Wei Chen1, Franziska Hopfner2, Silke Szymczak3, Oliver Granert2, Stefanie H Müller2, Gregor Kuhlenbäumer2, Günther Deuschl4. 1. Department of Neurology, University Hospital Schleswig Holstein, 24105 Kiel, Germany; Department of Neurology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200011 Shanghai, China. 2. Department of Neurology, University Hospital Schleswig Holstein, 24105 Kiel, Germany. 3. Institute of Medical Informatics and Statistics, Kiel University, 24105 Kiel, Germany. 4. Department of Neurology, University Hospital Schleswig Holstein, 24105 Kiel, Germany; Department of Neurology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200011 Shanghai, China. Electronic address: g.deuschl@neurologie.uni-kiel.de.
Abstract
INTRODUCTION: Topography of tremor manifestations is poorly investigated in essential tremor. The present study explores the prevalence and clinical correlates of head and/or voice tremor in essential tremor. METHODS: Out of a prospectively designed registry of 972 patients, 884 patients with definite and probable essential tremor had complete information on tremor localization. Demographic and clinical characteristics were compared among four subgroups: group A (without head or voice tremor, n = 619), B (with head but without voice tremor, n = 155), C (with voice but without head tremor, n = 47), and D (with both head and voice tremor, n = 63). RESULTS: In our patients, total prevalence of tremor was 24.7% for head, 12.4% for voice and 7.1% for the combination of head and voice. Logistic regression analyses showed that female gender is strongly associated with head tremor, which was confirmed by an additional meta-analysis. Severe hand tremor was the only factor associated with voice tremor. Both female gender and severe hand tremor increase the odds for having the combination of head and voice tremor. For males, hand tremor severity is significantly increased among those with head and voice tremor alone and in combination, but for females only for the combination. Patients with both head and voice tremor have more frequent involvement of legs and other localizations and are less responsive to β-blockers. CONCLUSIONS: Female gender and severe hand tremor may increase the odds of head and/or voice tremor in essential tremor. The association of hand tremor severity with midline tremor is stronger for males than females.
INTRODUCTION: Topography of tremor manifestations is poorly investigated in essential tremor. The present study explores the prevalence and clinical correlates of head and/or voice tremor in essential tremor. METHODS: Out of a prospectively designed registry of 972 patients, 884 patients with definite and probable essential tremor had complete information on tremor localization. Demographic and clinical characteristics were compared among four subgroups: group A (without head or voice tremor, n = 619), B (with head but without voice tremor, n = 155), C (with voice but without head tremor, n = 47), and D (with both head and voice tremor, n = 63). RESULTS: In our patients, total prevalence of tremor was 24.7% for head, 12.4% for voice and 7.1% for the combination of head and voice. Logistic regression analyses showed that female gender is strongly associated with head tremor, which was confirmed by an additional meta-analysis. Severe hand tremor was the only factor associated with voice tremor. Both female gender and severe hand tremor increase the odds for having the combination of head and voice tremor. For males, hand tremor severity is significantly increased among those with head and voice tremor alone and in combination, but for females only for the combination. Patients with both head and voice tremor have more frequent involvement of legs and other localizations and are less responsive to β-blockers. CONCLUSIONS: Female gender and severe hand tremor may increase the odds of head and/or voice tremor in essential tremor. The association of hand tremor severity with midline tremor is stronger for males than females.
Authors: Aasef G Shaikh; Sinem Balta Beylergil; Laura Scorr; Gamze Kilic-Berkmen; Alan Freeman; Christine Klein; Johanna Junker; Sebastian Loens; Norbert Brüggemann; Alexander Münchau; Tobias Bäumer; Marie Vidailhet; Emmanuel Roze; Cecilia Bonnet; Joseph Jankovic; Joohi Jimenez-Shahed; Neepa Patel; Laura Marsh; Cynthia Comella; Richard L Barbano; Brian D Berman; Irene Malaty; Aparna Wagle Shukla; Stephen G Reich; Mark S Ledoux; Alfredo Berardelli; Gina Ferrazzano; Natividad Stover; William Ondo; Sarah Pirio Richardson; Rachel Saunders-Pullman; Zoltan Mari; Pinky Agarwal; Charles Adler; Sylvain Chouinard; Susan H Fox; Allison Brashear; Daniel Truong; Oksana Suchowersky; Samuel Frank; Stewart Factor; Joel Perlmutter; Hyder Azad Jinnah Journal: Neurology Date: 2020-10-12 Impact factor: 9.910