Of at least 2 cardinal PD features [tremor, rigidity or bradykinesia] that are of a tremor-dominant form). Marked disabling tremor of at least level 3 or 4 on the Fahn-Tolosa-Marin Clinical Tremor Rating Scale (or equivalent scale) in the extremity intended for treatment, causing significant limitation in daily activities.

Session Time: 12:30pm-2:00pm Location: Exhibit Hall located in Hall B, Level 2 Objective: Using changes of perpendicular displacement in digital spiral drawing to evaluate the handwriting severity in essential tremor patients. Background: Essential tremor patients usually have prominent kinetic tremor, especially when handwriting or holding cups. Neurologists used spiral drawing analysis for severity evaluation subjectively, but sometimes have difficulty in rating subtle changes in those drawings.

The changes of perpendicular displacement to center of the spiral drawing under each unit of angle (dr/dθ) could be an indicator for objectively representing tremor severity. Methods: Ten essential tremor patients were recruited for digitized spiral drawing test. Each drawing was evaluated blindly by a movement disorder specialist with visual rating scale (VRS). All the patients were also rated with Fahn-Tolosa-Marin tremor scale (F-T-M scale) to define the total tremor severity. We analyzed correlation between dr/dθ and patient’s clinical scale. Results: The parameter dr/dθ has good correlation to clinical VRS (R=0.8436) and F-T-M scales (R=0.8425). Conclusions: Our findings suggest that dr/dθ in the digitized spiral drawing test can be an object parameter and has good correlation to clinical tremor severity in essential tremor.

Background The Fahn‐Tolosa‐Marin Clinical Rating Scale for Tremor (FTM) has been used in large trials for essential tremor (ET), but its anchors for ratings from 0 to 4 of upper limb tremor are probably too low for patients with severe tremor (tremor amplitude >4 cm; grade 4). The Essential Tremor Rating Assessment Scale (TETRAS) is a validated clinical scale designed specifically for the assessment of ET severity. TETRAS has anchors that span a larger range of tremor amplitudes (>20 cm = grade 4), making it more suitable for assessing patients with severe ET.

However, there is no direct comparison of these scales in any clinical trial. Results FTM ratings of postural and kinetic tremor correlated strongly with those of TETRAS. However, FTM exhibited a ceiling effect for severe tremor. Rest tremor, exclusive to FTM, correlated poorly with postural and kinetic tremor and had very poor test‐retest reliability. In contrast, wing‐beating postural tremor, exclusive to TETRAS, exhibited excellent test‐retest reliability and a strong correlation with kinetic and limbs‐extended‐forward postural tremor. Test‐retest reliabilities of the other TETRAS and FTM ratings were excellent, and both scales had good sensitivity to treatment effect.

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Clinical trials for essential tremor (ET) have employed dozens of different scales and assessments as measures of primary efficacy. The most commonly used scale in large trials has been the Fahn‐Tolosa‐Marin Clinical Rating Scale for Tremor (FTM).