RT Journal Article SR Electronic T1 Tremor in primary adult-onset dystonia: prevalence and associated clinical features JF Journal of Neurology, Neurosurgery & Psychiatry JO J Neurol Neurosurg Psychiatry FD BMJ Publishing Group Ltd SP 404 OP 408 DO 10.1136/jnnp-2012-303782 VO 84 IS 4 A1 Giovanni Defazio A1 Angelo Fabio Gigante A1 Giovanni Abbruzzese A1 Anna Rita Bentivoglio A1 Carlo Colosimo A1 Marcello Esposito A1 Giovanni Fabbrini A1 Arianna Guidubaldi A1 Paolo Girlanda A1 Rocco Liguori A1 Lucio Marinelli A1 Francesca Morgante A1 Lucio Santoro A1 Michele Tinazzi A1 Paolo Livrea A1 Alfredo Berardelli YR 2013 UL http://jnnp.bmj.com/content/84/4/404.abstract AB Objective To investigate the frequency and the main clinical features of tremor in primary adult-onset dystonia (PAOD). Methods This cross-sectional study was conducted on 429 patients with PAOD from eight Italian movement disorder centres. Results Of the 429 dystonic patients, 72 (16.7%) had tremor. Although sex and age at dystonia onset were similar in dystonic patients who had tremor and those who did not, patients who had tremor were affected more often by focal cervical dystonia and less often by focal blepharospasm. Dystonia had a greater tendency to spread in patients with tremor. According to the Movement Disorder Society Consensus Statement, tremor was classified as dystonic tremor (DT) in 43 patients and tremor associated with dystonia (TAWD) in 23 patients. Six patients had both types of tremor. Taking into account potential confounding by age at onset and body distribution of the corresponding dystonia type, all the clinical features in patients with DT and in those with TAWD were comparable except the tendency of dystonia to spread, which was greater in patients with DT. Conclusions Tremor is a relatively common feature occurring in about 17% of patients with primary late-onset dystonia. The association between tremor and dystonia spread suggests that this form of tremor may be a dystonic manifestation. Similarities in phenotypic features of DT and TAWD predominated over differences, suggesting that the two forms of tremor may be manifestations of the same disease. Differences in gender and body distribution of tremor between patients with dystonia and tremor and those of patients with essential tremor also suggest that tremor in dystonia and essential tremor are different entities.