Essential Tremor as a “Waste Basket” Diagnosis: Diagnosing Essential Tremor Remains a Challenge

Frontiers in Neurology

Elan D. Louis¹  Daniel Trujillo Diaz²  Christian J. Amlang³ 

[1] Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, United States;Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States;Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States;

关键词: essential tremor;    dystonia;    Parkinson's disease;    differential diagnosis;    clinical;   

DOI  :  10.3389/fneur.2020.00172

来源: DOAJ

【 摘 要 】

Introduction: The diagnosis of essential tremor (ET) remains a clinical one, and diagnostic errors are common. We aimed to (1) determine precisely how frequently ET diagnoses are misapplied (i.e., what percentage of patients who have been assigned an “ET” diagnosis actually have another movement disorder), (2) determine which other movement disorders are most often misclassified as “ET,” and (3) examine the clinical features that were most associated with diagnostic errors.Methods: One hundred four consecutive patients were included who met the following criteria: (1) initial outpatient evaluation by one of the authors (EDL) between January 2015 and December 2019 and (2) pre-evaluation diagnosis of ET. Data on an extensive number of clinical features were extracted from the electronic medical record.Results: Forty-seven (45.2%) patients received a post-evaluation diagnosis of ET, 29 (27.9%) of dystonia, and 28 (26.9%) of other diagnoses including Parkinson's disease (PD) [6 (5.8%)]. Factors associated with an alternative post-evaluation diagnosis other than ET were pre-evaluation diagnosis made by a non-neurologist, shorter tremor duration, irregular tremor, abnormal limb postures, among others.Discussion: Diagnosing ET remains a challenge, with the diagnosis being over-applied and being used as a “waste basket.” More than one-half of the patients who were referred to our clinic with an intake diagnosis of ET were given an alternative post-evaluation diagnosis. While PD was reported to be the most frequently missed diagnosis in a past study, dystonia was most commonly missed in our study. Several clinical features can help to differentiate ET from other tremor disorders.

【 授权许可】

Unknown