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Cited by 140Neurological disorders and treatmentsParkinson's Disease Mechanisms and TreatmentsMotor Control and Adaptation

Tremor stability index: a new tool for differential diagnosis in tremor syndromes

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di Biase, Lazzaro, Brittain, John-Stuart, Shah, Syed Ahmar, Pedrosa, David J., Cagnan, Hayriye, Mathy, Alexandre, Chen, Chiung Chu, Martín-Rodríguez, Juan Francisco +6 more·2017·Brain
DOI 10.1093/brain/awx104PMC PMC5493195
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Abstract

See Vidailhet et al. (doi:10.1093/brain/awx140) for a scientific commentary on this article. Misdiagnosis among tremor syndromes is common, and can impact on both clinical care and research. To date no validated neurophysiological technique is available that has proven to have good classification performance, and the diagnostic gold standard is the clinical evaluation made by a movement disorders expert. We present a robust new neurophysiological measure, the tremor stability index, which can discriminate Parkinson’s disease tremor and essential tremor with high diagnostic accuracy. The tremor stability index is derived from kinematic measurements of tremulous activity. It was assessed in a test cohort comprising 16 rest tremor recordings in tremor-dominant Parkinson’s disease and 20 postural tremor recordings in essential tremor, and validated on a second, independent cohort comprising a further 55 tremulous Parkinson’s disease and essential tremor recordings. Clinical diagnosis was used as gold standard. One hundred seconds of tremor recording were selected for analysis in each patient. The classification accuracy of the new index was assessed by binary logistic regression and by receiver operating characteristic analysis. The diagnostic performance was examined by calculating the sensitivity, specificity, accuracy, likelihood ratio positive, likelihood ratio negative, area under the receiver operating characteristic curve, and by cross-validation. Tremor stability index with a cut-off of 1.05 gave good classification performance for Parkinson’s disease tremor and essential tremor, in both test and validation datasets. Tremor stability index maximum sensitivity, specificity and accuracy were 95%, 95% and 92%, respectively. Receiver operating characteristic analysis showed an area under the curve of 0.916 (95% confidence interval 0.797–1.000) for the test dataset and a value of 0.855 (95% confidence interval 0.754–0.957) for the validation dataset. Classification accuracy proved independent of recording device and posture. The tremor stability index can aid in the differential diagnosis of the two most common tremor types. It has a high diagnostic accuracy, can be derived from short, cheap, widely available and non-invasive tremor recordings, and is independent of operator or postural context in its interpretation.

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  • Many statistical features from kinetic signals of tremor, including tremor intensity, dominant frequency, bursting duration, shape factors, and tremor stability index, have been discovered to be statistically different between PD and ET.

    “Many statistical features from kinetic signals of tremor, including tremor intensity, dominant frequency, bursting duration (Milanov, 2001), shape factors (Deuschl et al., 1995), tremor stability index (Di Biase et al., 2017) etc., have been discovered to be statistically different between PD and ET.”

    From A Novel Posture for Better Differentiation Between Parkinson's Tremor and Essential Tremor (2018) · cites this paper as Di Biase et al., 2017

  • Our best result with the arm-rested posture is superior to that of the state-of-the-art study by Di Biase et al. (2017) in specificity and accuracy, although sensitivity was slightly lower.

    “In comparison with the other electrophysiological measures identified for differentiation between Parkinson's disease tremor and essential tremor, we found that our best result with the arm-rested posture is superior to that of the state-of-the-art study by Di Biase et al. (2017), where the tremor stability index was proposed as a new tool for tremor differentiation (TPR = 95%, FPR = 5%, ACC = 92%”

    From A Novel Posture for Better Differentiation Between Parkinson's Tremor and Essential Tremor (2018) · cites this paper as Di Biase et al. (2017)

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Authors
di Biase, L., Brittain, J.-S., Shah, S. A., Pedrosa, D. J., Cagnan, H., Mathy, A., Chen, C. C., Martín-Rodríguez, J. F., Mir, P., Timmerman, L., Schwingenschuh, P., Bhatia, K., Di Lazzaro, V., & Brown, P.
Affiliations
  • Neurology Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
  • John Radcliffe Hospital (GB)
  • Chang Gung Memorial Hospital (TW)
  • Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, OX3 9DU, Oxford, UK
  • Biomedical Research Networking Center on Neurodegenerative Diseases (ES)
  • Universitätsklinikum Gießen und Marburg (DE)
  • Medical University of Graz (AT)
  • University College London (GB)
ORCID
Venue
Brain
Publisher
Oxford University Press (OUP)
Published
2017-04-27
Volume
140
Issue
7
Pages
1977-1986
ISSN
  • 0006-8950 (ISSN-L)
  • 1460-2156
DOI
10.1093/brain/awx104
PMC
PMC5493195
OpenAlex
W2608301715
Cited by
140
References
3
Citations by year
2026: 12 · 2025: 19 · 2024: 14 · 2023: 17 · 2022: 23 · 2021: 16 · 2020: 16 · 2019: 9 · 2018: 9 · 2017: 5
FWCI
7.43
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Brain (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
  • PubMed Central (acceptedVersion, cc-by)
  • Deposito de Investigacion Universidad de Sevilla (University of Seville) (submittedVersion, cc-by)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by)
  • RISalud Institutional Health Repository of Andalucía (submittedVersion, cc-by)
  • UCL Discovery (University College London) (submittedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
Funders
  • Rosetrees Trust (M235-CD1)
  • Deutsche Forschungsgemeinschaft
  • Medical Research Council (MR/N003446/1, MR/M014762/1, MC_UU_12024, MR/N003446/2, MC_UU_12024/1)
Topics
  • Health Sciences › Medicine › Neurology › Neurological disorders and treatments
  • Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Motor Control and Adaptation
Keywords
essential tremor, tremor differential diagnosis, resting tremor, postural tremor, neurophysiological markers, diagnostic accuracy
MeSH terms
Aged, Biomechanical Phenomena, Diagnosis, Differential, Humans, Middle Aged, Parkinson Disease, Sensitivity and Specificity, Severity of Illness Index, Essential Tremor

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