Unawareness of head tremor in essential tremor: a study of three samples of essential tremor patients.

To broadly sample ET in different settings, we selected cases from three settings: a tertiaryreferral center (largest sample),5 a population-based study in Manhattan,6 and a brain repository.7 As expected, cases differed in several respects (Table). Using the same clinical questionnaire, each case was asked whether he/she sometimes has a head tremor. A 20 minute videotaped tremor examination was performed, which included assessments of arm and head tremors (including sitting facing the camera, sustained phonation, reading aloud, finger-nosefinger maneuver, drinking, using a spoon, stand facing camera, and walking). The videotape was reviewed (E.D.L.); arm tremors were rated using a 0 –3 scale.8 Head tremor was rated as absent (0), mild or equivocal (1), intermittent yet clearly present (2), moderate (3), or severe (4).