Affiliations: [a] Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| [b] Doctoral School of Clinical Neurosciences, University of Pécs, Pécs, Hungary
| [c] National School of Public Health, Institute of Health Carlos III and REDISSEC, Spain
| [d] National Center of Epidemiology, Institute of Health Carlos III and CIBERNED, Spain
| [e] MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
Correspondence:
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Correspondence to: Dávid Pintér, MD, Department of Neuro-logy, Medical School, University of Pécs, 7623, Pécs, Rét utca 2, Hungary. Tel.: +36 70 310 5416; Fax: +36 72 535 911; E-mail: david_pinter@outlook.com.
Abstract: Background:Several scales are available for rating the severity of tremor at present. However, the sensitivity to change of these instruments has remained to be clarified. Objective:To compare the sensitivity of the Fahn-Tolosa-Marin Tremor Rating Scale, the Part III of the Movement Disorder Society-sponsored Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and the MDS-UPDRS Tremor Scale to the effects of various antitremor treatments. Methods:Enrolling subjects with parkinsonism associated with tremor, we analyzed two scenarios: (1) tremor changes associated with acute levodopa challenge (n = 287) and (2) a 12-month outcome of different treatment options (n = 512) including deep brain stimulation (n = 146), levodopa/carbidopa intestinal gel infusion (n = 30), and initiating (n = 63) or adjusting oral antiparkinsonian medication (n = 273). Changes in tremor scales were assessed by effect size values (Cohen’s d and eta-square). Results:Part B of the Fahn-Tolosa-Marin Tremor Rating Scale was the most sensitive to acute levodopa challenge (Cohen’s d = –1.04, η2 = 0.12). However, Part A of the Fahn-Tolosa-Marin Tremor Rating Scale showed the highest effect size, which was a small one (Cohen’s d = –0.33, η2 = 0.03), for detecting a treatment-related change in the severity of tremor during long-term follow-up. Conclusions:The Fahn-Tolosa-Marin Tremor Rating Scale has a better ability to capture changes due to levodopa challenge or antiparkinsonian treatment than MDS-UPDRS Part III or MDS-UPDRS Tremor Scale.
