Correlates of functional disability in essential tremor

Abstract

The decision to treat patients with essential tremor (ET) is based primarily on the functional impact of the tremor. Correlates of functional disability, apart from the severity of the tremor itself, have not been studied. The objective of this work was to study correlates of functional disability in ET, and to present data on the extent of functional disability in community-dwelling ET cases. ET cases and age-matched control subjects were ascertained from a tertiary referral center at Columbia-Presbyterian Medical Center and a community in northern Manhattan, N.Y. Subjects underwent a 2.5-hour evaluation, including a tremor disability questionnaire, a videotaped tremor examination rated by a neurologist, a performance-based test of function, quantitative computerized tremor analysis, the Hamilton Anxiety Rating Scale, and the depression module of the Structured Clinical Interview for DSM-IV. Seventy-six (85.4%) of 89 cases reported disability on > or =1 item on the disability questionnaire. In multivariate linear regression analyses, current major depression, Hamilton Anxiety Rating Scale score, age, and tremor severity were independently correlated with performance-based test scores. Twenty-seven (73.0%) of 37 community cases reported disability on > or =1 (mean = 8.4) item on the questionnaire, and 25 (67.6%) demonstrated moderate or greater difficulty on > or =1 (mean = 4.2) task in a performance-based test. Depression, anxiety, and age, independent of the severity of tremor, were associated with greater functional disability in ET, so that these factors must be considered when assessing the impact of new treatments in ET. Among a group of community-dwelling cases, approximately three-quarters reported disability, suggesting that the number of individuals who might receive some benefit from advances in the treatment of ET is probably a great deal larger than previously thought.

Association between essential tremor and blood lead concentration.

“…As such, ET is one of the most common neurologic diseases. The pathogenesis of this progressive ) and often disabling (Louis et al 2001a) disease is poorly understood, although there is evidence of cerebellar involvement (Bucher et al 1997;Louis et al 2002a;Wills et al 1994). There is no cure for ET, and there has been no attempt to favorably modulate or halt its progression with neuroprotective therapy.…”

Closed-Loop Modulation of a Notch-Filter Stimulation Strategy for Tremor Management with a Neuroprosthesis

“…Drugs constitute the standard treatment for the various types of tremor, and refractory patients-normally with severe symptoms-may undergo neurosurgery. In spite of the existence of these various treatments, a large proportion of patients exhibit significant disability when performing their daily chores [4,5]. This motivates the research on novel forms to manage tremor.…”

Octanoic acid in alcohol-responsive essential tremor

“…12 The aim of this phase I/II, double-blind, placebo-controlled, crossover study was to investigate the safety and efficacy of a low dose of oral OA (4 mg/kg) in patients with ET. The primary outcome was to determine the efficacy of OA in reducing postural tremor power of the dominant hand, 80 minutes after administration, compared with placebo.…”