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Udwani SK, Desai SD. Epidemiologic Disparities and Challenges in Non-parkinsonian Tremor Disorders Research: A Scoping Review Emphasizing the Indian Context. Ann Indian Acad Neurol 2024; 27:122-130. [PMID: 38751925 PMCID: PMC11093173 DOI: 10.4103/aian.aian_36_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
Non-parkinsonian tremors represent a heterogeneous spectrum of movement disorders where knowledge gaps persist regarding epidemiology, pathophysiology, and clinical burden. This scoping review aimed to systematically consolidate literature on these disorders in India across the domains of prevalence, biological mechanisms, psychiatric comorbidity, disability impact, and quality of life. A systematic search was undertaken across databases to identify studies on non-parkinsonian tremors in India. Extracted data were synthesized descriptively under themes spanning reported prevalence estimates and variability, proposed biological processes, psychiatric symptom rates, stigma perceptions, and quality-of-life deficits. Methodological appraisal was undertaken. Twenty-nine studies reported prevalence estimates displaying wide variability from 0.09% to 22% for essential tremor, partly attributable to definitional inconsistencies. Proposed pathologic processes centered on cerebellar dysfunction, neurotransmitter disturbances, and genetic risks. Nine studies revealed variable anxiety (6.8%-90%) and depression (3.4%-60%) rates among essential tremor patients, while two indicated perceived stigma. Five studies unanimously concurred significant quality of life impairment in essential tremors. Evidence of dystonic tremor, functional tremor, and other tremors was limited. This review exposed critical knowledge gaps and methodological limitations, while systematically evaluating the Indian literature on non-parkinsonian tremors concerning epidemiology, mechanisms, and clinical burden. Large-scale collaborative research applying standardized diagnostic criteria is imperative to determine contemporary prevalence statistics and comprehensively characterize the multifaceted disability footprint to inform patient-centric models optimizing diagnosis and holistic care.
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Affiliation(s)
- Sachin K. Udwani
- Department of Neurology, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Soaham D. Desai
- Department of Neurology, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
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Calomino C, Quattrone A, Bianco MG, Nisticò R, Buonocore J, Crasà M, Vaccaro MG, Sarica A, Quattrone A. Combined cortical thickness and blink reflex recovery cycle to differentiate essential tremor with and without resting tremor. Front Neurol 2024; 15:1372262. [PMID: 38585347 PMCID: PMC10995929 DOI: 10.3389/fneur.2024.1372262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/14/2024] [Indexed: 04/09/2024] Open
Abstract
Objective To investigate the performance of structural MRI cortical and subcortical morphometric data combined with blink-reflex recovery cycle (BRrc) values using machine learning (ML) models in distinguishing between essential tremor (ET) with resting tremor (rET) and classic ET. Methods We enrolled 47 ET, 43 rET patients and 45 healthy controls (HC). All participants underwent brain 3 T-MRI and BRrc examination at different interstimulus intervals (ISIs, 100-300 msec). MRI data (cortical thickness, volumes, surface area, roughness, mean curvature and subcortical volumes) were extracted using Freesurfer on T1-weighted images. We employed two decision tree-based ML classification algorithms (eXtreme Gradient Boosting [XGBoost] and Random Forest) combining MRI data and BRrc values to differentiate between rET and ET patients. Results ML models based exclusively on MRI features reached acceptable performance (AUC: 0.85-0.86) in differentiating rET from ET patients and from HC. Similar performances were obtained by ML models based on BRrc data (AUC: 0.81-0.82 in rET vs. ET and AUC: 0.88-0.89 in rET vs. HC). ML models combining imaging data (cortical thickness, surface, roughness, and mean curvature) together with BRrc values showed the highest classification performance in distinguishing between rET and ET patients, reaching AUC of 0.94 ± 0.05. The improvement in classification performances when BRrc data were added to imaging features was confirmed by both ML algorithms. Conclusion This study highlights the usefulness of adding a simple electrophysiological assessment such as BRrc to MRI cortical morphometric features for accurately distinguishing rET from ET patients, paving the way for a better classification of these ET syndromes.
