Abstract
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.
Highlights
The diagnosis of essential tremor (ET) remains a clinical one, and diagnostic errors are common
Our a priori hypothesis was that diagnostic errors with respect to Essential tremor (ET) would remain common, likely more than 25%, but that misdiagnosis with Parkinson’s disease (PD) would be less of an issue than reported in earlier studies
Through our university computerized clinical interface, we searched and identified all consecutive patients who fulfilled each of the following inclusion criteria: [1] initial outpatient evaluation by one of the authors (EDL), [2] preevaluation diagnosis of ET, [3] initial evaluation by evaluated by solely one provider (EDL) occurred between January 2015 and December 2019
Summary
The diagnosis of essential tremor (ET) remains a clinical one, and diagnostic errors are common. The diagnosis remains a clinical one, and diagnostic errors are quite common, with frequent misclassification with respect to other movement disorders, especially Parkinson’s disease (PD), dystonia, and enhanced physiologic tremor [2,3,4]. With the advent of greater societal awareness of PD and the widespread availability of DaTSCAN, it is quite probable that this is less often the case. This topic has not been revisited in the past 15–20 years [2, 3], with no studies during the intervening period. Our a priori hypothesis was that diagnostic errors with respect to ET would remain common, likely more than 25%, but that misdiagnosis with PD would be less of an issue than reported in earlier studies
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
