Clinical Characteristics In Patients With Essential Tremor

PartⅠClinical characteristics in patients with Essential TremorObjective:To study the Clinical characteristics and the common clinical manifestation,incidence and influencing factors of non-motor symptoms in patients with essential tremor(ET).We also observed the diversity of clinical symptoms among groups with different age,age onset and course of disease.Method:62 ET patients were enrolled in this study.Pittsburgh Sleep Quality Index (PSQI),Epworth Sleepiness Scale(ESS),Fatigue Severity Scale(FSS),Hamilton Depression Rating Scale for Depression(HAMD),Mini-Mental State Examination (MMSE) were used to evaluate sleep quality in recent a month,somnolence under different conditions in daily life,the impact of fatigue on daily life,depression in recent a month and cognitive impairment,as well as the Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS) was performed in patients with ET.Result:There were 48.3%patients had family history with ET.Upper limbs(100 %) and head(50%) were the most commonly affected,the total score of tremor was lower in females than in males(30.41±13.87,34.17±17.33),the probability of head tremor was higher in females than in male(20/33,11/29).The incidence of sleep disorders, somnolence,fatigue and depression were 51.6%(32/62),11.3%(7/62),19.4%(12/62) and 53.2%(33/62)separately.The mean score of MMSE is 26.29±3.75 in patients with ET. The FTMTRS total score is associated with non-motor symptoms.There are statistically differences on scores of FTMTRS in groups of different age and onset age.Conclusion:ET is characterized by postural and kinetic tremor involving the arms and,less commonly the head,the common non-motor symptoms as affective disorder, sleep disorders,followed by cognitive impairment,excessive daytime sleepiness,severe fatigue.Using motor and non-motor-related symptoms scales about ET contribute to evaluating the severity of ET patients o To concern the clinical features of ET patients can help optimizing the treatment plan,minimizing disability of the disease,improving quality of life,reducing the burden of the family and the society. PartⅡSleep disorders Associated With Essential TremorObjective:To evaluate the quality of sleep and investigate the abnormal appearance of sleep structure,the incidence of sleep disorder,factors associated with sleep disorder in ET patients.Method:63 ET patients were enrolled in this study.We recorded patients' age,gender, age onset,family history,history of treatments,course of disease,beginning symptom, tremor position,and the score of tremor.PSQI was used to evaluate sleep quality in recent a month.The PSQI consists of 19 self-rated questions and five questions rated by the bedpartner or roommate.Nineteen individual items generate seven "component" scores: subjective sleep quality,sleep latency,sleep duration,habitual sleep efficiency,sleep disturbances,use of sleeping medication,and daytime dysfunction.Each component weighted equally on a 0-3 scale.The seven component scores are summed to yield a global PSQI score,which has a range of 0-21,higher scores indicate worse sleep quality.The Hamilton Depression Rating Scale(HAMD),Fahn-Tolosa-Marin Tremor Rating Scale(FTMTRS),Epworth sleepiness scale(ESS) were as well as performed in patients with ET.Result:The poor quality of sleep was observed in 36 of 68(52.9%) ET patients compared with 25 of 70(35.7%) in controls(x~2=4.150,P=0.042).The manifestation of sleep disorders in 68 ET patients included:difficulties in the initiation of sleep, fragmented sleep and excessive daytime sleepiness(EDS).There were marked differences in the score of Hamilton Depression Rating Scale(HAMD) and age(t=2.381,P=0.021; t=4.058,P=0.000) between sleep disorder group and non-sleep disorder group.Meanwhile, there were statistical differences in subjective sleep(F1),quality sleep latency(F2),sleep duration hatitual(F3),sleep efficiency(F4),sleep disturbances(F5) and daytime dystunction(F7) between sleep disorder group and non-sleep disorder group.44.1%of ET patients and 15.7%of heathy subjects were found to be excessive daytime sleepiness (EDS score of 7or higher),19.1%of ET patients and 15.7%of heathy subjects fell into the mildly excessive daytime sleepiness range(EDS score between 7 and 9),25.0%of ET patients and 8.6%of heathy subjects fell into severely excessive daytime sleepiness range (EDS score of 10 or higher).There were statistical differences in ET group and heathy subjects group(x~2=4.361,P=0.037;x~2=6.703,P=0.010)Conclusion:Sleep disorders were more common in ET patients than in controls.The manifestation of sleep disorders in patients with ET include difficulties in the initiation of sleep,fragmented sleep,and excessive daytime sleepiness.Sleep disorders relate to depression and age.PartⅢComparision of depression between Parkinson's disease and essential tremorObjeetve:To study the incidence and associated factors of depression in Parkinson's disease and essential tremor.Methods.Unified Parkinson's Diseas Rating Scale(UPDRS)-motor examination (UPDRS-Ⅲ) and Hoehn and Yahr scale were used in 121 PD patients to evaluate the severity of the disease.Tremor Rating Scale for Tremor-motor examination(items 1-15 of the rating scale) was prforrned in ET patients.Hamilton Depression Rating Scale(24 items) was tested in all participants to measure the depression.Results:56.2%of PD patients and 53.2%%of ET patients were found to be depressed. There were no differences on the incidence of depression,mild depression,moderate depression and severe depression between the two groups.Anxiety/somatization,lose weight,changes day and night,block and sleep disorders were different between PD group and ET group.Score of HAMD was positively correlated with the score of UPDRS -Ⅲin PD patients(r=0.511,P＜0.01),as well as in ET patients,it was positively correlated with score of Tremor Rating Scale for Tremor-motor subscale(r=0.828,P＜0.01P).Conclusions:The incidence of depression is higher in PD and ET patients.The severity of depression was similar between the two groups.The mainly manifestations of depression were anxiety/somatization,dysthymia,anhedonia,retardation and insomnia. Depression was positivly correlated with motor disturbance.