Furthermore, most cases also display a prominent action tremor that impairs eating and writing. We have also noted that the tremor is typically refractory to medications, including maximally tolerated levodopa.

What has distinguished them has been a consistent constellation of clinical features: (1) prominent resting tremor that is the first or among the first signs and that persistently overshadows other aspects of parkinsonism throughout the course (2) nontremor components of parkinsonism that remain mild (3) absence of gait disorder apart from reduced arm swing or mild stooping (4) no more than mild progression, except for tremor, despite at least 8 years of parkinsonism and (5) absence of disability apart from tremor. These patients fulfill minimum criteria for PD with resting tremor plus other parkinsonian signs, without evidence of ataxia, corticospinal signs, apraxia, cognitive impairment, or prominent early dysautonomia. In our routine movement disorders clinical practice, we have occasionally encountered patients with features similar to classic idiopathic Parkinson disease (PD) yet with a unique clinical course. In this series, most patients had immediate family members with a diagnosis of tremor or PD. The tremor is often not very responsive to levodopa therapy. Three patients required thalamic deep brain surgery to treat their tremor.Ĭonclusions Benign tremulous parkinsonism may be a distinct clinical entity characterized by tremor predominance plus minimal progression of other aspects of parkinsonism. A family history of PD and/or tremor was reported in 10 (63%) of our patients. A moderate to marked postural tremor was noted in 13 of the 16 patients, including 6 with a kinetic tremor. Mean age at onset, 58.5 years, was younger than in most PD series, and most patients had a poor levodopa response (although levodopa trials were inadequate in some).

Results Mean disease duration was 11 years (range, 8-25 years) at last follow-up. Main Outcome Measures Age at onset of disease, response to levodopa therapy, tremor characteristics, and family history. Patients Of 116 patients identified, 16 (10 male and 6 female) had at least an 8-year history of this disease, had been examined by a senior movement disorders specialist, and had ultimately been diagnosed as having benign tremulous parkinsonism after an initial diagnosis of Parkinson disease (PD). Objective To report the clinical features and longitudinal course of patients with benign tremulous parkinsonism encountered in our movement disorders practice.ĭesign Computer search of medical records database. Shared Decision Making and Communicationīackground Benign tremulous parkinsonism has never been precisely defined nor has the long-term course been studied.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.

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