1
Rajput
ESSENTIAL TREMOR: Clinical profile and Pathological findings – Table 1
Patient Identifi-cation(Sex) / Site of tremor onset
(onset age) / Final site(s) of tremor / Maximum ETseverity (amplitude) of tremor at any site
(UPDRS) / Presence of Rest tremor
Bradykinesia
Rigidity
(ever) / Drugs used for tremor / Symptomatic benefit
Yes – No / Psychological
Distressand/or psychiatric diagnosis / Physical
disability
due to tremor / Other illness of significance / (Age at death)
Brain Pathology
Case 1
(M) / UL
(68 yrs) / UL
+ Head
+ Voice / 2 / None / Primidone - Yes
(leg edema)
Phenytoin - No
Levodopa - No / None / Feeding
Drinking / Dysphagia / (85)
Cerebral arterio-
sclerosis,
hippocampus
ischemic
changes (recent)
Case 2
(F) / UL and
Head
(childhood) / UL
Head
+Jaw
+LL / 4 / Rest tremor
Bradykinesia
Rigidity / Anticholinergic - Yes
Propranolol - Yes
Levodopa - No / Depression / Feeding
Drinking
from a cup
Writing
Dysarthria / Polyneuro-
pathy (mild)
Ataxia (mild) / (78)
Cerebral arterio-
sclerosis
Status cribrosus
basal ganglia
Case 3
(M) / UL and
Head
(childhood) / UL
Head / 1 / None / Phenobarb - No
(Drowsiness) / Alcoholism / None reported / Hypertension / (50)
Normal brain
histology
Case 4
(F) / UL
(55) / UL
+ Head / 1 / Rest tremor / Unknown / None known / Drinking
from a cup
(with left
hand) / Stroke
Rt hemiplegia / (95)
Left cerebral
infarct
Cerebellar
purkinje cell
loss
Case 5
(F) / UL and
Head
(51) / UL
Head
+ LL / 2 / Rest tremor
Bradykinesia Rigidity / Amantadine - No
(Hallucinations)
Propranolol - No
Anticholinergic - No
Levodopa - Yes
(Dyskinesia)
Bromocriptine - Yes / None / Drinking
Feeding
Other hand
functions / Vertigo
(episodic) / (79)
Substantia nigra
(PD) neuronal
loss and Lewy
body inclusions
Patient Identifi-cation
(Sex) / Site of tremor onset
(onset age) / Final site(s) of tremor / Maximum ETseverity (amplitude) of tremor at any site
(UPDRS) / Presence of Rest tremor
Bradykinesia
Rigidity
(ever) / Drugs used for tremor / Sympto-
matic benefit
Yes – No / Psychological
distressand/or
psychiatric diagnosis / Physical
disabilitydue to tremor / Other illness of significance / (Age at death)
Brain Pathology
Case 6
(M) / UL
(20) / UL
+ Head
+ Lips / 4 / None / Primidone - Unknown / Unknown / Writing
Drinking
from a cup / Chronic obst-
ructive
pulmonary
disease / (81)
Normal brain
histology
Case 7
(F) / UL
(56) / UL
+ Lips / 2 / None / Propranolol - Yes / None reported / Writing
Drinking
from a cup / Arthritis
Leukemia / (69)
Normal brain
histology
Case 8
(F) / Head
(26) / Head / 2 / None / Anticholinergic - No / Social embar-
rasssment / None / Ruptured
abdominal
aneurysm
Rheumatoid
arthritis / (83)
Lacunar infarct
Status cribrosus
basal ganglia
Case 9
(F) / UL
(35) / UL
+ Head / 2 / None / Propranolol - Yes / Depression / Writing
Holding a
cup / Deafness
Polyneuropathy
(mild)
Ischemic heart
disease
Ankylosing
spondylitis
Ataxia (mild) / (64)
Normal brain
histology
Case 10
(M) / UL
(64) / UL / 2 / Rest tremor / Propranolol - No
(wheezing)
Primidone - Yes
Deprenyl - No
Sinemet - No / None / Writing
Fine motor
task / Coronary artery
disease / (73)
Normal brain
histology
Case 11
(F) / UL
(65) / UL
+ Head / 2 / None / None / None / Writing
Knitting
