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Tremor Other Hyperkinet Mov (N Y). 2017 Mar 25;7:453. doi: 10.7916/D8KW5MRG. eCollection 2017.

Early Head Tremor in Essential Tremor: A Case Series and Commentary.

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Division of Movement Disorders, Department of Neurology, Yale School of Medicine, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, USA.
Division of Movement Disorders, Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA.



Classically, the onset of head tremor in essential tremor (ET) patients follows that of hand tremor, such that there is a somatotopic spread of involved areas. Here we present a series of seven self-reportedly "unaffected" relatives of ET cases. These seven were clinically asymptomatic and had normal levels of arm tremor on examination, yet each evidenced a transient head wobble on examination. We estimate the prevalence of this phenotype within the two studies from which cases were ascertained.


ET cases and their self-reportedly affected and unaffected relatives, enrolled in two family studies, underwent a medical history and videotaped neurological examination.


In seven self-reportedly "unaffected" relatives, a transient and subtle head wobble was seen, always during sustained phonation, speech, or reading aloud. Total tremor score (a measure of arm tremor) ranged from 5 to 12 (i.e., mild tremor within the range of normal). The prevalence of this phenotype of early head tremor was 3.7% in one study and 23.1% in the other.


We present a series of seven individuals who had early head tremor in an evolving transition state from normal to ET. These cases raise a number of broad clinical, phenotypic, and pathophysiological issues about ET.


Essential tremor; clinical; head tremor; phenotype

Conflict of interest statement

Funding: This work was supported by the National Institutes of Health (NINDS #R01 NS094607 and NINDS #R01 NS073872). This funding body played no role in the design of the study, the collection, analysis, and interpretation of data, or the writing of the manuscript. Conflict of Interest: The authors declare no conflict of interest. Ethics Statements: All patients that appear on video have provided written informed consent; authorization for the videotaping and for publication of the videotape was provided.

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