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Becktepe J, Gövert F, Balint B, et al. Exploring Interrater Disagreement on Essential Tremor Using a Standardized Tremor Elements Assessment. Mov Disord Clin Pract. 2021;8(3):371-376doi: 10.1002/mdc3.13150.
Becktepe, J., Gövert, F., Balint, B., Schlenstedt, C., Bhatia, K., Elble, R., & Deuschl, G. (2021). Exploring Interrater Disagreement on Essential Tremor Using a Standardized Tremor Elements Assessment. Movement disorders clinical practice, 8(3), 371-376. https://doi.org/10.1002/mdc3.13150
Becktepe, Jos, et al. "Exploring Interrater Disagreement on Essential Tremor Using a Standardized Tremor Elements Assessment." Movement disorders clinical practice vol. 8,3 (2021): 371-376. doi: https://doi.org/10.1002/mdc3.13150
Becktepe J, Gövert F, Balint B, Schlenstedt C, Bhatia K, Elble R, Deuschl G. Exploring Interrater Disagreement on Essential Tremor Using a Standardized Tremor Elements Assessment. Mov Disord Clin Pract. 2021 Feb 12;8(3):371-376. doi: 10.1002/mdc3.13150. eCollection 2021 Apr. PMID: 33816665; PMCID: PMC8015892.
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Mov Disord Clin Pract. 2021 Feb 12;8(3):371-376. doi: 10.1002/mdc3.13150. eCollection 2021 Apr.

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

Movement disorders clinical practice

Jos Becktepe, Felix Gövert, Bettina Balint, Christian Schlenstedt, Kailash Bhatia, Rodger Elble, Günther Deuschl

Affiliations

  1. Department of Neurology University Hospital Schleswig-Holstein, Christian-Albrechts-University Kiel Germany.
  2. Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London London UK.
  3. Department of Neurology University Hospital Heidelberg Heidelberg Germany.
  4. Department of Neurology Southern Illinois University School of Medicine Springfield Illinois USA.

PMID: 33816665 PMCID: PMC8015892 DOI: 10.1002/mdc3.13150

Abstract

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.

© 2021 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC. on behalf of International Parkinson and Movement Disorder Society.

Keywords: dystonic tremor; essential tremor; tremor; tremor classification

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