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A comparison of different bedside tests for essential tremor
1Department of Neurology, the Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Summary
The finger-to-nose maneuver is most sensitive for detecting essential tremor (ET), while sustained arm extension and spiral drawing are better for excluding controls. Test selection depends on diagnostic goals.
Area of Science:
- Neurology
- Clinical Diagnostics
Background:
- Essential tremor (ET) diagnosis relies on various bedside tests.
- Optimizing test selection is crucial for efficient large-scale epidemiological studies of ET.
Purpose of the Study:
- To evaluate and compare the diagnostic performance of different bedside tests for essential tremor (ET).
Main Methods:
- 154 subjects (42 ET, 112 controls) underwent a tremor examination with six distinct tests.
- Tests were performed with dominant and nondominant arms and rated for tremor severity by neurologists.
- Videotaped examinations allowed for standardized and reproducible tremor severity assessments.
Main Results:
- Significant variation in test performance was observed for essential tremor (ET) cases.
- The finger-to-nose maneuver showed high sensitivity (88.1% rated >+2 tremor) in ET cases.
- Sustained arm extension and spiral drawing tests demonstrated utility in differentiating ET cases from controls, with lower false positive rates.
Conclusions:
- Bedside test performance for essential tremor (ET) diagnosis varies considerably.
- The finger-to-nose maneuver is recommended for screening populations for ET.
- Sustained arm extension, pouring water, and spiral drawing tests are useful for excluding non-ET subjects.