2014 Articles

The ‘‘Tremor Diary’’: A Useful Tool in the Management of Patients with Tremor

Louis, Elan D.; Shah, Hiral G.

When caring for patients with essential tremor (ET) and other action tremors in the outpatient setting, a challenge for the clinician is to assess interval changes in tremor severity, particularly if such changes are subtle. Patients are often asked to report whether their tremor has worsened between visits or whether they have experienced an improvement in the setting of a therapeutic challenge with a new medication or an increase in dosage of an existing medication. Conversely, patients may be asked to report whether their tremor has worsened in the setting of a reduction in dosage. In these various settings, patients often have difficulty assessing whether their tremor has changed or improved, and this is made more challenging by the presence of normal day-to-day fluctuations in tremor severity that patients often experience. The patient’s level of anxiety or mood may further affect their ability to objectively assess the severity of their tremor. The tremor on the day of their clinical visit may be influenced by their psychological state or level of fatigue, confounding the neurological examination. In addition, “white coat syndrome” might influence the amount of tremor observed in the office.

For several years, one of us (E.D.L.) has used a simple clinical aid to help assess response to medication change. To our knowledge, this method has not been published elsewhere. The goal of this brief report is to share this method with the larger community of movement disorder neurologists and discuss its benefits.