The Italian tremor Network (TITAN): rationale, design and preliminary findings

Abstract

Introduction The recently released classification has revised the nosology of tremor, defining essential tremor (ET) as a syndrome and fueling an enlightened debate about some newly conceptualized entities such as ET-plus. As a result, precise information of demographics, clinical features, and about the natural history of these conditions are lacking. Methods The ITAlian tremor Network (TITAN) is a multicenter data collection platform, the aim of which is to prospectively assess, according to a standardized protocol, the phenomenology and natural history of tremor syndromes. Results In the first year of activity, 679 patients have been recruited. The frequency of tremor syndromes varied from 32% of ET and 41% of ET-plus to less than 3% of rare forms, including focal tremors (2.30%), task-specific tremors (1.38%), isolated rest tremor (0.61%), and orthostatic tremor (0.61%). Patients with ET-plus were older and had a higher age at onset than ET, but a shorter disease duration, which might suggest that ET-plus is not a disease stage of ET. Familial aggregation of tremor and movement disorders was present in up to 60% of ET cases and in about 40% of patients with tremor combined with dystonia. The body site of tremor onset was different between tremor syndromes, with head tremor being most commonly, but not uniquely, associated with dystonia. Conclusions The TITAN study is anticipated to provide clinically relevant prospective information about the clinical correlates of different tremor syndromes and their specific outcomes and might serve as a basis for future etiological, pathophysiological, and therapeutic research.

Longitudinal study of clinical and neurophysiological features in essential tremor

“…We also found that anxiety and depression were more common in ET than in normal subjects, in line with previous evidence [3]. Finally, consistent with previous data, 80% of patients presented soft signs [1], including rest tremor, subtle bradykinesia and dystonia [33], impaired tandem gait, and MCI, and thus could be categorized as ET‐plus [29, 34–36]. At follow‐up evaluation, we found that tremor severity in ET increased, with tremor spread in different body segments and a worsening of tremor during specific complex tasks (i.e., drawing spirals and several activities of daily living).…”

“…By definition, all patients presented upper limb postural and/or kinetic tremor, but a considerable proportion also had tremor in other body segments, with the head being the most involved segment [ 5 , 18 ]. More than half of patients had a family history of tremor [ 29 ]. Cognitive and psychiatric disorders were also observed, confirming a higher prevalence of MCI in ET than in the general population [ 30 ], with executive function and memory being the most involved domains [ 31 , 32 ].…”

Age and Sex Affect Essential Tremor (ET) Plus: Clinical Heterogeneity in ET Based on the National Survey in China

“…However, some previous studies retrospectively reclassified ET patients evaluated before 2018, which were prone to recall bias [11][12][13][14]. Several ET cohorts with relatively small sample sizes were prospectively enrolled, most of which were conducted in a single center [5,[15][16][17][18][19][20]. The Italian tremor network (TITAN) prospectively assessesed the phenomenology and natural history of different tremor syndromes based on the new classification in Italy [20].…”

“…Several ET cohorts with relatively small sample sizes were prospectively enrolled, most of which were conducted in a single center [5,[15][16][17][18][19][20]. The Italian tremor network (TITAN) prospectively assessesed the phenomenology and natural history of different tremor syndromes based on the new classification in Italy [20]. To further study the clinical heterogeneity of ET according to the new consensus statement, determine the proportion of ET plus in mainland China, recognize the deviations from ET, evaluate the non-motor symptoms in patients with ET, and explore the possible factors related to ET plus, the China Essential Tremor Alliance launched a large multicenter registry study of ET named the National Survey of Essential Tremor Plus in China (NSETP-China).…”

Instagram for Measuring Tremor: Who Holds the Camera?

“…scored both p-spirals and d-spirals of 11 patients with the most common action tremor syndromes, including ET, ET-plus, and dystonic tremor. 3 Using the Spearman test, a significant, strong correlation was found between p-spiral and d-spiral scores (ρ = 0.772, P < 0.001; Fig. 1A).…”