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Triggering essential head tremor with sustained phonation: a clinical phenomenon with potential diagnostic value
Brenton A Wright1, Monika Michalec2, Elan D Louis3
1Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Parkinsonism & Related Disorders
|November 28, 2013
Summary
Sustained phonation can trigger or worsen head tremor in essential tremor (ET) patients. This voice activation maneuver may help diagnose ET, especially when arm tremor is mild.
Area of Science:
- Neurology
- Clinical Medicine
Background:
- Head tremor is a common symptom in essential tremor (ET).
- The effect of sustained phonation on head tremor has not been previously reported or studied.
Purpose of the Study:
- To report and investigate a clinical phenomenon where sustained phonation triggers or exacerbates head tremor.
- To estimate the prevalence and analyze clinical correlates of this phenomenon in essential tremor patients.
Main Methods:
- Qualitative assessment of head tremor using the Tremor Research Group Essential Tremor Rating Assessment Scale.
- Scores were assigned pre-, during, and post-sustained phonation in 102 essential tremor patients.
Main Results:
- 68.6% of patients showed increased head tremor during or after sustained phonation.
- In 4.9% of patients, head tremor was only detected during the voice activation maneuver.
- Women were more likely than men to exhibit this phenomenon (p=0.05).
Conclusions:
- Sustained voice activation is a valuable maneuver to elicit or amplify head tremor in essential tremor.
- This maneuver may aid in differentiating essential tremor from enhanced physiological tremor, particularly in mild cases.
- The phenomenon may serve as a useful diagnostic supplement in clinical and research settings.
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