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How Are We Misdiagnosing Essential Tremor?

Samay Jain, MD; Steven E. Lo, MD; Elan D. Louis, MD, MS

Arch Neurol. 2006;63:1100-1104.

Background  As a common neurological disorder, the diagnosis of essential tremor (ET) is considered routine. Despite this, previous work suggests that misdiagnoses may be common. Among other things, these misdiagnoses can lead to treatment errors.

Objectives  To estimate how often other tremor disorders are misdiagnosed as ET and to identify factors that increase the odds of misdiagnosing ET and to precisely quantify the extent to which they do so.

Design  Seventy-one consecutive patients underwent an evaluation at the Neurological Institute of New York, New York, between January 1, 2000, and December 31, 2005; these patients had a preevaluation diagnosis of ET. The criteria for ET were adapted from the consensus statement of the Movement Disorder Society.

Results  Twenty-six patients (37%) were misdiagnosed as having ET ("false ET"). Their true diagnoses were Parkinson disease (11 patients [15%]), dystonia (6 patients [8%]), Parkinson disease with ET (5 patients [7%]), and other disorders (4 patients [6%]). Factors associated with misdiagnosed ET included unilateral arm tremor (odds ratio, 10.5; 95% confidence interval, 1.2-95.4; P=.02), spooning of the hands and other dystonic postures (odds ratio, 16.3; 95% confidence interval, 4.0-66.4; P<.001), and other unusual features (isolated thumb tremor, isolated leg tremor, and nonrhythmic tremor) (odds ratio, 49.4; 95% confidence interval, 2.7-895.0; P<.001).

Conclusions  About 1 in 3 patients with tremor was misdiagnosed as having ET, with the most frequent false diagnoses being Parkinson disease and dystonia. Several factors that increased the odds of misdiagnosing ET were identified. These factors could be incorporated into improved diagnostic algorithms.

Author Affiliations: Department of Neurology (Drs Jain, Lo, and Louis), Gertrude H. Sergievsky Center (Dr Louis), and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (Dr Louis), College of Physicians and Surgeons, Columbia University, New York, NY.

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