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Affiliation(s)
- Camilla Calomino
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Andrea Quattrone
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Maria Giovanna Bianco
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Rita Nisticò
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Jolanda Buonocore
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Marianna Crasà
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Maria Grazia Vaccaro
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Alessia Sarica
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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Rajan R, Anandapadmanabhan R, Vishnoi A, Latorre A, Thirugnanasambandam N, Dipani A, Biswas D, Radhakrishnan DM, Srivastava A, Bhatia KP. Essential Tremor and Essential Tremor Plus Are Essentially Similar Electrophysiologically. Mov Disord Clin Pract 2024; 11:136-142. [PMID: 38386479 PMCID: PMC10883406 DOI: 10.1002/mdc3.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/25/2023] [Accepted: 11/10/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The merits of classifying the heterogeneous group of essential tremors into essential tremor (ET) and essential tremor plus (ETP) are debated. OBJECTIVES We studied the electrophysiological and spiral characteristics of tremor in ET and ETP. METHODS We reviewed standardized videos from a tremor database and clinically classified patients into ET, ETP, or dystonic tremor (DT). The following variables were derived from combined tri-axial accelerometry-surface electromyography (EMG)-peak frequency, total power, peak power, full width half maximum, tremor stability index and EMG-coherence. We analyzed hand-drawn spirals to derive mean deviation, tremor variability, inter-, and intra-loop widths. We compared these variables among the groups. RESULTS We recruited 72 participants (81.9% male) with mean age 47.7 ± 16.1 years and Fahn-Tolosa-Marin Tremor Rating Scale total score 31.1 ± 14.1. Patients with ET were younger (P = 0.014) and had less severe tremor (P = 0.020) compared to ETP and DT. In ETP group, 48.6% had subtle dystonia. Peak frequency was greater in ETP (7.3 ± 0.3 Hz) compared to DT (6.1 ± 0.4 Hz; P = 0.024). Peak power was greater in ETP and DT for postural tremor. Rest tremor was recordable on accelerometry in 26.7% of ET. Other variables were similar among the groups. CONCLUSION Electrophysiological evaluation revealed postural tremor of frequency 6 to 7 Hz in ET, ETP, and DT with subtle differences more severe tremor in ETP and DT, and higher frequency in ETP compared to DT. Our findings suggest a similar tremor oscillator in these conditions, supporting the view that these entities are part of a spectrum of tremor disorders, rather than distinct etiological entities.
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Affiliation(s)
- Roopa Rajan
- All India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | | | - Aayushi Vishnoi
- All India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | - Anna Latorre
- University College London Hospitals (UCL)LondonUnited Kingdom
| | | | - Alish Dipani
- National Brain Research Centre (NBRC)ManesarIndia
| | - Deblina Biswas
- All India Institute of Medical Sciences (AIIMS)New DelhiIndia
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Antonazzo IC, Rozza D, Conti S, Fornari C, Cortesi PA, Eteve-Pitsaer C, Paris C, Gantzer L, Valentine D, Mantovani LG, Mazzaglia G. Treatment patterns in essential tremor: Real-world evidence from a United Kingdom and France primary care database. Eur J Neurol 2024; 31:e16064. [PMID: 37738526 DOI: 10.1111/ene.16064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND PURPOSE Essential tremor (ET) is one of the most common neurological disorders, but information on treatment pattern is still scant. The aim of this study was to describe the demographic and clinical characteristics, treatment patterns, and determinants of drug use in patients with newly diagnosed ET in France and the United Kingdom. METHODS Incident cases of ET diagnosed between January 1, 2015 and December 31, 2018 with 2 years of follow-up were identified by using The Health Improvement Network (THIN®) general practice database. During the follow-up, we assessed the daily prevalence of use and potential switches from first-line to second-line treatment or other lines of treatment. Logistic regression models were conducted to assess the effect of demographic and clinical characteristics on the likelihood of receiving ET treatment. RESULTS A total of 2957 and 3249 patients were selected in the United Kingdom and France, respectively. Among ET patients, drug use increased from 12 months to 1 month prior the date of index diagnosis (ID). After ID, nearly 40% of patients received at least one ET treatment, but during follow-up drug use decreased and at the end of the follow-up approximately 20% of patients were still on treatment. Among treated patients, ≤10% maintained the same treatment throughout the entire follow-up, nearly 20% switched, and 40%-75% interrupted any treatment. Results from the multivariate analysis revealed that, both in France and the United Kingdom, patients receiving multiple concomitant therapies and affected by psychiatric conditions were more likely to receive an ET medication. CONCLUSION This study shows that ET is an undertreated disease with a lower-than-expected number of patients receiving and maintaining pharmacological treatment. Misclassification of ET diagnosis should be acknowledged; thus, results require cautious interpretation.