Drinking
from a cup / Diabetes mellitus
Coronary artery
disease / (80)
Cerebellar
Purkinje cell
loss
Patient Identifi-cation (ID)
(Sex) / Site of tremor onset
(onset age) / Final site(s) of tremor / Maximum ET severity (amplitude) of tremor at any site
(UPDRS) / Presence of Rest tremor
Bradykinesia
Rigidity
(ever) / Drugs used for tremor / Sympto-matic benefit
Yes – No / Psychological distress
and /or psychiatric diagnosis / Physical
disability
due to tremor / Other illness of significance / (Age at death)
Brain Pathology
Case 12
(M) / UL
(42) / UL
+ Head / 2 / None / Propranolol - No
(impotence)
Metoprolol - No
(depression)
Primidone - ? / Anxious doing
things in
public
e.g. writing / Writing - had to retire early
(could not sign in public) / Multifocal
glioblastoma
Hypertension
Diabetes mellitus / (65)
Glioblastoma
(multifocal)
Case 13
(M) / UL
(23) / UL
+ Head / 2 / Rest tremor
Rigidity
Bradykinesia / Levodopa - No / Depression
(chlorproma-
zine, ECT) / Drinking
from cup
Feeding / DIP
Generalized
atherosclerosis
Hypertension
Coronary artery
Disease
Myocardial
infarction / (58)
Normal brain
histology
Case 14
(F) / UL
(30) / UL / 3 / Rest tremor / Propranolol -
(did not tolerate)
Primidone - No
Clonazepam - No / Depression
(ECT and Neuroleptics / Hand function
(could not
work as a
nurse) / Neuroleptic
malignant
syndrome / (62)
Recent peri-
vascular
hemorrhages in
thalamus and
hypothalamus
Case 15
(M) / UL
(61) / UL / 2 / Rest tremor
Bradykinesia
Rigidity / Propranolol - Yes / Depression
(ECT & Neuroleptics) / Tremor interfered with writing / Drug induced
parkinsonism
Coronary artery
disease
Died of ven-tricular fibrilla-tion. (Terminal stroke) / (67)
Normal brain
histology
Patient Identifi-cation (ID)
(Sex) / Site of tremor onset
(onset age) / Final site(s) of tremor / Maximum ETseverity (amplitude) of tremor at any site
(UPDRS) / Presence of Rest tremor
Bradykinesia
Rigidity
(ever) / Drugs used for tremor / Symptomatic benefit
Yes – No / Psychological distress and/or
psychiatric diagnosis / Physical Handicap due to tremor / Other illness of significance / (Age at death)
Brain Pathology
Case 16
(M) / UL
(30) / UL / 2 / Rest tremor / None tried / Depression
(mild) / None reported / None / (81)
Normal brain histology
Case 17
(F) / UL
Jaw
(57) / UL
Jaw
+ LL / 2 / Rest tremor / Propranolol - Yes
Levodopa - ? / None / Drinking
Feeding
Writing / Subdural hematoma / (92)
Normal brain histology
Case 18
(M) / UL
(60) / UL
+ Head
+ Chin
+ LL / 4 / Rest tremor Bradykinesia
Rigidity / Propranolol - Yes
Primidone - Yes
Levodopa - Yes / Socially embarrassing / Feeding
Drinking
Writing / Falls causing
fractures
Atrial fibril-
lation / (89)
Progressive Supranuclear palsy
Case 19
(M) / UL
(childhood)
/ UL / 2 / Rest tremor
Bradykinesia
Rigidity / Levodopa - Yes / Obsessive compulsive personality / None reported / None / (84)
Progressive supranuclear palsy
Case 20
(F) / UL
(58) / UL
+ Head
+ LL / 1 / Rest tremor / Levodopa - No
Deprenyl - No / None / None significant / Hypothyroidism / (79)
Normal brain
histology
Anterior com-
municating
artery berry
aneurysm
(unruptured)
UL = Upper limb; LL = Lower limb; DIP = Drug induced parkinsonism; UPDRS = Unified Parkinson’s Disease Rating Scale