Essential tremor 10, 20, 30, 40: clinical snapshots of the disease by decade of duration

Authors

  • E. D. Louis,

    Corresponding author
    1. Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
    2. Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
    3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
    • G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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  • M. Gerbin,

    1. G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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  • M. Galecki

    1. G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Correspondence: E. Louis, Unit 198, Neurological Institute, 710 West 168th Street, New York, NY 10032, USA (tel.: +(212) 305 9194; fax: +(212) 305 1304; e-mail: EDL2@columbia.edu).

Abstract

Background and purpose

Essential tremor (ET) is a chronic, progressive neurological disorder in which disease burden may slowly accrue. There are few long-term studies, and the clinical and functional status of patients, with each decade of disease duration, has not been documented in detail. We used cross-sectional data on 335 patients with ET (disease duration 1–81 years) to produce clinical snapshots of the disease at each 10-year milestone (i.e. < 10, 10–19, 20–29, 30–39, ≥ 40 years). We hope these data will be of value in clinical-prognostic settings both to patients and their treating physicians.

Methods

In this cross-sectional, clinical-epidemiological study at Columbia-University Medical Center, each patient underwent a single evaluation, including self-reported measures of tremor-related disability, performance-based measures of function, and neurologist-assessments of tremor type, location and severity.

Results

A variety of metrics of tremor severity increased across the 10-year time intervals. By ≥ 40 years duration, one-third of patients had tremor in at least two cranial locations (neck, voice, jaw), and the proportion with high-amplitude tremor reached 20.3% (while drawing spirals), 33.8% (spilling while drinking) and 60.8% (spilling while using a spoon). Yet even in the longest tremor duration group, very few (< 10%) were incapacitated (i.e. completely unable to perform the above-mentioned tasks), and one-third continued to exhibit no cranial tremor.

Conclusions

These data paint a picture of progressive decade-by-decade decline in ET. Yet patients with long disease duration did not relentlessly converge at the same end-stage of severe, functionally incapacitating, diffuse tremor. In this respect, long-duration ET patients presented a heterogeneous picture.

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