Ataxic Gait in Essential Tremor: A Disease-Associated Feature?

Ashwini K Rao,Elan D Louis

doi:10.5334/tohm.507

Ashwini K Rao, Elan D Louis

Open Access

https://doi.org/10.5334/tohm.507

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Abstract

Background: While accumulating evidence suggests that balance and gait impairments are commonly seen in patients with essential tremor (ET), questions remain regarding their prevalence, their relationship with normal aging, whether they are similar to the impairments seen in spinocerebellar ataxias, their functional consequences, and whether some ET patients carry greater susceptibility. Methods: We conducted a literature search (until December 2018) on this topic. Results: We identified 23 articles on gait or balance impairments in ET. The prevalence of balance impairment (missteps on tandem walk test) was seven times higher in ET patients than controls. Gait impairments in ET included reduced speed, increased asymmetry, and impaired dynamic balance. While balance and gait problems worsened with age, ET patients were more impaired than controls, independent of age. The pattern of impairments seen in ET was qualitatively similar to that seen in spinocerebellar ataxias. Balance and gait impairments resulted in greater number of near falls in ET patients. Factors associated with balance and gait impairments in ET included age, presence of tremor in midline structures, and cognitive dysfunction. Discussion: Accumulating evidence suggests that balance and gait impairments are common in ET patients and occur to a greater extent in controls. Thus, they represent a disease-associated feature. These impairments, which are qualitatively similar to those seen in spinocerebellar ataxias, are not merely subclinical but result in difficulty performing functional tasks and increase falls risk. A subset of patients is more susceptible to balance and gait impairments. The full spectrum of impairments remains to be characterized.

Highlights

Essential tremor (ET) is among the most common movement disorders, and its primary feature is action tremor.[1]
Despite recent advances in characterizing balance and gait dysfunction in essential tremor (ET), a number of questions remain unanswered: (1) How common are balance and gait impairments in ET? (2) Are balance problems in ET the result of advanced age? (3) Are the balance and gait impairments similar to those seen in cerebellar ataxia? (4) What are the functional consequences of these impairments? (5) Are some ET patients more susceptible to balance and gait impairments? (6) Does intervention improve balance and gait in ET? The purpose of this article was to conduct a comprehensive review of studies on balance and gait impairments in ET
When we combined the results of the five studies (N = 379 ET patients), tandem walk abnormality was seen in 42% (N = 159) of ET patients and 22% (N = 33 out of 144) of controls

Summary

Introduction

Essential tremor (ET) is among the most common movement disorders, and its primary feature is action (i.e., kinetic and postural) tremor.[1]. While tremor is the defining feature of ET, impairments of gait and balance are commonly seen.[5] Numerous studies have shown that ET patients have difficulty with tandem walk, in which subjects are required to walk 10 steps in a straight line, with the heel of the leading foot touching the toe of the following foot.[6,7,8,9] Early studies examining tandem walk suggested that balance impairment during this test might be because of advanced age of ET patients.[7,9] recent case studies have challenged this notion.[6,10,11] quantitative analysis of gait with. While accumulating evidence suggests that balance and gait impairments are commonly seen in patients with essential tremor (ET), questions remain regarding their prevalence, their relationship with normal aging, whether they are similar to the impairments seen in spinocerebellar ataxias, their functional consequences, and whether some ET patients carry greater susceptibility

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