Embarrassment in essential tremor: prevalence, clinical correlates and therapeutic implications

Embarrassment is a commonly described feature of essential tremor (ET) but has not been the focus of clinical research.

To estimate the prevalence, identify susceptible patient groups, and quantify the therapeutic correlates of reported embarrassment.

A total of 106 ET cases from a population-based sample and 349 ET cases from a clinical sample were asked, "Does your tremor often embarrass you?"

In the clinical sample, the prevalence of embarrassment was high (58.2%). Even in those ET cases with no head tremor and mild arm tremor, nearly one-half (29/61 [47.5%]) reported embarrassment. While the prevalence of embarrassment was lower in the population-based sample, it was not negligible (18.9%). Embarrassment was associated with younger age of onset (p=0.003) and women were nearly twice as likely as men to report embarrassment (OR=1.85, p=0.01). Independent of tremor severity, embarrassment nearly doubled the odds of using tremor medication (OR=1.86, p=0.01).

Embarrassment may be a source of disability in ET. Even among clinic patients with mild tremor, nearly one-half reported embarrassment. We identified a number of patient characteristics linked to embarrassment. Embarrassment alone (i.e., independent of tremor severity) was responsible for a doubling of tremor medication usage. The majority of clinical trials do not assess the therapeutic effects of medication on embarrassment. These trials may benefit from scaled assessments of level of embarrassment.