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Comparative Study
. 2024 Jun;11(6):645-654.
doi: 10.1002/mdc3.14026. Epub 2024 Apr 9.

Comparing Essential Tremor with and without Soft Dystonic Signs and Tremor Combined with Dystonia: The TITAN Study

Roberto Erro  1 , Giulia Lazzeri  2 , Carmen Terranova  3 , Giulia Paparella  4   5 , Angelo Fabio Gigante  6 , Rosa De Micco  7 , Luca Magistrelli  8   9 , Francesca Di Biasio  10 , Francesca Valentino  11 , Vincenzo Moschella  12 , Andrea Pilotto  13 , Marcello Esposito  14 , Enrica Olivola  5 , Maria Chiara Malaguti  15 , Roberto Ceravolo  16 , Carlo Dallocchio  17 , Francesca Spagnolo  18 , Alessandra Nicoletti  19 , Anna De Rosa  20 , Raffaella Di Giacopo  21 , Cristiano Sorrentino  1 , Alessandro Padovani  13 , Maria Concetta Altavista  12 , Claudio Pacchetti  11 , Roberta Marchese  10 , Elena Contaldi  8 , Alessandro Tessitore  7 , Salvatore Misceo  6 , Matteo Bologna  4   5 , Vincenzo Rizzo  3 , Giulia Franco  2 , Paolo Barone  1 ; TITAN study group
Collaborators, Affiliations
Comparative Study

Comparing Essential Tremor with and without Soft Dystonic Signs and Tremor Combined with Dystonia: The TITAN Study

Roberto Erro et al. Mov Disord Clin Pract. 2024 Jun.

Abstract

Background: Tremor disorders remain as clinical diagnoses and the rate of misdiagnosis between the commonest non-parkinsonian tremors is relatively high.

Objectives: To compare the clinical features of Essential Tremor without other features (pure ET), ET plus soft dystonic signs (ET + DS), and tremor combined with dystonia (TwD).

Methods: We compared the clinical features of patients with pure ET, ET + DS, and TwD enrolled in The ITAlian tremor Network (TITAN). Linear regression models were performed to determine factors associated with health status and quality of life.

Results: Three-hundred-eighty-three patients were included. Sex distribution was significantly different between the groups with males being more represented in pure ET and females in TwD. The initial site of tremor was different between the groups with about 40% of TwD having head tremor and ET + DS unilateral upper limb tremor at onset. This pattern mirrored the distribution of overt dystonia and soft dystonic signs at examination. Sensory trick, task-specificity, and position-dependence were more common, but not exclusive, to TwD. Pure ET patients showed the lowest degree of alcohol responsiveness and ET + DS the highest. Midline tremor was more commonly encountered and more severe in TwD than in the other groups. Regression analyses demonstrated that tremor severity, sex, age, and to a lesser degree the variable "group", independently predicted health status and quality of life, suggesting the existence of other determinants beyond tremor.

Conclusions: Pure ET and TwD manifest with a phenotypic overlap, which calls for the identification of diagnostic biomarkers. ET + DS shared features with both syndromes, suggesting intra-group heterogeneity.

Keywords: dystonia; essential tremor plus; gender; quality of life; soft signs.

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Figures

Figure 1
Figure 1
Distribution of the soft dystonic signs in ET + DS and of dystonia in TwD. ET + DS, essential tremor plus soft dystonic signs; TwD, tremor combined with dystonia.
See this image and copyright information in PMC

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