Tremor Types in Parkinson Disease: A Descriptive Study Using a New Classification

Abstract

Background. The current classification of tremor types in Parkinson disease (PD) is potentially confusing, particularly for mixed tremor, and there is no label for pure resting tremor. With a view to better defining the clinical phenomenological classification of these tremors, our group relabeled the different types as follows: pure resting tremor (type I); mixed resting and action tremor with similar frequencies (type II) divided, according to action tremor presentation, into II-R when there is a time lag and II-C otherwise; pure action tremor (type III); and mixed resting and action tremor with differing frequencies (type IV). We performed a descriptive study to determine prevalence and clinical correlates for this new tremor classification. Patient/Methods. A total of 315 consecutively recruited patients with PD and tremor were clinically evaluated. X2 tests were used to assess tremor type associations with categorical variables, namely, sex, family history of PD, motor fluctuations, and anticholinergic and beta-blocker use. With tremor type as the independent variable, ANOVA was performed to study the relationship between dependent quantitative variables, namely, age, age at PD diagnosis, disease duration, and UPDRS scores for rigidity. Results. The studied patients had tremor types as follows: type I, 30%; type II, 50% (II-R, 25% and II-C, 25%); type III, 19%; and type IV, 1%. No significant association was found between the studied clinical variables and tremor types. Conclusions. Mixed tremor was the most common tremor type in our series of patients with PD according to our proposed classification, which we hope will enhance understanding of the broad clinical phenomenology of PD.