Intention Tremor of the Legs in Essential Tremor: Prevalence and Clinical Correlates

To estimate the prevalence and assess the clinical correlates of intention tremor in the legs in essential tremor (ET) patients.

The cerebellar features of ET are of growing interest to clinical neurologists. Arm tremor has an intentional component in many ET patients. Intention tremor in the legs, however, has never been systematically evaluated.

One-hundred-twenty-eight ET patients were enrolled in a clinical-epidemiological study at Columbia University. A videotaped neurological examination included 10 toe-to-target movements with each foot. Videotapes were independently reviewed by two movement disorder neurologists who noted the presence vs. absence of intentional leg tremor. Two patients underwent quantitative computerized tremor analysis to study the physiological characteristics of the tremor.

Thirty-five patients (27.3%) had intentional leg tremor; in 21, tremor was unilateral and in 14 it was bilateral. The 35 patients with intentional leg tremor did not differ from the remaining 93 patients in their clinical characteristics. Analyses comparing the 14 patients with bilateral intentional leg tremor to the 93 patients with no intentional leg tremor showed trends towards longer disease duration and more severe intentional arm tremor in the former. Tremor analysis showed a 3-fold increase in average tremor amplitude from movement onset to the point just prior to touching the target.

Our data suggest that intentional leg tremor, another cerebellar feature, is common in ET patients. The tremor may be associated with longer disease duration and more severe intentional arm tremor, but these preliminary trends need to be assessed in larger study samples.