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Elan D. Louis, MD, MS; Blair Ford, MD; Seth L. Pullman, MD

Arch Neurol. 1997;54(2):197-200.

Abstract
Background
The extent to which essential tremor (ET) clusters within families (ie, the familial aggregation of ET) is not precisely known. In part, this is because studies assign disease status in relatives of patients with ET based solely on interviews without conducting physical examinations. This may lead to underascertainment of affected relatives with mild asymptomatic ET.

Objective
To determine the prevalence of asymptomatic ET among relatives of patients with ET.

Methods
Interview and examination of 25 patients with ET and 58 of their relatives. The interview included 12 questions that screened the patients for ET. Two neurologists who specialize in movement disorders reviewed the videotaped examinations. Based on standardized criteria, diagnoses included ET (definite, probable, or possible) or normal.

Results
Of the 8 relatives who received diagnoses of ET, 5 (62.5%) had asymptomatic ET. Hence, 5 (8.6%) of the 58 relatives (95% confidence interval, 1.4%-15.8%) had asymptomatic ET. In those with asymptomatic ET, there was a preponderance of young individuals with mild tremor in the nondominant hand.

Conclusions
The prevalence of asymptomatic ET in relatives of patients with ET was similar to that of symptomatic ET. Family studies that do not perform both an interview and a physical examination will underascertain the number of affected relatives. Therefore, future family studies should evaluate relatives of patients with ET with an interview supplemented by a physical examination.

Author Affiliations
From the Department of Neurology (Drs Louis, Ford, and Pullman) and the Gertrude H. Sergievsky Center (Dr Louis), College of Physicians and Surgeons, Columbia University, New York, NY.

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