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December 2021; 11 (6) Research

Mixed Motor Disorder

Essential Tremor Families With Heterogeneous Motor Phenomenology

Elan D. Louis, Nora C. Hernandez, View ORCID ProfileRuth Ottman, Lorraine N. Clark
First published April 22, 2021, DOI: https://doi.org/10.1212/CPJ.0000000000001100
Elan D. Louis
Department of Neurology (EDL, NCH), University of Texas Southwestern, Dallas; G.H. Sergievsky Center (RO), Department of Neurology (RO), College of Physicians and Surgeons, and Department of Epidemiology (RO), Mailman School of Public Health, Columbia University; Division of Translational Epidemiology (RO), New York State Psychiatric Institute; and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (LNC), College of Physicians and Surgeons, Columbia University, New York.
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Nora C. Hernandez
Department of Neurology (EDL, NCH), University of Texas Southwestern, Dallas; G.H. Sergievsky Center (RO), Department of Neurology (RO), College of Physicians and Surgeons, and Department of Epidemiology (RO), Mailman School of Public Health, Columbia University; Division of Translational Epidemiology (RO), New York State Psychiatric Institute; and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (LNC), College of Physicians and Surgeons, Columbia University, New York.
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Ruth Ottman
Department of Neurology (EDL, NCH), University of Texas Southwestern, Dallas; G.H. Sergievsky Center (RO), Department of Neurology (RO), College of Physicians and Surgeons, and Department of Epidemiology (RO), Mailman School of Public Health, Columbia University; Division of Translational Epidemiology (RO), New York State Psychiatric Institute; and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (LNC), College of Physicians and Surgeons, Columbia University, New York.
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  • ORCID record for Ruth Ottman
Lorraine N. Clark
Department of Neurology (EDL, NCH), University of Texas Southwestern, Dallas; G.H. Sergievsky Center (RO), Department of Neurology (RO), College of Physicians and Surgeons, and Department of Epidemiology (RO), Mailman School of Public Health, Columbia University; Division of Translational Epidemiology (RO), New York State Psychiatric Institute; and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (LNC), College of Physicians and Surgeons, Columbia University, New York.
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Citation
Mixed Motor Disorder
Essential Tremor Families With Heterogeneous Motor Phenomenology
Elan D. Louis, Nora C. Hernandez, Ruth Ottman, Lorraine N. Clark
Neurol Clin Pract Dec 2021, 11 (6) e817-e825; DOI: 10.1212/CPJ.0000000000001100

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Abstract

Background and Objectives Essential tremor (ET) is one of the most prevalent movement disorders. Because ET is so common, individuals with other neurologic disorders may also have ET. There is evidence, however, that the cooccurrence of ET with Parkinson disease (PD) and/or dystonia is not merely a chance cooccurrence. We have observed combinations of these 3 movement disorders within individuals and across individuals within families containing multiple individuals with ET. This observation has a number of implications. Our objective is to present 4 ET families in whom motor phenomenology was heterogeneous and discuss the implications of this finding.

Methods ET cases and their relatives were enrolled in the Family Study of Essential Tremor (2015–present). Phenotyping was performed by a senior movement disorders neurologist based on neurologic examination.

Results We present 4 families, including 14 affected individuals, among whom assigned diagnoses were ET, PD, ET + PD, and ET + dystonia. In those with ET and another movement disorder, the predominant and earliest phenotype was ET.

Discussion There are assortments of these 3 involuntary motor disorders, ET, dystonia, and PD, both within individuals and in different individuals within ET families. This observation has mechanistic implications. Furthermore, we believe that the concept of the mixed motor disorder should enter into and inform the clinical dialogue. In assigning diagnoses, clinicians are swayed by family history information, and they should be prepared to observe a mix of different motor disorders to manifest within particular families.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Received December 28, 2020.
  • Accepted April 9, 2021.
  • © 2021 American Academy of Neurology
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  • Tremor

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