Interrater and intrarater agreement on the 2018 consensus statement on classification of tremors

Rajan, Roopa; Pandey, Sanjay; Anandapadmanabhan, Reghu; Srivastava, Achal K.

doi:10.1002/mds.27513

Cited by 13 publications

(24 citation statements)

References 7 publications

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“…The consensus definition further states that the ET plus syndrome does not include other defined syndromes such as dystonic tremor and task‐specific tremor. However, in a clinical setting interpretation of questionable dystonic posturing is subjective with a high rate of discordance and one of the major challenges is to differentiate ET plus from a dystonic tremor syndrome …”

Section: Questionable Dystonia In Different Body Segmentsmentioning

confidence: 99%

“…However, in a clinical setting interpretation of questionable dystonic posturing is subjective with a high rate of discordance and one of the major challenges is to differentiate ET plus from a dystonic tremor syndrome. 2,3 We are reporting a video-based assessment of ET plus patients with a perspective of describing the spectrum of questionable dystonia. A retrospective chart review was done of 121 ET patients diagnosed using the 1998 criteria who attended our movement disorder clinic during the past 4 years.…”

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confidence: 99%

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Questionable Dystonia in Essential Tremor Plus: A Video‐Based Assessment of 19 Patients

Pandey

Bhattad

2019

Movement Disord Clin Pract

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Section: Questionable Dystonia In Different Body Segmentsmentioning

confidence: 99%

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confidence: 99%

Questionable Dystonia in Essential Tremor Plus: A Video‐Based Assessment of 19 Patients

Pandey

Bhattad

2019

Movement Disord Clin Pract

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“…Disagreement on dystonic signs in tremor patients has been reported by other investigators and needs to be investigated fully. 12 STEA was conceived as a tool for documenting the presence of neurologic signs that are relevant to the classification of tremor. STEA is not a rating scale per se, and total scores are not meaningful.…”

Section: Movement Disorders Clinicalmentioning

confidence: 99%

Exploring Interrater Disagreement on Essential Tremor Using a Standardized Tremor Elements Assessment

Becktepe

Gövert

Balint

et al. 2021

Movement Disord Clin Pract

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Background Patients with upper limb action tremor frequently exhibit additional neurological signs of uncertain significance. Clinicians vary in their interpretation, and interrater agreement on the final diagnosis is poor. Objectives A new clinical tool for assessing the presence or absence of clinical signs that are important in axis‐1 classification of tremor patients is introduced: the Standardized Tremor Elements Assessment (STEA). Interrater agreement is determined, and signs leading to disagreement in the final diagnosis are identified. Methods Three tremor‐focussed and one dystonia‐focussed movement disorder specialists rated 59 videos of patients with upper limb action tremor syndromes using STEA. Interrater agreements for final diagnosis and STEA items were calculated. Results Interrater agreement regarding the final diagnosis was higher within the group of tremor specialists and poor between dystonia and tremor specialists. Greater agreement was found for items characterizing tremor than for signs of dystonia. Conclusions Clinical signs leading to diagnostic disagreement were identified with STEA, and STEA should therefore be useful in future studies of diagnostic disagreement. The thresholds for considering neurological signs as soft versus significant for ataxia, parkinsonism, dystonia, etc. are critically important in tremor classification and must be studied across movement disorder subspecialties, not simply within a pool of tremor specialists.

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“…The classifications ET and ET plus are purely clinical, and it is recognized that experts will disagree on the Axis 1 classification of patients, particularly those patients who are older and have greater tremor severity (18,30). The presence of one questionably-abnormal sign, such as three missteps in a 10-step tandem walk, may not be deemed sufficient to exclude an older person from a therapeutic trial of ET but will likely reach the threshold for ET plus in a 20-year old with no other medical problems.…”

Section: The Limitations Of Clinical Syndromesmentioning

confidence: 99%

Do We Belittle Essential Tremor by Calling It a Syndrome Rather Than a Disease? No

Elble

2020

Front. Neurol.

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A task force of the International Parkinson and Movement Disorder Society (MDS) recently published a tremor classification scheme that is based on the nosologic principle of two primary axes for classifying an illness: clinical manifestations (Axis 1) and etiology (Axis 2). An Axis 1 clinical syndrome is a recurring group of clinical symptoms, signs (physical findings), and possibly laboratory results that suggests the presence of at least one underlying Axis 2 etiology. Syndromes must be defined and used consistently to be of value in finding specific etiologies and effective treatments. The MDS task force concluded that essential tremor is a common neurological syndrome that has never been defined consistently by clinicians and researchers. The MDS task force defined essential tremor as a syndrome of bilateral upper limb action tremor of at least 3 years duration, with or without tremor in other locations (e.g., head, voice, or lower limbs), in the absence of other neurological signs (e.g., dystonia, parkinsonism, myoclonus, ataxia, peripheral neuropathy, and cognitive impairment). Deviations from this definition should not be labeled as essential tremor. Patients with additional questionably-abnormal signs or with signs of uncertain relevance to tremor are classified as essential tremor plus. The MDS classification scheme encourages a thorough unbiased phenotyping of patients with tremor, with no assumptions of etiology, pathology, pathophysiology, or relationship to other neurological disorders. The etiologies, pathology, and clinical course of essential tremor are too heterogeneous for this syndrome to be viewed as a disease or a family of diseases.

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Interrater and intrarater agreement on the 2018 consensus statement on classification of tremors

Cited by 13 publications

References 7 publications

Questionable Dystonia in Essential Tremor Plus: A Video‐Based Assessment of 19 Patients

Questionable Dystonia in Essential Tremor Plus: A Video‐Based Assessment of 19 Patients

Exploring Interrater Disagreement on Essential Tremor Using a Standardized Tremor Elements Assessment

Do We Belittle Essential Tremor by Calling It a Syndrome Rather Than a Disease? No

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