Tremor, gait, and balance disorders in essential tremor and the efficacy of atenolol

Background: To assess gait and balance in patients with essential tremor (ET), which is the most common tremor disorder characterized by bilateral action tremor of the hands with possible involvement of further tremor locations and to test the efficacy of atenolol on tremor and gait and balance. Methods: In this prospective study, gait and balance were evaluated by static posturography in addition to International Cooperative Ataxia Rating Scale (ICARS) in 22 ET patients without any additional neurologic signs on examination. Tremor severity was assessed by The Essential Tremor Rating Assessment Scale (TETRAS). The efficacy of atenolol 100 mg/day both on tremor and gait and balance was investigated. Posturographic recordings were performed in gender, age-, and height-matched healthy volunteers who constituted the control group. Results: The mean center of gravity sway velocity of the ET patients recorded on firm and foam surfaces with eyes open and closed was not significantly different from the healthy controls but sway velocity on tandem stance was significantly increased (P = 0.032). Gait speed (P = 0.015) was decreased and step width was increased (P = 0.001). An improvement in TETRAS scores was recorded with atenolol treatment (P = 0.046). An improvement not reaching statistical significance was present in ICARS scores (P = 0.059). However, posturographic parameters did not change significantly (P > 0.05). Conclusion: Increased sway velocity on tandem stance, decreased gait speed and increased step width are consistent with midline cerebellar dysfunction in ET patients with no obvious gait and balance deficits on clinical examination. Atenolol seems to be effective on tremor but does not cause a significant improvement in gait and balance deficits.