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Affiliation(s)
- Ippazio Cosimo Antonazzo
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Davide Rozza
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Carla Fornari
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | | | - Claire Paris
- Cegedim Health data, Boulogne-Billancourt, France
| | | | | | | | - Giampiero Mazzaglia
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
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Erro R, Lazzeri G, Gigante AF, Pilotto A, Magistrelli L, Bologna M, Terranova C, Olivola E, Dallocchio C, Moschella V, Valentino F, Di Biasio F, Nicoletti A, De Micco R, Brusa L, Sorrentino C, Matinella A, Bertino S, Paparella G, Modugno N, Contaldi E, Padovani A, Di Fonzo A, Restaino M, Barone P. Clinical correlates of "pure" essential tremor: the TITAN study. Front Neurol 2023; 14:1233524. [PMID: 37681007 PMCID: PMC10481166 DOI: 10.3389/fneur.2023.1233524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/24/2023] [Indexed: 09/09/2023] Open
Abstract
Background To date, there are no large studies delineating the clinical correlates of "pure" essential tremor (ET) according to its new definition. Methods From the ITAlian tremor Network (TITAN) database, we extracted data from patients with a diagnosis of "pure" ET and excluded those with other tremor classifications, including ET-plus, focal, and task-specific tremor, which were formerly considered parts of the ET spectrum. Results Out of 653 subjects recruited in the TITAN study by January 2022, the data of 208 (31.8%) "pure" ET patients (86M/122F) were analyzed. The distribution of age at onset was found to be bimodal. The proportion of familial cases by the age-at-onset class of 20 years showed significant differences, with sporadic cases representing the large majority of the class with an age at onset above 60 years. Patients with a positive family history of tremor had a younger onset and were more likely to have leg involvement than sporadic patients despite a similar disease duration. Early-onset and late-onset cases were different in terms of tremor distribution at onset and tremor severity, likely as a function of longer disease duration, yet without differences in terms of quality of life, which suggests a relatively benign progression. Treatment patterns and outcomes revealed that up to 40% of the sample was unsatisfied with the current pharmacological options. Discussion The findings reported in the study provide new insights, especially with regard to a possible inversed sex distribution, and to the genetic backgrounds of "pure" ET, given that familial cases were evenly distributed across age-at-onset classes of 20 years. Deep clinical profiling of "pure" ET, for instance, according to age at onset, might increase the clinical value of this syndrome in identifying pathogenetic hypotheses and therapeutic strategies.
