Common misdiagnosis of a common neurological disorder - How are we misdiagnosing essential tremor?
Common misdiagnosis of a common neurological disorder - How are we misdiagnosing essential tremor?
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DOI：
10.1001/archneur.63.8.1100
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发表时间：
2006-08-01
影响因子：
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通讯作者：
Louis, Elan D.
中科院分区：
文献类型：
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作者：
Jain, Samay;Lo, Steven E.;Louis, Elan D.
背景：特发性震颤（essential tremor，ET）是一种常见的神经系统疾病，其诊断被认为是常规的.尽管如此，以前的工作表明误诊可能很常见。除此之外，这些误诊可能导致治疗错误。目的：估计其他震颤障碍被误诊为ET的频率，并确定增加误诊ET几率的因素，并精确量化它们的程度。设计：2000年1月1日至12月31日期间，在纽约神经病学研究所（纽约）对71名连续患者进行了评估，二○ ○五年;这些患者具有ET的评估前诊断。ET的标准改编自运动障碍Society.Results的共识声明：26例（37%）被误诊为ET（“假ET”）。他们的真实诊断为帕金森病（11例患者[15%]）、造口障碍（6例患者[8%]）、帕金森病伴ET（5例患者[7%]）和其他疾病（4例患者[6%]）。与ET误诊相关的因素包括单侧手臂震颤（比值比，10.5; 95%置信区间，1.2-95.4; P= 0.02），手的匙形和其他肌张力障碍姿势（比值比，16.3; 95%置信区间，4.0-66.4; P <0.01）和其他异常特征（孤立性拇指震颤、孤立性腿部震颤和非节律性震颤）（比值比，49.4; 95%可信区间，2.7-895.0; P
Background: As a common neurological disorder, the diagnosis of essential tremor (ET) is considered routine. Despite this, previous work suggests that misdiagnoses may be common. Among other things, these misdiagnoses can lead to treatment errors.Objectives: To estimate how often other tremor disorders are misdiagnosed as ET and to identify factors that increase the odds of misdiagnosing ET and to precisely quantify the extent to which they do so.Design: Seventy-one consecutive patients underwent an evaluation at the Neurological Institute of New York, New York, between January 1, 2000, and December 31, 2005; these patients had a preevaluation diagnosis of ET. The criteria for ET were adapted from the consensus statement of the Movement Disorder Society.Results: Twenty-six patients (37%) were misdiagnosed as having ET ("false ET"). Their true diagnoses were Parkinson disease (11 patients [15%]), dystoma (6 patients [8%]), Parkinson disease with ET (5 patients [7%]), and other disorders (4 patients [6%]). Factors associated with misdiagnosed ET included unilateral arm tremor (odds ratio, 10.5; 95% confidence interval, 1.2-95.4; P=.02), spooning of the hands and other dystonic postures (odds ratio, 16.3; 95% confidence interval, 4.0-66.4; P < 001), and other unusual features (isolated thumb tremor, isolated leg tremor, and nonrhythmic tremor) (odds ratio, 49.4; 95% confidence interval, 2.7-895.0; P