title: Are patients with limb and head tremor a clinically distinct subtype of essential tremor?
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Several demographic and clinical variables suggest that ET patients with HT have a distinct clinical phenotype.
authors: 1Department of Clinical Neurosciences,National Institute of Mental Health & Neurosciences,Hosur Road,Bangalore-560029,Karnataka,India.
authors: Abhishek
authors: A
authors: Lenka
authors: 1Department of Clinical Neurosciences,National Institute of Mental Health & Neurosciences,Hosur Road,Bangalore-560029,Karnataka,India.
authors: Ketaki Swapnil
authors: KS
authors: Bhalsing
authors: 1Department of Clinical Neurosciences,National Institute of Mental Health & Neurosciences,Hosur Road,Bangalore-560029,Karnataka,India.
authors: Ketan Ramakant
authors: KR
authors: Jhunjhunwala
authors: 2Department of Neurology,National Institute of Mental Health & Neurosciences,Hosur Road,Bangalore-560029,Karnataka,India.
authors: Vijay
authors: V
authors: Chandran
authors: 2Department of Neurology,National Institute of Mental Health & Neurosciences,Hosur Road,Bangalore-560029,Karnataka,India.
authors: Pramod Kumar
authors: PK
authors: Pal
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D020329:Essential Tremor / Q000503:physiopathology*; D005121:Extremities / Q000503:physiopathology*; D005260:Female; D005820:Genetic Testing; D006257:Head / Q000503:physiopathology*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D014103:Torticollis / Q000150:complications / Q000503:physiopathology; D014832:Voice Disorders / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult
keywords: voice tremor