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Abstract Details

A Simple Means of Distinguishing the Tremor of Parkinson Disease from Essential Tremor: The Alien Finger
Movement Disorders
P05 - (-)
039
BACKGROUND: Frequently it is difficult to distinguish the tremor of PD from ET, hence the need for a simple test.
DESIGN/METHODS: We studied 50 consecutive tremor-preponderant PD patients and 30 consecutive ET patients. Mean age of PD patients was 63.4 years (range 43-81) with mean duration of 4.9 years (range 2-13). 33 were on levodopa, 31 patients had a bilateral tremor, and 19 had a unilateral tremor. In 29 patients with bilateral tremor, one-side dominated. Mean age of ET patients was 63.9 years (range 29-86) with mean duration 13.7 years (range 2-40). 16 had a family history and 28 patients had bilateral tremor. In 23 patients with bilateral tremor, one-side dominated. Patients sat opposite the examiner and pointed both index fingers at the examiner's index fingers. Then they closed their eyes. Within 15 seconds the patient's index finger levitated or deviated laterally: the alien finger. None of the patients had impaired sensation including 2-point discrimination. The alien finger appeared only with bilateral simultaneous pointing of the patient's fingers.
RESULTS: All the PD patients had levitation or deviation of their index finger. In 46 patients, it occurred on the side of the dominant tremor, in 4 it occurred bilaterally. In 4 of 30 ET patients it occurred unilaterally on the side of the dominant tremor. In 26 of 30 ET patients no levitation or deviation occurred: Odds ratio 0.0017, 95% confidence level (0.0001, 0.0324).
CONCLUSIONS: The alien finger can distinguish the tremor of PD from ET. The alien finger, like the alien limb implies that the tremor of PD unlike ET encompasses circuits involving frontal, anterior-parietal, and supplementary motor loops.
Authors/Disclosures
Abraham N. Lieberman, MD, FAAN
PRESENTER 		No disclosure on file
Narayanan Krishnamurthi No disclosure on file
Rohit Dhall, MD, FAAN (University of Arkansas for Medical Sciences) Dr. Dhall has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Best Doctors Inc. Dr. Dhall has stock in Verve Therapeutics Inc. Dr. Dhall has stock in Roche Holding Limited. Dr. Dhall has stock in Enliven Therapeutics Inc. The institution of Dr. Dhall has received research support from Amneal. The institution of Dr. Dhall has received research support from Neuroderm. The institution of Dr. Dhall has received research support from Cerevel Therapeutics. The institution of Dr. Dhall has received research support from Neurocrine. The institution of Dr. Dhall has received research support from Neuraly. The institution of Dr. Dhall has received research support from SPARC. The institution of Dr. Dhall has received research support from Pharma2B. The institution of Dr. Dhall has received research support from Alexion. The institution of Dr. Dhall has received research support from Parkinsons Foundation. The institution of Dr. Dhall has received research support from UCB Pharma. The institution of Dr. Dhall has received research support from Inhibikase Therapeutics. The institution of Dr. Dhall has received research support from Amylyx Pharma.
Peter Bede, MD, PhD (Academic Unit of Neurology) Dr. Bede has nothing to disclose.
Tracy T. Batchelor, MD, MPH (Brigham and Women's Hospital) Dr. Batchelor has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Up To Date, Inc. An immediate family member of Dr. Batchelor has received publishing royalties from a publication relating to health care. Dr. Batchelor has received publishing royalties from a publication relating to health care.
Anthony J. Santiago, MD (Gila River Health Care) No disclosure on file
Sara S. Dhanani, MD (Banner Sun Health Research Institute) Dr. Dhanani has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie.
No disclosure on file