Objective: To study the percentage of transformation of the diagnosis of essential tremor (ET) into Parkinson’s disease (PD)

Background: during the initial onset of movement disorders, the differential diagnosis of ET and PD can be difficult and often time-consuming.

However, when the diagnosis of ET is not in doubt during the observed period, additional symptoms may appear,  prompting a reassessment of the diagnosis and,onsequently, of patient management tactics.

Method: retrospective analysis of the medical records of patients with ET from 2009 to 2021

Results: out of 681 registered patients, the number of males was 187 (27.5%) and females were 494 (72.5%).  The diagnosis of ET was made on the basis of clinical diagnostic criteria (P. Bain et al., 2000; R.J. Elble, 2000; J. Jankovic, 2002).

Classical essential tremor, according to R.J. Elble, 2000, is a disease manifested most often by kinetic tremor of the upper extremities and less often by tremor of the head, voice, trunk, and lower extremities without any other neurological pathology.

In our study, in addition to the classic symptoms of ET, other symptoms were identified at the initial and follow-up examinations 〔Table 1〕

Bradykinesia, anosymia, and the presence of resting tremor can be regarded as minimal signs of parkinsonism at the initial stage of ET diagnosis. Resting tremor has also been described in patients with essential tremor by H.A. Teive, in 2012 and occurs quite frequently (up to 19%), which may cause diagnostic difficulties in the differential diagnosis with Parkinson’s disease.

During follow-up according to our study, the diagnosis of ET was changed to PD in 14 (2%) cases, in 10 (2%) women and 4 (2%) men, which correlates with the literature data, according to which PD is diagnosed in 2-19% of cases in patients with ET. Only three people (0.4%) declared hereditary nature of essential tremor, and the average duration of ET before PD debut was 11.5 years.

Conclusion: The presence of atypical symptoms for ET, as well as the presence of a history of relatives with PD, should alert the physician to further more careful monitoring of patients in this group, timely correction of the diagnosis and subsequent treatment.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/transformation-of-essential-tremor-into-parkinsons-disease/