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Guillain-Barré syndrome (GBS) is the most common acute paralytic neuropathy, characterized by symmetrical weakness of the limbs and hyporeflexia or areflexia. GBS usually occurs after an infection, with two-thirds of GBS patients having a history of respiratory or gastrointestinal infection before GBS onset. 1 During the progressive phase, 20%-30% of patients need mechanical ventilation (MV) in an intensive care unit (ICU) because of respiratory failure, which can worsen functional outcomes and even lead to death. 2-4 Therefore, it is very important to find early predictors of MV in patients with GBS.

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including cognition deficiency, psychiatry symptoms, sleep disruption, and sensory abnormalities, has recently been reported in ET syndrome. 2 Besides, accumulating evidence on different etiologies, pathophysiologies, and clinical features has demonstrated the heterogeneity of ET syndrome, even giving rise to a new placeholder, ET-plus. 2,3 Due to such heterogeneity, its disease sub-types should be extensively studied to understand the inherent mechanisms of ET syndrome.

Background The International Parkinson and Movement Disorder Society introduced the category of essential tremor (ET)‐plus in its new ET classification scheme, but how the clinical correlates of ET‐plus differ from those of “pure” ET is unclear. By comparing the clinical characteristics of ET and ET‐plus patients, we expect to better understand the impact and invoked questions of the new classification on clinical practice. Methods We reviewed the medical records of 280 ET syndrome patients in an ongoing cross‐sectional study in a Chinese population and reclassified them according to the new criteria. Clinico‐demographic characteristics were compared between ET and ET‐plus patients. Risk factors of diagnosis of ET‐plus were explored using logistic regression. Results A total of 121 patients (50.8%) were reclassified as having ET and 117 as having ET‐plus. ET‐plus group was significantly older at tremor onset, less educated, and more likely to have cranial tremor, depression symptom, anxiety symptom, and probable REM sleep behavior disorder. ET‐plus group also showed more severe upper limb tremor and cognition impairment. Regression analysis identified four independent risk factors associated with ET‐plus: late tremor onset (OR 3.04, 95%CI 1.60‐5.79), less educated (OR 0.91, 95%CI 0.85‐0.97), severe upper limb tremor (OR 2.46, 95%CI 1.30‐4.62), and presence of cranial tremor (OR 2.30, 95%CI 1.20‐4.41). Conclusions The new classification scheme emphasized that ET syndrome is heterogeneous. ET‐plus cannot be seen as a subtype or a diagnosis of ET syndrome, but rather as a placeholder, representing an area of current scientific uncertainty.