Agreement among movement disorder specialists on the clinical diagnosis of essential tremor

Even though essential tremor (ET) is the most prevalent movement disorder, there has been little agreement in the neurologic literature regarding diagnostic criteria for ET. The authors attempted to determine the extent and source of agreement and disagreement among neurologists regarding diagnostic criteria for clinically definite ET. The authors designed and mailed a semistructured questionnaire to 160 neurologists who specialize in movement disorders in 24 countries. The questionnaire included three sections: a list of inclusion criteria, a list of exclusion criteria, and a list of potential clinical scenarios (for example, isolated site‐specific tremor and primary orthostatic tremor). The questionnaire was completed by 98 (61%) of 160 targeted neurologists. There was greater consensus regarding features considered unnecessary inclusion criteria for clinically definite ET (extent of disability, disease duration, and positive family history) than for those considered necessary inclusion criteria (postural versus action tremor). With regard to exclusion criteria, there was some consensus in terms of the presence of Parkinson's disease, dystonia, history of hyperthyroidism or concurrent use of tremor‐inducing medications, and cerebellar signs. The majority of neurologists would diagnose ET in the setting of isolated head or voice tremor. There are areas of both consensus and divergence among neurologists with regard to diagnostic criteria for ET. The choice of diagnostic criteria may vary depending on the intended use of the criteria (that is, clinical versus genetic studies). Hopefully, this study will foster further discussion to achieve a more general consensus.

[1]  W. Koller,et al.  Handbook of tremor disorders , 1995 .

[2]  R. Elble,et al.  Primary writing tremor. A form of focal dystonia? , 1990, Movement disorders : official journal of the Movement Disorder Society.

[3]  M. Gresty,et al.  Tremor, the cogwheel phenomenon and clonus in Parkinson's disease. , 1981, Journal of neurology, neurosurgery, and psychiatry.

[4]  W. Koller,et al.  Essential tremor , 1987, Neurology.

[5]  W. Rocca,et al.  Prevalence of essential tremor , 1994, Neurology.

[6]  W Koller,et al.  Kinetic predominant essential tremor , 1987, Neurology.

[7]  W. Koller,et al.  Classification of essential tremor. , 1992, Clinical neuropharmacology.

[8]  E. Louis,et al.  How familial is familial tremor? , 1996, Neurology.

[9]  N. Yanagisawa,et al.  Familial dystonia musculorum deformans and tremor. , 1972, Journal of the neurological sciences.

[10]  R. Pahwa,et al.  Is there a relationship between Parkinson's disease and essential tremor? , 1993, Clinical neuropharmacology.

[11]  J C Rothwell,et al.  Writing tremor: its relationship to benign essential tremor. , 1985, Journal of neurology, neurosurgery, and psychiatry.

[12]  W. Koller,et al.  Essential tremor and dystonia , 1993, Neurology.

[13]  C. Marsden,et al.  A genetic study of idiopathic torsion dystonia in the United Kingdom. , 1990, Brain : a journal of neurology.

[14]  M. Hallett NINDS Myotatic Reflex Scale , 1993, Neurology.

[15]  C D Marsden,et al.  A study of hereditary essential tremor. , 1994, Brain : a journal of neurology.

[16]  T. Britton,et al.  Essential tremor and its variants. , 1995, Current opinion in neurology.

[17]  W. Johnson,et al.  Studies on dystonia musculorum deformans. , 1962, Archives of neurology.

[18]  C. S. Bartheld,et al.  Functional morphology of the paratympanic organ in the middle ear of birds. , 1994 .

[19]  Macdonald Critchley,et al.  OBSERVATIONS ON ESSENTIAL (HEREDOFAMILIAL) TREMOR , 1949 .

[20]  S. Pullman,et al.  Prevalence of asymptomatic tremor in relatives of patients with essential tremor. , 1997, Archives of neurology.

[21]  A. Rajput,et al.  Clinicopathologic observations in essential tremor , 1991, Neurology.