with head tremor enrolled in a clinical-epidemiological study of ET at Columbia University. Each had a videotaped neurological examination. Videotapes were viewed and coded by a movement disorders neurologist for head tremor direction ("no-no", "yes-yes", or mixed) and continuity (continuous, intermittent, or rare). Direction was correlated with a wide range of clinical features. RESULTS: Fourteen cases (27.5%) had "no-no" tremor, 9 (17.6%) had "yes-yes" tremor, and 28 (54.9%) had a mixed tremor. Mixed and "yes-yes" cases were older (p = 0.004) and had a longer tremor duration (p = 0.018) than "no-no" cases. Tremor severity (arms) was higher for mixed cases than for "yes-yes" and "no-no" cases (p = 0.04). More mixed cases had continuously present tremor while more "no-no" cases had rare head tremor (p < 0.001). CONCLUSIONS:Head tremor in ET seems to start as an infrequent tremor in one direction (esp. "no-no") and becomes more frequent while acquiring additional directionality and a mixed phenotype as the disease progresses. These findings add to our understanding of the clinical spectrum of ET.
Authors: Jeanne P Vu; Elizabeth Cisneros; Ha Yeon Lee; Linh Le; Qiyu Chen; Xiaoyan A Guo; Ryin Rouzbehani; Joseph Jankovic; Stewart Factor; Christopher G Goetz; Richard L Barbano; Joel S Perlmutter; Hyder A Jinnah; Sarah Pirio Richardson; Glenn T Stebbins; Rodger Elble; Cynthia L Comella; David A Peterson Journal: J Neurol Sci Date: 2022-01-22 Impact factor: 4.553