Abstract
BackgroundPatients with upper limb action tremor frequently exhibit additional neurological signs of uncertain significance. Clinicians vary in their interpretation, and interrater agreement on the final diagnosis is poor.ObjectivesA new clinical tool for assessing the presence or absence of clinical signs that are important in axis‐1 classification of tremor patients is introduced: the Standardized Tremor Elements Assessment (STEA). Interrater agreement is determined, and signs leading to disagreement in the final diagnosis are identified.MethodsThree tremor‐focussed and one dystonia‐focussed movement disorder specialists rated 59 videos of patients with upper limb action tremor syndromes using STEA. Interrater agreements for final diagnosis and STEA items were calculated.ResultsInterrater agreement regarding the final diagnosis was higher within the group of tremor specialists and poor between dystonia and tremor specialists. Greater agreement was found for items characterizing tremor than for signs of dystonia.ConclusionsClinical signs leading to diagnostic disagreement were identified with STEA, and STEA should therefore be useful in future studies of diagnostic disagreement. The thresholds for considering neurological signs as soft versus significant for ataxia, parkinsonism, dystonia, etc. are critically important in tremor classification and must be studied across movement disorder subspecialties, not simply within a pool of tremor specialists.
Highlights
Patients with upper limb action tremor frequently exhibit additional neurological signs of uncertain significance
We have shown that the diagnosis of Essential tremor (ET) differs considerably among movement disorder specialists, our raters made their diagnosis based on the MDS classification scheme.[5]
The interrater reliability is low for many neurologic signs that are suggestive or indicative of ET plus questionable signs of dystonia or a dystonia tremor syndrome
Summary
Patients with upper limb action tremor frequently exhibit additional neurological signs of uncertain significance. Clinicians vary in their interpretation, and interrater agreement on the final diagnosis is poor. Interrater agreement is determined, and signs leading to disagreement in the final diagnosis are identified. Methods: Three tremor-focussed and one dystonia-focussed movement disorder specialists rated 59 videos of patients with upper limb action tremor syndromes using STEA. Interrater agreements for final diagnosis and STEA items were calculated. Results: Interrater agreement regarding the final diagnosis was higher within the group of tremor specialists and poor between dystonia and tremor specialists. Are critically important in tremor classification and must be studied across movement disorder subspecialties, not within a pool of tremor specialists The thresholds for considering neurological signs as soft versus significant for ataxia, parkinsonism, dystonia, etc. are critically important in tremor classification and must be studied across movement disorder subspecialties, not within a pool of tremor specialists
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