What is the functional significance of nondominant arm tremor in essential tremor?
Tremor in the dominant arm is often the focus of clinical attention in essential tremor (ET) yet many daily activities require both arms. The functional relevance of nondominant arm tremor has rarely been studied. In 181 right-handed patients with ET, action tremor in each arm was rated using a clinical rating scale. Tremor disability was self-reported and a performance-based test of function was administered. Independently of tremor on the right, greater tremor severity on the left was associated with greater self-reported disability (P = 0.02) and greater performance-based dysfunction (P < 0.001). In 5.0% of patients, tremor was largely restricted to the nondominant arm. Nondominant arm tremor, independent of dominant arm tremor, had a significant functional correlate, contributing to both greater perceived and greater observable functional difficulty. In 5% of patients, tremor in the nondominant arm was the likely motivator for seeking care, which is another indication of its functional significance. © 2010 Movement Disorder Society.
Louis
Elan D
ED
GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA. EDL2@columbia.edu
Gerbin
Marina
M
Mullaney
Mary M
MM
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000503:physiopathology*; D020329:Essential Tremor / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014202:Tremor / Q000503:physiopathology*
Neurologist. 2007 Sep;13(5):253-60
17848865
Mov Disord. 2000 May;15(3):516-23
10830418
Brain. 1994 Aug;117 ( Pt 4):805-24
7922467
Lancet. 2007 Apr 7;369(9568):1152-4
17416247
J Neurol Neurosurg Psychiatry. 1972 Jun;35(3):365-72
5035310
J Neurol. 1993 Nov;241(1):54-61
8138823
Curr Neurol Neurosci Rep. 2002 Jul;2(4):324-30
12044252
Arch Phys Med Rehabil. 2006 May;87(5):661-70
16635629
Arch Neurol. 1985 Nov;42(11):1082-3
4051838
Arch Neurol. 1999 Jul;56(7):841-6
10404986
Arch Neurol. 1998 Dec;55(12):1553-9
9865800
J Am Geriatr Soc. 1968 May;16(5):622-6
5646906
Mov Disord. 1998 Mar;13(2):287-93
9539343
Neurology. 2005 Aug 9;65(3):391-6
16087903
Mov Disord. 2009 Jan 15;24(1):108-11
18973247
Brain. 1949 Jun;72(Pt. 2):113-39
18136705