Distinct non‐motor features of essential tremor with head tremor patients

Abstract

Background There have been few comprehensive scale studies on the non‐motor symptoms (NMS) of patients with essential tremor (ET) with head tremor (ETh) and those with ET without head tremor (ETol). We aimed to explore the motor symptoms and NMS of these two subgroups. Methods We enrolled 199 patients with ET (125, ETol; 74 ETh) and 132 healthy controls. We evaluated motor symptoms using the Fahn‐Tolosa‐Marin Tremor Rating Scale (TRS) and NMS using the Non‐Motor Symptom Scale (NMSS). We compared NMSS scores and the prevalence of each NMS between the patient subgroups. Finally, we conducted a logistic regression analysis of the correlation between head tremor and NMS severity, as well as other determinants. Results There were no significant between‐subgroup differences in demographic characteristics. Further, they presented similar tremor clinical manifestation; however, the ETh subgroup showed a higher prevalence of rest tremor, feeling of sadness, forgetting things or events, and swallowing difficulty, as well as TRS scores, compared with the ETol subgroup. Both patient subgroups showed high scores and prevalence (>50%) in difficulty falling asleep. Logistic regression analysis indicated age as a tremor severity determinant; further, head tremor and tremor severity were NMS determinants. Conclusion Both patient subgroups presented various NMS including sleep disturbances, cognitive deficits, and affective disorders. The ETh subgroup showed a high prevalence of certain NMS aspects including memory and affective disorder; further, they had aggravated NMS. ET with both upper limb tremor and head tremor may be regarded as a more severe clinical subtype.

Non‐motor symptoms are associated with midline tremor in essential tremor

“…In our previous study, we explored the correlation between affective symptoms and MT, which revealed MT to be associated with anxiety and depression symptoms in ET 22 . Recently, Bologna et al 9 reported patients with head tremor to have a higher occurrence of psychiatric disorders, and Peng et al 23 showed that ET patients with head tremor had a higher incidence of memory and affective disorders than patients without head tremor. Several mechanisms could explain the pronounced mental symptoms observed in ET patients with MT.…”

Phenotypic Features of Isolated Essential Tremor, Essential Tremor Plus, and Essential Tremor-Parkinson’s Disease in a Movement Disorders Clinic

“…Essential tremor was defined as an Axis 1 tremor syndrome with "isolated tremor syndrome of bilateral upper limb action tremor" of "at least 3 years' duration" in the "absence of other neurological signs, such as dystonia, ataxia, or parkinsonism". "Essential tremor plus" was adopted to describe tremor with the characteristics of ET as well as "additional neurological signs of uncertain significance" [1], in order to accommodate the additional movement disorders and non-motor symptoms increasingly described in ET patients [2][3][4][5][6][7][8].…”

Prodromal Markers of Parkinson's Disease in Patients With Essential Tremor

“…Essential tremor patients with jaw tremor have more severe clinical symptoms and more widely distributed tremor than patients without it. Essential tremor patients with head tremor may be also regarded as a more severe clinical subtype (66). This manifestation combined with the hypothesis that the evolution from ET to PD is caused by the spread of Lewy bodies in the cerebellothalamocortical circuit leads us to speculate that there may be some relationship between jaw tremor and subsequent PD.…”