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Clinical Correlates of Action Tremor in Parkinson Disease
Elan D. Louis, MD, MS;
Gilberto Levy, MD;
Lucien J. Côte, MD;
Helen Mejia, MA;
Stanley Fahn, MD;
Karen Marder, MD, MPH
Arch Neurol. 2001;58:1630-1634.
Background Action tremor is often noted in patients with Parkinson disease (PD),
yet the clinical correlates of this type of tremor have been the focus of
few studies. It is not clear whether this action tremor is a manifestation
of the underlying basal ganglia disease.
Objective To determine whether the severity of action tremor in PD is associated
with age, age at disease onset, disease duration, levodopa dose, severity
of rest tremor, or other motor (ie, bradykinesia, rigidity) and nonmotor manifestations
of PD.
Methods Patients with PD (N = 197) were ascertained as part of a familial aggregation
study. All patients underwent a neurological examination. Rest tremor was
rated with the Unified Parkinson Disease Rating Scale; and action tremor,
with the Washington Heights–Inwood Genetic Study of Essential Tremor
Rating Scale.
Results Action tremor was present in 184 (93.4%) of 197 patients. Four patients
(2%) met criteria for definite essential tremor. The action tremor score was
not associated with age, age at onset, or disease duration. The action tremor
score was associated with the rest tremor score (r
= 0.37; P<.001), and more strongly with the ipsilateral
than contralateral rest tremor score. The association between the action tremor
score and the rest tremor score was diminished but still significant (r = 0.21, P<.02) even when
we excluded these 63 patients with re-emergent tremor. Neither the action
nor the rest tremor score was associated with the bradykinesia or rigidity
scores, Hoehn and Yahr scale score, or modified Mini-Mental State Examination
score.
Conclusions Action tremor was associated with rest tremor in PD, suggesting that,
at least in part, action tremor is a manifestation of the underlying basal
ganglia disease. Neither tremor was associated with other motor and nonmotor
manifestations of PD. This in turn suggests that tremor in PD may represent
an underlying pathophysiological process different from these other manifestations.
From the Gertrude H. Sergievsky Center (Drs Louis, Levy, Côte,
and Marder, and Ms Mejia) and the Department of Neurology (Drs Louis, Côte,
Marder, and Fahn), College of Physicians and Surgeons, Columbia University,
New York, NY.
Corresponding author and reprints: Elan D. Louis, MD, MS, Unit 198,
Neurological Institute, 710 W 168th St, New York, NY 10032 (e-mail:
EDL2{at}columbia.edu).
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ABSTRACT
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