In conclusion, our results show that hereditary essential tremor has a bimodal age of onset, with a median age of onset in the second dccade. Penetrance is virtually complete by the age of 65 years and there were no examples of the disease skipping a generation. Men and woman were affected with equal severity. The sex of the affected parent had no influence on tremor severity or the extent of disability found in their affected children. The condition did not produce dystonic postures, isolated tremors of the head, legs, voice. jaw, face or tongue or cause primary orthostatic or task specific tremor. There were no cases of Parkinson's disease. There was a possible association with classical migraine. Within a single kindred some individuals had tremors that were alcohol responsive, whilst others did not. Disability typically commenced in the second or third decade and increased with the duration of tremor and the age of the subject. Age at tremor onset had no independent effect on outcome. Many individuals with tremors of modest severity reported significant social handicap. Physicians probably underestimate the effect of tremor on patients' lives and overestimate the practical benefits of the medical treatments available. Many previous studies of 'essential tremor' have been confused by including patients with dystonia. The segregation ratio (0.46 for affected;total kin) and the median age of onset (15 years) found in this study suggests that late onset sporadic cases of postural tremor ('senile tremor') may have different etiologies to hereditary essential tremor. Whether or not they all share the same pathophysiology is another story. Acknowledgements We wishs to thank Paul Atchison, Peter Asselman, Madhuri Behari, Tom Britton, Richard Bedlington. John Caviness, Elizabeth Chitty, Judit Mally and Tom Warner for their help with various aspects of this study. 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Accepted February 18. 1994 ---------------------------------------------------------------------- Appendix 1 Activities of daily living For each item the patients were asked to circle the number that describes how easy or difficult it was for them to perform the relevant activity. Percentage of patients reporting difficulty with each item Percent Percent Index Secondary Patients cases * 1 Cut food with a knife and fork 1 2 3 4 60 23 2 Use a spoon to drink soup 1 2 3 4 95 65 3 Hold a cup of tea 1 2 3 4 95 63 4 Pour milk from a bottle or carton 1 2 3 4 85 47 5 Wash and dry dishes 1 2 3 4 25 16 6 Brush your teeth 1 2 3 4 45 16 7 Use a handkerchief to blow your nose 1 2 3 4 20 9 8 Use a bath 1 2 3 4 25 9 9 Use a lavatory 1 2 3 4 20 7 10 Wash your face and hands 1 2 3 4 15 7 11 Tie up your shoelaces 1 2 3 4 60 23 12 Do up buttons 1 2 3 4 70 44 13 Do up a zip 1 2 3 4 50 19 14 Write a letter 1 2 3 4 85 58 15 Put a letter in an envelope 1 2 3 4 50 33 16 Hold and read a newspaper 1 2 3 4 70 37 17 Dial a telephone 1 2 3 4 65 19 18 Make yourself understood on the telephone 1 2 3 4 25 14 19 Watch a television 1 2 3 4 5 9 20 Pick up your change in a shop 1 2 3 4 80 44 21 Insert an electric plug into a socket 1 2 3 4 50 23 22 Unlock your front door with the key 1 2 3 4 55 30 23 Walk up and down stairs 1 2 3 4 30 9 24 Get up out of an armchair 1 2 3 4 25 12 25 Carry a full shopping bag 1 2 3 4 35 21 ___________________________________________________________ Key: 1 = able to do activity without difficulty. 2 = able to do the activity with a little effort. 3 = able to do the activity with a lot of effort. 4 = cannot do the activity by yourself. * Percentage of those definite secondary cases who returned completed questionaires (81.1% of all secondary cases). ---------------------------------------------------------- Appendix 2 (i) Please answer the following question by putting a circle around the appropriate letter: A, B, C, or D. Has your tremor stopped you: (a) Shopping by yourself? A B C D (b) Eating out? A B C D (c) Accepting a party invitation? A B C D (d) Doing your favourite sport or hobby? A B C D (e) Traveling by public transport? A B C D (f) Driving a car? A B C D (g) Applying for a job or promotion? A B C D (h) Going on holiday? A B C D Key: A = No B = Yes, because you are EMBARRASSED by the tremor. C = Yes, because of the PHYSICAL DIFFICULTIES produced by the tremor. D = Yes, because of BOTH the PHYSICAL DIFFICULTIES and EMBARRASSMENT produced by the tremor. (ii) The following question is only applicable if you have been in full-time employment: As a result of the tremor have you ever had to change your job or take compulsory early retirement? Please circle one of these answers: Yes No Not applicable ----------------------------------------------------------- END John Cottingham "KNOWLEDGE is of two kinds: we know a subject, or we know where we can find information upon it." [log in to unmask] Dr. Samuel Johnson