Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Kateřinská 30, Prague, 128 21, Czech Republic.
Cerebellum. 2013 Feb;12(1):27-34. doi: 10.1007/s12311-012-0384-4.
Disorders of balance and gait have been observed in patients with essential tremor (ET), but their association with tremor severity remains unclear. This study aimed to evaluate postural instability and gait changes in ET patients and to investigate their relationship to tremor characteristics with regard to cerebellar dysfunction as a possible common pathogenetic mechanism in ET. Thirty ET patients (8F, mean (SD) age 55.8 (17.8), range 19-81 years) and 25 normal controls (7F, 53.0 (17.7), 19-81) were tested with the scales of Activities-specific Balance Confidence (ABC), Fullerton Advanced Balance (FAB), and International Cooperative Ataxia Rating Scale (ICARS). Posturography and gait were assessed using a Footscan® system. Tremor was evaluated by the Fahn-Tolosa-Marin Tremor Rating Scale (TRS) and accelerometry in five upper limb positions. A mean (SD) TRS sum score of 27.0 (13.2) corresponded to mild to moderate tremor severity in most patients. In comparison with controls, ET subjects exhibited lower tandem gait velocity (0.21 vs. 0.26 m/s, P = 0.028), more missteps (0.57 vs. 0.12, P = 0.039), and increased postural sway in tandem stance (sway area 301.1 vs. 202.9 mm(2), P = 0.045). In normal gait, step width increased with the midline tremor subscore of TRS (Pearson r = 0.60, P = 0.046). Moreover, significant correlations were found between age and quantitative measures of normal and tandem gait in ET patients but not in controls. ABC, FAB, and ICARS scores did not significantly differ between patients and controls. In conclusion, gait and balance alterations in ET patients occur even without subjective complaints. Their relationship with midline tremor and dependence on age suggest a connection with cerebellar dysfunction.
平衡和步态障碍在特发性震颤（ET）患者中已被观察到，但它们与震颤严重程度的关系尚不清楚。本研究旨在评估 ET 患者的姿势不稳定和步态变化，并探讨其与震颤特征的关系，以小脑功能障碍为可能的共同发病机制。
三十名 ET 患者（8 名女性，平均（标准差）年龄 55.8（17.8）岁，范围 19-81 岁）和 25 名正常对照者（7 名女性，53.0（17.7）岁，19-81 岁）接受了活动特异性平衡信心量表（ABC）、富尔顿高级平衡量表（FAB）和国际合作共济失调评定量表（ICARS）的测试。使用 Footscan®系统进行了姿势描记术和步态评估。震颤通过 Fahn-Tolosa-Marin 震颤评定量表（TRS）和五个上肢位置的加速度计进行评估。大多数患者的平均（标准差）TRS 总分 27.0（13.2）对应于轻度至中度震颤严重程度。与对照组相比，ET 受试者的足跟-足尖步态速度较慢（0.21 与 0.26 m/s，P = 0.028），错误更多（0.57 与 0.12，P = 0.039），并且在足跟-足尖站立时姿势摆动增加（摆动面积 301.1 与 202.9 mm²，P = 0.045）。在正常步态中，步宽随 TRS 的中线震颤亚评分增加（Pearson r = 0.60，P = 0.046）。此外，在 ET 患者中，年龄与正常和足跟-足尖步态的定量测量之间存在显著相关性，但在对照组中则没有。患者和对照组之间的 ABC、FAB 和 ICARS 评分没有显著差异。
总之，即使没有主观抱怨，ET 患者也会出现步态和平衡改变。它们与中线震颤的关系以及对年龄的依赖性提示与小脑功能障碍有关。
