Tandem gait performance in essential tremor: Clinical correlates and association with midline tremors

• Published in: Movement disorders 2010-08, Vol.25 (11), p.1633-1638
• Main Authors: Louis, Elan D., Rios, Eileen, Rao, Ashwini K.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arm - physiopathology; ataxia; balance; Biological and medical sciences; cerebellum; clinical correlate; Disability Evaluation; essential tremor; Essential Tremor - complications; Essential Tremor - pathology; Female; gait; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - pathology; head tremor; Humans; Jaw - physiopathology; Leg - physiopathology; Male; Medical sciences; Middle Aged; Neck - physiopathology; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Severity of Illness Index; Statistics as Topic
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.23144

Gait difficulty has been reported in essential tremor (ET) although it has been the subject of a limited number of studies. We broadly assessed these clinical correlates, including the association of gait difficulty with a variety of midline tremors (jaw, voice, neck). Tandem gait (10 steps) was assessed in 122 ET cases. Cranial tremor score (0–3) was the number of locations (neck, jaw, voice) in which tremor was present. Number of tandem mis‐steps positively correlated with age (P < 0.001), age of tremor onset (P = 0.001), and presence of neck (P < 0.001), jaw (P = 0.001), and voice tremors (P = 0.047). Number of tandem mis‐steps increased markedly with cranial tremor score: 0 (0.8 ± 1.2), 1 (1.1 ± 1.6), 2 (2.3 ± 3.0), 3 (3.7 ± 1.6) (P < 0.001). It was not correlated with severity of arm or leg tremors. ET patients with cranial tremors (neck, jaw, voice), those with older age of onset, and those of current older age are more likely to manifest tandem gait difficulty. Tandem gait difficulty was not correlated with severity of limb tremors. Tandem gait difficulty and cranial tremors in ET may both be symptomatic of the same underlying pathophysiology, a disturbance of cerebellar regulation of the midline, which is distinct from its regulation of the limbs. © 2010 Movement Disorder Society