Lenka Abhishek, Bhalsing Ketaki Swapnil, Jhunjhunwala Ketan Ramakant, Chandran Vijay, Pal Pramod Kumar
1Department of Clinical Neurosciences,National Institute of Mental Health & Neurosciences,Hosur Road,Bangalore-560029,Karnataka,India.
2Department of Neurology,National Institute of Mental Health & Neurosciences,Hosur Road,Bangalore-560029,Karnataka,India.
Can J Neurol Sci. 2015 May;42(3):181-6. doi: 10.1017/cjn.2015.23. Epub 2015 Apr 10.
Essential tremor (ET) is the most common tremor disorder in adults. In addition to upper limbs, the tremor in ET may also involve head, jaw, voice, tongue, and trunk. Though head tremor (HT) is commonly present in patients with ET, large comparative studies of ET patients with HT (HT+) and without HT (HT-) are few.
To determine whether ET with HT is a distinct clinical subtype by comparing ET patients with and without HT, a chart review of 234 consecutive patients with ET attending the neurology clinics of the National Institute of Mental Health and Neurosciences, India, was done. A movement disorder specialist confirmed the diagnosis of ET in all patients using the National Institutes of Health collaborative genetic criteria.
HT was present in 44.4% of the patients. Comparison between HT+ and HT- showed that the HT+ group patients: (1) were older, (2) had later onset of tremor, (3) had unimodal distribution of age at onset with a single peak in the fifth decade, (4) had more frequent voice tremor, and (5) were more likely to have mild cervical dystonia. HT was part of presenting symptoms in nearly two thirds of the ET patients and in the rest it was detected during clinical examination.
Several demographic and clinical variables suggest that ET patients with HT have a distinct clinical phenotype.
特发性震颤（ET）是成人中最常见的震颤疾病。除上肢外，ET中的震颤还可能累及头部、下颌、声音、舌头和躯干。尽管头部震颤（HT）在ET患者中很常见，但对有HT（HT+）和无HT（ET-）的ET患者进行的大型比较研究却很少。
为了通过比较有HT和无HT的ET患者来确定伴有HT的ET是否为一种独特的临床亚型，我们对印度国家心理健康和神经科学研究所神经科门诊连续就诊的234例ET患者进行了病历回顾。一名运动障碍专家使用美国国立卫生研究院的协作基因标准对所有患者的ET诊断进行了确认。
44.4%的患者存在HT。HT+组和HT-组的比较显示，HT+组患者：（1）年龄更大，（2）震颤起病更晚，（3）起病年龄呈单峰分布，在第五个十年出现一个峰值，（4）声音震颤更频繁，（5）更有可能患有轻度颈部肌张力障碍。HT在近三分之二的ET患者中是首发症状的一部分，其余患者在临床检查中被发现。
一些人口统计学和临床变量表明，伴有HT的ET患者具有独特的临床表型。
