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Disorders of Balance and Gait in Essential Tremor Are Associated with Midline Tremor and Age

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Abstract

Disorders of balance and gait have been observed in patients with essential tremor (ET), but their association with tremor severity remains unclear. This study aimed to evaluate postural instability and gait changes in ET patients and to investigate their relationship to tremor characteristics with regard to cerebellar dysfunction as a possible common pathogenetic mechanism in ET. Thirty ET patients (8F, mean (SD) age 55.8 (17.8), range 19–81 years) and 25 normal controls (7F, 53.0 (17.7), 19–81) were tested with the scales of Activities-specific Balance Confidence (ABC), Fullerton Advanced Balance (FAB), and International Cooperative Ataxia Rating Scale (ICARS). Posturography and gait were assessed using a Footscan® system. Tremor was evaluated by the Fahn–Tolosa–Marin Tremor Rating Scale (TRS) and accelerometry in five upper limb positions. A mean (SD) TRS sum score of 27.0 (13.2) corresponded to mild to moderate tremor severity in most patients. In comparison with controls, ET subjects exhibited lower tandem gait velocity (0.21 vs. 0.26 m/s, P = 0.028), more missteps (0.57 vs. 0.12, P = 0.039), and increased postural sway in tandem stance (sway area 301.1 vs. 202.9 mm2, P = 0.045). In normal gait, step width increased with the midline tremor subscore of TRS (Pearson r = 0.60, P = 0.046). Moreover, significant correlations were found between age and quantitative measures of normal and tandem gait in ET patients but not in controls. ABC, FAB, and ICARS scores did not significantly differ between patients and controls. In conclusion, gait and balance alterations in ET patients occur even without subjective complaints. Their relationship with midline tremor and dependence on age suggest a connection with cerebellar dysfunction.

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Acknowledgments

The authors wish to thank Klára Plichtová; Martina Puršová, M.Sc.; Marie Vinopalová, MD; and František Zahálka, M.Sc. for their technical help and Aaron Rulseh, MD for his correction of English. This study was supported by the Czech Ministry of Health, NS10336-3/2009; by the Czech Ministry of Education, MSM 0021620849; and by the Czech Technical University in Prague, SGS10/279/OHK3/3T/13.

Conflict of Interest

None of the authors report a conflict of interest with respect to financial or personal relationships with organizations that may have influence on this work.

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Authors and Affiliations

  1. Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Kateřinská 30, Prague, 128 21, Czech Republic

    Martina Hoskovcová, Olga Ulmanová, Tomáš Sieger, Robert Jech & Evžen Růžička

  2. Department of Control Engineering, Faculty of Electrical Engineering, Czech Technical University in Prague, Karlovo náměstí 13, Prague, 121 35, Czech Republic

    Otakar Šprdlík & Jana Nováková

  3. Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Karlovo náměstí 13, Prague, 121 35, Czech Republic

    Tomáš Sieger

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  1. Martina Hoskovcová
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  2. Olga Ulmanová
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  7. Evžen Růžička
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Correspondence to Evžen Růžička.

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Hoskovcová, M., Ulmanová, O., Šprdlík, O. et al. Disorders of Balance and Gait in Essential Tremor Are Associated with Midline Tremor and Age. Cerebellum 12, 27–34 (2013). https://doi.org/10.1007/s12311-012-0384-4

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  • DOI: https://doi.org/10.1007/s12311-012-0384-4

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