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      How Many People in the USA Have Essential Tremor? Deriving a Population Estimate Based on Epidemiological Data

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          Abstract

          Background

          Essential tremor (ET) is often reported to be among the most prevalent movement disorders, yet the precise number of cases in the USA is not known. The goal of the current analyses was to use published data from epidemiological studies to derive an estimate of the number of people currently residing in the USA who have ET.

          Methods

          A PubMed search was conducted to identify population-based prevalence studies of ET. The methodology of 34 identified studies was assessed. Then the three most methodologically rigorous studies were selected, and age-specific prevalence data were abstracted. US census data from 2012 were used to determine the population in the USA by 10-year age categories.

          Results

          Using data from three studies, estimates of the number of ET cases (2012) ranged from 6.38 to 7.63 million (mean = 7.01 million). This corresponds to approximately 2.2% of the US population.

          Discussion

          Knowing the number of ET cases in the USA is important in terms of estimating the medical burden on communities and society, and providing an objective metric on which to base health resource planning.

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          Most cited references30

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          How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor.

          Elan Louis, Joaquim Ferreira (2010)
          Essential tremor (ET) is among the more prevalent neurological disorders, yet prevalence estimates have varied enormously, making it difficult to establish prevalence with precision. We: (1) reviewed the worldwide prevalence of ET in population-based epidemiological studies, (2) derived as precisely as possible an estimate of disease prevalence, and (3) examined trends and important differences across studies. We identified 28 population-based prevalence studies (19 countries). In a meta-analysis, pooled prevalence (all ages) = 0.9%, with statistically significant heterogeneity across studies (I(2) = 99%, P or= 65 years) = 4.6%, and in additional descriptive analyses, median crude prevalence (age >or= 60-65) = 6.3%. In one study of those age >or= 95 years, crude prevalence = 21.7%. Several studies reported ethnic differences in prevalence, although more studies are needed. Greater than one-third of studies show a gender difference, with most demonstrating a higher prevalence among men. This possible gender preference is interesting given clinical, epidemiological, and pathological associations between ET and Parkinson's disease. Precise prevalence estimates such as those we provide are important because they form the numerical basis for planned public health initiatives, provide data on the background occurrence of disease for family studies, and offer clues about the existence of environmental or underlying biological factors of possible mechanistic importance. (c) 2010 Movement Disorder Society.
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            Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee.

            G. Deuschl, P Bain, M Brin (1998)
            This is a proposal of the Movement Disorder Society for a clinical classification of tremors. The classification is based on the distinction between rest, postural, simple kinetic, and intention tremor (tremor during target-directed movements). Additional data from a medical history and the results of a neurologic examination can be combined into one of the following clinical syndromes defined in this statement: enhanced physiologic tremor, classical essential tremor (ET), primary orthostatic tremor, task- and position-specific tremors, dystonic tremor, tremor in Parkinson's disease (PD), cerebellar tremor, Holmes' tremor, palatal tremor, drug-induced and toxic tremor, tremor in peripheral neuropathies, or psychogenic tremor. Conditions such as asterixis, epilepsia partialis continua, clonus, and rhythmic myoclonus can be misinterpreted as tremor. The features distinguishing these conditions from tremor are described. Controversial issues are outlined in a comment section for each item and thus reflect the open questions that at present cannot be answered on a scientific basis. We hope that this statement provides a basis for better communication among clinicians working in the field and stimulates tremor research.
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              Prevalence of essential tremor in three elderly populations of central Spain.

              Julián Benito-León, Felix Bermejo-Pareja, Jose-Manuel Morales … (2003)
              Although essential tremor (ET) is considered the most prevalent adult movement disorder, the available information on its prevalence and distribution worldwide is not completely understood. We investigated the prevalence and distribution of ET in three elderly Spanish populations using a door-to-door, two-phase approach. A brief screening instrument was administered on May 1, 1994 to subjects over 64 years old taken from the census of one urban municipality of Greater Madrid (quarter of Margaritas, Getafe), one urban district of Madrid (Lista), and one rural site (Arévalo county, Avila) (N = 5278). Study subjects were limited to those who screened positively (N = 472). To increase reliability, each patient was examined by 3 experienced neurologists, and was classified as having ET only when all 3 neurologists agreed (183 of 472). The present study was part of a large-scale epidemiological survey of neurological diseases, and served as a baseline investigation in a 3-year incidence study. Accordingly, 41 ET patients were identified when evaluating subjects who had screened positively for dementia, stroke, or parkinsonism, despite the fact that they had screened negatively for tremor; furthermore, 32 additional ET prevalent cases were detected when evaluating subjects who had screened positively for tremor in the second cross-sectional study (May 1, 1997), although they had screened negatively for tremor in the first cross-sectional study. We identified 256 persons (152 women, 104 men) with ET; of these, 87 patients (34.0%) reported having an affected relative. Two hundred and four (79.7%) of the subjects with ET were detected through this screening and had not been diagnosed previously. The prevalence of ET was 4.8% (95% CI = 4.2-5.4) for the total population; 4.6% (95% CI = 3.7-5.4) in men and 5.0% (95% CI = 4.2-5.8) in women. Age-specific prevalence increased with advancing age for both men and women. Despite the variability in worldwide data, ET is a frequently encountered disorder in elderly people. Furthermore, as ET may be seen as a relatively benign condition, a large proportion of patients may never seek neurological attention. Copyright 2002 Movement Disorder Society
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                Author and article information

                Journal
                Journal ID (nlm-ta): Tremor Other Hyperkinet Mov (N Y)
                Journal ID (iso-abbrev): Tremor Other Hyperkinet Mov (N Y)
                Journal ID (publisher-id): TOHM
                Title: Tremor and Other Hyperkinetic Movements
                Publisher: Columbia University Libraries/Information Services
                ISSN (Electronic): 2160-8288
                Publication date Collection: 2014
                Publication date (Electronic): 14 August 2014
                Volume: 4
                Electronic Location Identifier: 259
                Affiliations
                [1 ]GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
                [2 ]Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
                [3 ]Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
                [4 ]Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
                [5 ]Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA
                Hospital “12 de Octubre”, Spain
                Author notes
                *To whom correspondence should be addressed. E-mail: EDL2@ 123456columbia.edu
                Article
                DOI: 10.7916/D8TT4P4B
                PMC ID: 4137360
                PubMed ID: 25157323
                SO-VID: acc8d4f7-f050-4792-9406-4d40e1bfd085
                Copyright statement: Copyright @ 2014
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution–Noncommerical–No Derivatives License, which permits the user to copy, distribute, and transmit the work provided that the original author and source are credited; that no commercial use is made of the work; and that the work is not altered or transformed.

                History
                Date received : 19 June 2014
                Date accepted : 21 July 2014
                Page count
                Pages: 4
                Categories
                Subject: Brief Reports

                Keywords: essential tremor,population,epidemiology,prevalence,public health
                Data availability:
                Keywords: essential tremor, population, epidemiology, prevalence, public health

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