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Background: Patients presenting with asymmetrical postural tremor with or wot hout mild rest tremor may be diagnosed as having essential tremor (ET), although there is considerable diagnostic uncertainty as to the long term outcome of the se patients. Abstract Objective: In this study, retrospective observations were made on 1 3 patients presenting originally with asymmetrical postural tremor, initially th ough to have ET based on tremor characteristics, alcohol responsiveness, and fam ily history but who subsequently met the criteria of Parkinson’s disease (PD). Methods: The patients were observed and followed up clinically with ancillary i maging using dopamine transporter SPECT scan or levodopa challenge tests in some cases. The diagnosis at original presentation with postural tremor was made wit h retrospective case note review. Results: After a variable and long latent peri od all patients developed additional signs suggesting a clinical diagnosis of PD although picking up an initial label of ET. Conclusions: We Suggest exercising caution regarding a diagnosis of ET in patients presenting with late onset asymm etrical postural tremor even if there is no rest tremor. Alcohol sensitivity of tremor, family history of tremor, or responsiveness to β blockers may not be h elpful in diagnosing ET in these cases and some may develop PD in the longs term .
Background: Patients presenting with asymmetrical postural tremor with or wot hout mild rest tremor may be diagnosed as having having essential tremor (ET), although there is considerable diagnostic uncertainty as to the long term outcome of the se patients. Abstract Objective: In this study, retrospective observations were made on 1 3 patients presenting originally with asymmetrical postural tremor, initially though to have ET based on tremor characteristics, alcohol responsiveness, and fam ily history but previously presented the criteria of Parkinson’s disease (PD). Methods: The patients were observed and followed up clinically with ancillary i maging using dopamine transporter SPECT scan or levodopa challenge tests in some cases. The diagnosis at original presentation with postural tremor was made wit h retrospective case note review. Results: After a variable and long latent peri od all patients developed additional signs suggesting a clinical diagnosis of PD though picking up an init ial label of ET. Conclusions: We Suggest exercising caution regarding a diagnosis of ET in patients presenting with late onset asymm etrical postural tremor even if there is no rest tremor. Alcohol sensitivity of tremor, family history of tremor, or responsiveness to β blockers may not be h elpful in diagnosing ET in these cases and some may develop PD in the longs term.