Tremor Study Group

Rodger Elble          

Rodger Elble             Günther Deuschl
Chair                             Chair

MDS Staff Liaison: Ken Buesing
 

Members

Giovanni Abbruzzese
Alberto Albanese
Peter Bain
Nin Bajaj
Jos Becktepe
Bettina Balint
Julián Benito-León
Kailash Bhatia
Ahmad El Kouzi
Alberto Espay
Alfonso Fasano
Joaquim Ferreira
Victor Fung

Felix Gövert
Mark Hallett
Anhar Hassan 
Dietrich Haubenberger
Rich Helmich
Franziska Hopfner
Hyder Jinnah 
Maria Joao Forjaz
Norbert Kovacs
Elan Louis
Kelly Lyons
Pablo Martinez-Martin
Aristide Merola

   Tiago Mestre   
   William Ondo
   Ming-Kai Pan
   Sanjay Pandey
   Shweta Prasad
   Jan Raethjen
   Evžen Růžička
   Maria Stamelou
   Glenn Stebbins
   Eng-King Tan
   Claudia Testa
   Diego Torres Rusotto

 

The Tremor Study Group (TSG) evolved from the Task Force on Tremor, which completed its work in June 2017. The Task Force reviewed published rating scales1 and transducers2 for measuring tremor and developed a revised classification scheme for tremor.3 An evidence-based review of published treatments for pathologic tremors was conducted and is being revised and updated. Based on this work, the following objectives for the TSG were identified.

1. Deep tremor phenotyping

A systematic, deep phenotyping of patients with monosymptomatic tremor disorders (e.g., essential tremor) is needed. The TSG is therefore developing an ordinal assessment tool that will guide clinicians in deep tremor phenotyping, so as to distinguish essential tremor from essential tremor plus and other forms of tremor that are commonly mistaken as essential tremor. The assessment tool will capture subtle or questionable features of dystonia, myoclonus, parkinsonism and ataxia. A video protocol is being developed in conjunction with this tool. To validate this assessment and video protocol, each member of the TSG will produce a video assessment of three patients: essential tremor, essential tremor plus and a combined tremor syndrome that presented with the sole complaint of tremor (monosymptomatic tremor disorder). The ultimate goal is to incorporate this assessment tool and video protocol into a web-based REDCap database that can be used in conjunction with clinical research studies.

2. Tremor scales development

Othostatic tremor severity scale

In our previous review of available tremor assessment scales, it was found that there is no validated scale for orthostatic tremor.1 Treatment of this relatively rare condition is being approached pharmacologically and surgically, and a validated scale for orthostatic tremor is therefore being developed.

Unified Tremor Rating Scale

A scale is needed that captures typical (action tremor) and atypical (e.g., rest tremor, prominent lower limb tremor) tremor in patients with essential tremor and essential tremor plus. We are developing a new scale that builds upon the strengths of the Fahn-Tolosa-Marín scale and the Essential Tremor Rating Assessment Scale (TETRAS). This scale will become one of a battery of scales for the clinical assessment of tremor.

3. Instrumented measures of tremor

Certain aspects of tremor are believed to be useful in distinguishing essential tremor from other tremors (e.g., dystonic tremor and rhythmic cortical myoclonus). However, these tremor characteristics (e.g., irregularity in amplitude and rhythm, fluctuating axis of rotation, posturing of the head or limb) are very difficult to assess by clinical inspection. We believe there is a role for motion transducers, computerized video analysis, and other electrophysiologic methods in the characterization of tremor. We envision such methods being used in a deep phenotyping of tremor patients.

4. Web-based tremor database

The TSG has the overall goal of promoting greater depth and standardization in the phenotyping of patients with tremor disorders, particularly monosymptomatic tremor disorders such as essential tremor. The scales developed by the TSG will be incorporated into a web-based tremor database that will have data elements in common with the Dystonia Coalition database. This database will be linked to an archive of patient videos and to repositories of DNA samples for research.

Membership

The TSG is chaired by Günther Deuschl and Rodger Elble and is comprised of those members of the original Task Force who agreed to participate in one or more of the above projects. Additional members have been added through their participation in an ongoing project. Persons desiring membership should contact Günther Deuschl or Rodger Elble. New members must participate in an ongoing project or propose to spearhead a new project. Bylaws for the TSG have been developed.

References

1. Elble R, Bain P, Forjaz MJ, et al. Task force report: scales for screening and evaluating tremor: critique and recommendations. Mov Disord 2013;28(13):1793-1800. 
2. Haubenberger D, Abbruzzese G, Bain PG, et al. Transducer-based evaluation of tremor. Mov Disord 2016;31(9):1327-1336.
3. Bhatia KP, Bain P, Bajaj N, et al. Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord 2018;33(1):75-87. 

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