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Affiliation(s)
- Roberto Erro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Neuroscience Section, University of Salerno, Baronissi, SA, Italy
| | - Giulia Lazzeri
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Angelo Fabio Gigante
- Department of Medical Sciences and Public Health, Section of Neurology, San Paolo Hospital, Bari, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luca Magistrelli
- Department of Translational Medicine, Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale, Novara, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Neuromed Institute IRCCS, Pozzilli, IS, Italy
| | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Carlo Dallocchio
- Neurology Unit, Department of Medical Area, ASST Pavia, Voghera, PV, Italy
| | | | - Francesca Valentino
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Alessandra Nicoletti
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Catania, Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences, Università della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Livia Brusa
- Neurology Department, S.Eugenio Hospital, Rome, Italy
| | - Cristiano Sorrentino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Neuroscience Section, University of Salerno, Baronissi, SA, Italy
| | - Angela Matinella
- Neurology Unit, Department of Medical Area, ASST Pavia, Voghera, PV, Italy
| | - Salvatore Bertino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Elena Contaldi
- Department of Translational Medicine, Movement Disorders Centre, Neurology Unit, University of Piemonte Orientale, Novara, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessio Di Fonzo
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Marialuisa Restaino
- Department of Economics and Statistics, University of Salerno, Fisciano, SA, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Neuroscience Section, University of Salerno, Baronissi, SA, Italy
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Andrews L, Keller SS, Osman-Farah J, Macerollo A. A structural magnetic resonance imaging review of clinical motor outcomes from deep brain stimulation in movement disorders. Brain Commun 2023; 5:fcad171. [PMID: 37304793 PMCID: PMC10257440 DOI: 10.1093/braincomms/fcad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/05/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
Patients with movement disorders treated by deep brain stimulation do not always achieve successful therapeutic alleviation of motor symptoms, even in cases where surgery is without complications. Magnetic resonance imaging (MRI) offers methods to investigate structural brain-related factors that may be predictive of clinical motor outcomes. This review aimed to identify features which have been associated with variability in clinical post-operative motor outcomes in patients with Parkinson's disease, dystonia, and essential tremor from structural MRI modalities. We performed a literature search for articles published between 1 January 2000 and 1 April 2022 and identified 5197 articles. Following screening through our inclusion criteria, we identified 60 total studies (39 = Parkinson's disease, 11 = dystonia syndromes and 10 = essential tremor). The review captured a range of structural MRI methods and analysis techniques used to identify factors related to clinical post-operative motor outcomes from deep brain stimulation. Morphometric markers, including volume and cortical thickness were commonly identified in studies focused on patients with Parkinson's disease and dystonia syndromes. Reduced metrics in basal ganglia, sensorimotor and frontal regions showed frequent associations with reduced motor outcomes. Increased structural connectivity to subcortical nuclei, sensorimotor and frontal regions was also associated with greater motor outcomes. In patients with tremor, increased structural connectivity to the cerebellum and cortical motor regions showed high prevalence across studies for greater clinical motor outcomes. In addition, we highlight conceptual issues for studies assessing clinical response with structural MRI and discuss future approaches towards optimizing individualized therapeutic benefits. Although quantitative MRI markers are in their infancy for clinical purposes in movement disorder treatments, structural features obtained from MRI offer the powerful potential to identify candidates who are more likely to benefit from deep brain stimulation and provide insight into the complexity of disorder pathophysiology.
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Affiliation(s)
- Luke Andrews
- Correspondence to: Luke Andrews The BRAIN Lab, University of Liverpool Cancer Research Centre 200 London Rd, Liverpool L3 9TA, United Kingdom E-mail:
| | - Simon S Keller
- The Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 9TA, UK
| | - Jibril Osman-Farah
- Department of Neurology and Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L97LJ, UK
| | - Antonella Macerollo
- Correspondence may also be sent to: Antonella Macerollo. The Walton Centre NHS Trust, Lower Lane Liverpool L9 7LJ, United Kingdom E-mail:
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Erro R, Picillo M, Pellecchia MT, Barone P. Diagnosis Versus Classification of Essential Tremor: A Research Perspective. J Mov Disord 2023; 16:152-157. [PMID: 37258278 DOI: 10.14802/jmd.23020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/07/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, Italy
| | - Marina Picillo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, Italy
| | - Maria Teresa Pellecchia
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, Italy
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8
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Lenka A, Pandey S. Dystonia and tremor: Do they have a shared biology? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:413-439. [PMID: 37482399 DOI: 10.1016/bs.irn.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Dystonia and tremor are the two most commonly encountered hyperkinetic movement disorders encountered in clinical practice. While there has been substantial progress in the research on these two disorders, there also exists a lot of gray areas. Entities such as dystonic tremor and tremor associated with dystonia occupy a major portion of the "gray zone". In addition, there is a marked clinical heterogeneity and overlap of several clinical and epidemiological features among dystonia and tremor. These facts raise the possibility that dystonia and tremor could be having shared biology. In this chapter, we revisit critical aspects of this possibility that may have important clinical and research implications in the future. We comprehensively review the points in favor and against the theory that dystonia and tremor have shared biology from clinical, epidemiological, genetic and neuroimaging studies.
