Vol 4: Shaky drawing: what is the rate of decline during prospective follow-up of essential tremorReport as inadecuate



 Vol 4: Shaky drawing: what is the rate of decline during prospective follow-up of essential tremor


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This article is from BMJ Open, volume 4.AbstractObjective: Few studies have attempted to estimate the rate of decline over time in essential tremor ET. The study objectives were to: 1 measure change, deriving a single summary measure for the entire group, and relate it to a commonly used clinical rating scale ie, yearly change in points on that scale; 2 to assess change as a function of baseline clinical characteristics and 3 to answer the basic clinical question—is change perceptible-obvious during the follow-up of ET cases? Setting: Prospective collection of longitudinal data on ET cases enrolled in a study of the environmental epidemiology of ET at Columbia University Medical Center 2000–2008. Participants: 116 unselected ET cases. Interventions: Each case underwent the same evaluation at baseline and during one follow-up visit mean follow-up interval range=5.8 1.4–12.4 years. Primary and secondary outcome measures: We assessed tremor during a commonly affected daily activity—drawing ie, spirography, quantifying tremor using a simple, standardised 10-point rating scale developed by Bain and Findley. Results: The Bain and Findley spiral score increased at an average rate of 0.12±0.23 points per year maximum=1 point-year. In cases who had been followed for ≥5 years, the change was obvious—a blinded neurologist was able to correctly order their spirals baseline vs follow-up in three-fourth of cases. The rate of change was higher in cases with versus without familial ET p=0.01. Conclusions: Tremor in ET is slowly progressive; yet in the majority of cases, a clear difference in handwritten spirals was visible with a follow-up interval of five or more years. There may be differences between familial and non-familial ET in the rate of progression. These clinical data are intended to aid in the prognostic discussions that treating physicians have with their patients with ET.



Author: Louis, Elan D; Michalec, Monica; Gillman, Art

Source: https://archive.org/







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