More Time with Tremor: The Experience of Essential Tremor Versus Parkinson's Disease Patients

Abstract

Background A broad range of tremors occur in patients with essential tremor and Parkinson's disease; despite this, there are virtually no published data that focus on the patient perspective. The aims were to (1) assess the subjective experience of tremor, comparing essential tremor and Parkinson's disease patients, and (2) assess the clinical correlates of that experience (i.e., what specific clinical characteristics were associated with more experienced tremor)? Methods 121 essential tremor and 100 Parkinson's disease cases enrolled in a cross-sectional, clinical-epidemiological study underwent a detailed clinical assessment, which included a series of standardized questionnaires and neurological examination. The question, “On a typical day, how many waking hours do you have tremor in any body part?”, was also administered. Results Essential tremor cases reported more than three times the median number of waking hours experiencing tremor than Parkinson's disease cases: 10.1 ± 7.8 (median 10.0) vs. 5.5 ± 6.3 (median 3.0) hours (p<0.001). A small number of cases (esp., essential tremor) reported spending ≥16 hours/day shaking. Greater number of hours experiencing tremor was associated with female gender, higher Center for Epidemiological Studies Depression Scale scores, greater perceived disability and, in essential tremor, higher Essential Tremor Embarrassment Assessment scores. Conclusions Essential tremor patients reported more than three times the median number of waking hours experiencing tremor than Parkinson's disease patients. Certain clinical characteristics tracked with more reported tremor, and the number of such hours had clear clinical ramifications - greater number of hours was associated with both psycho-social and functional consequences.

Impact of Tremor on Patients With Early Stage Parkinson's Disease

“…Parkinson's disease-related tremor is a source of significant social anxiety and embarrassment that negatively affects early stage patients' self-image, sense of security, and well-being ( 18 , 19 ). In a survey of 103 PD patients (93.5% Hoehn & Yahr stage I or II), Louis et al found that more than one-quarter agreed with following statements: “My tremor makes me feel negative about myself; I am embarrassed about my tremor; I am depressed because of my tremor; I worry about the future; I am nervous or anxious; I have difficulty concentrating because of my tremor” ( 18 ).…”

“…In a survey of 103 PD patients (93.5% Hoehn & Yahr stage I or II), Louis et al found that more than one-quarter agreed with following statements: “My tremor makes me feel negative about myself; I am embarrassed about my tremor; I am depressed because of my tremor; I worry about the future; I am nervous or anxious; I have difficulty concentrating because of my tremor” ( 18 ). In a separate survey of 100 PD patients, 36 indicated other people often comment on their tremor ( 19 ). These findings highlight the psychosocial impact tremor can have for patients with early stage PD.…”

“…When asked to answer the following question in their own words: “What two problems related to tremor bother you most?” 28% of participants described tremors/shaking, which was the most frequently cited problem ( 13 ). Furthermore, PD patients reported spending an average of 5.5 waking hours with tremor each day ( 19 ). Parkinson's disease patients with the most severe tremor scores on the Unified Parkinson's Disease Rating Scale (UPDRS) experienced on average 7.9 waking hours per day with tremor.…”

Coronal Transcranial Sonography and M‐Mode Tremor Frequency Determination in Parkinson's Disease and Essential Tremor

“…Bilateral postural tremor of at least 6 Hz was much more frequent in ET patients than in PD patients and represented a typical finding of ET patients in combination with normal echogenicity size of SN. As it was shown by Louis et al, ET patients reported the occurrence of tremor symptoms three times more often than PD patients, which makes this technique especially useful for the evaluation of this population.…”

Using Portable Transducers to Measure Tremor Severity

“…The percentage of time with tremor is a valid measure of essential tremor and Parkinson rest tremor severity, 21 and correlates with patient disability. 53 The use of wearable transducers is still an active area of research and development. We do not yet know if continuous recordings of tremor can detect clinical change better than rating scales or transducers used in isolated assessments with prescribed activities.…”