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Affiliation(s)
- Abhishek Lenka
- Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, United States
| | - Sanjay Pandey
- Department of Neurology, Amrita Hospital, Faridabad, Delhi National Capital Region, India.
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Sun Q, He R, Huang H, Cao H, Wang X, Liu H, Wang C, Lei L, Wang P, Cui G, Ma J, Gu P, An D, Jia M, Sun Z, Wu H, Lin J, Tang J, Zhou X, Li M, Zeng S, Chen Y, Yan X, Guo J, Xu Q, Liu Z, Shen L, Jiang H, Wu X, Xiao Q, Chen H, Xu Y, Tang B. Age and Sex Affect Essential Tremor (ET) Plus: Clinical Heterogeneity in ET Based on the National Survey in China. Aging Dis 2022:AD.2022.1205. [PMID: 37163423 PMCID: PMC10389817 DOI: 10.14336/ad.2022.1205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/05/2022] [Indexed: 05/12/2023] Open
Abstract
The new term essential tremor (ET) plus was proposed in the 2018 tremor consensus criteria. The National Survey of Essential Tremor Plus in China, a large multicenter registry study, aimed to evaluate the clinical features of pure ET and ET plus and explore possible factors related to ET plus. All patients with ET underwent neurological examination and neuropsychological assessment at 17 clinical sites. The diagnosis was made according to the 2018 consensus criteria. Clinicodemographic characteristics were analyzed. A total of 1160 patients were included, including 546 patients with pure ET and 614 patients with ET plus. The proportion of females was significantly higher in the ET plus than that in the pure ET (P = 0.001). The age at onset (AAO) of pure ET showed a bimodal distribution, with peaks in the 2nd and 5th decades. However, the AAO of the ET plus group demonstrated a skewed distribution, with a single peak in the 6th decade. Female sex (OR=1.645, P<0.001), older age (OR=1.023, P<0.001), lower educational level (OR=0.934, P<0.001), head tremor (OR=1.457, P<0.001), and higher the Tremor Research Group Essential Tremor Rating Assessment Scale (TETRAS)-II scores (OR=1.134, P<0.001) were significantly associated with ET plus. Old age and female sex may contribute to ET plus development. Pure ET showed a bimodal distribution for AAO, whereas ET plus showed a unimodal distribution. It remains unclear whether pure ET and ET plus are merely different stages of a single disease or represent distinct disease entities.
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Affiliation(s)
- Qiying Sun
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Runcheng He
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hongyan Huang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongmei Cao
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xuejing Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hong Liu
- Department of Neurology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shangxi, China
| | - Chunyu Wang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lifang Lei
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Puqing Wang
- Department of Neurology, Xiang Yang No. 1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei, China
| | - Guiyun Cui
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jianjun Ma
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Ping Gu
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Di An
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Min Jia
- Department of Neurology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Zhanfang Sun
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Heng Wu
- Department of Neurology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China
| | - Jinsheng Lin
- Department of Neurology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Jiayu Tang
- Department of Neurology, Hunan Provincial Brain Hospital, Changsha, Hunan, China
| | - Xun Zhou
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mingqiang Li
- Department of Neurology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China
| | - Sheng Zeng
- Department of Geriatric Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yase Chen
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinxiang Yan
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jifeng Guo
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qian Xu
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhenhua Liu
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lu Shen
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
| | - Hong Jiang
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
| | - Xinyin Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qin Xiao
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haibo Chen
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Yanming Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Beisha Tang
- Department of Neurology, Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
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Cerebellar voxel-based morphometry in essential tremor. J Neurol 2022; 269:6029-6035. [DOI: 10.1007/s00415-022-11291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/29/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022]
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Delgado N, Berry DS, Louis ED. Distribution of rest tremor in patients with Essential Tremor: Does it lateralize with simple kinetic, postural, or intention tremors? Parkinsonism Relat Disord 2022; 102:36-41. [DOI: 10.1016/j.parkreldis.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/11/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
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