Prevalence of essential tremor in a multiethnic, community-based study in northern Manhattan, New York, N.Y.

Our aims were to: (1) estimate the prevalence of essential tremor (ET) in a community-based study in northern Manhattan, New York, N.Y., USA; (2) compare prevalence across ethnic groups, and (3) provide prevalence estimates for the oldest old. Methods: This study did not rely on a screening questionnaire. Rather, as part of an in-person neurological evaluation, each participant produced several handwriting samples, from which ET diagnoses were assigned. Results: There were 1,965 participants (76.7 ± 6.9 years, range = 66–102 years); 108 had ET [5.5%, 95% confidence interval (CI) = 4.5–6.5%]. Odds of ET were robustly associated with Hispanic ethnicity versus white ethnicity [odds ratio (OR) = 2.19, 95% CI = 1.03–4.64, p = 0.04] and age (OR = 1.14, 95% CI = 1.03–1.26, p = 0.01), i.e. with every 1 year advance in age, the odds of ET increased by 14%. Prevalence reached 21.7% among the oldest old (age ≥95 years). Conclusions: This study reports a significant ethnic difference in the prevalence of ET. The prevalence of ET was high overall (5.5%) and rose markedly with age so that in the oldest old, more than 1 in 5 individuals had this disease

Celiac disease and risk of myasthenia gravis – nationwide population-based study

Background Case reports suggest there may be an association between celiac disease (CD) and myasthenia gravis (MG). Methods We identified 29,086 individuals with CD in Sweden from 1969 to 2008. We compared these individuals with 144,480 matched controls. Hazard ratios (HRs) for future MG (identified through ICD codes) were estimated using Cox regression. Results During 326,376 person-years of follow-up in CD patients, there were 7 MG cases (21/million person-years) compared to 22 MG cases in controls during 1,642,273 years of follow-up (14/million person-years) corresponding to a HR of 1.48 (95% CI = 0.64–3.41). HRs did not differ when stratifying for age, sex or calendar period. HRs were highest in the first year after follow-up, though insignificant. Individuals with CD were at no increased risk of MG more than 5 years after CD diagnosis (HR = 0.70; 95% CI = 0.16–3.09). Conclusion This study found no increased risk of MG in patients with CD

Essential tremor is associated with dementia: Prospective population-based study in New York

Background: Mild cognitive deficits, mainly in frontal-executive function and memory, have been reported in patients with essential tremor (ET). Furthermore, an association between ET and dementia has been reported in a single population-based study in Spain. This has not been confirmed elsewhere. Objective: To determine whether baseline ET is associated with prevalent and incident dementia in an ethnically diverse, community-based sample of elders. Methods: Community-dwelling elders in northern Manhattan were enrolled in a prospective cohort study. Baseline ET diagnoses were assigned from handwriting samples. Dementia was diagnosed at baseline and follow-up using DSM-III-R criteria. Results: In cross-sectional analyses, 31/124 (25.0%) ET cases had prevalent dementia vs 198/2,161 (9.2%) controls (odds ratio [OR]unadjusted = 3.31, 95% confidence interval [CI] = 2.15–5.09, p < 0.001; ORadjusted = 1.84, 95% CI = 1.13–2.98, p = 0.01). In prospective analyses, 17/93 (18.3%) ET cases vs 171/1,963 (8.7%) controls developed incident dementia (hazard ratio [HR]unadjusted = 2.78, 95% CI = 1.69–4.57, p < 0.001; HRadjusted = 1.64, 95% CI = 0.99–2.72, p = 0.055). Conclusions: In a second population-based study of elders, essential tremor (ET) was associated with both increased odds of prevalent dementia and increased risk of incident dementia. Presence of dementia, therefore, appeared to be greater than that expected for age (i.e., a disease-associated feature). Rather than attributing cognitive complaints in patients with ET to old age, assessment and possible treatment of dementia should be routinely incorporated into the treatment plan

Time to Onset of Paresthesia Among Community Members Exposed to the World Trade Center Disaster

We examined whether time to onset of paresthesia was associated with indicators of severity of World Trade Center (WTC) exposure. We analyzed data from 3411 patients from the Bellevue Hospital&#8212;WTC Environmental Health Center. Paresthesia was defined as present if the symptom occurred in the lower extremities with frequency &#8220;often&#8222; or &#8220;almost continuous.&#8222; We plotted hazard functions and used the log-rank test to compare time to onset of paresthesia between different exposure groups. We also used Cox regression analysis to examine risk factors for time-to-paresthesia after 9/11/2001 and calculate hazard ratios adjusted for potential confounders. We found significantly elevated hazard ratios for paresthesia for (a) working in a job that required cleaning of WTC dust in the workplace; and (b) being heavily exposed to WTC dust on September 11, 2001, after adjusting for age, race/ethnicity, depression, anxiety, post-traumatic stress disorder, and body mass index. These observational data are consistent with the hypothesis that exposure to WTC dust or some other aspect of cleaning WTC dust in the workplace, is associated with neuropathy and paresthesia. Further neurological evaluations of this and other WTC-exposed populations is warranted

Epilepsy monitoring unit length of stay

With an increasing focus on quality metrics, hospital length of stay (LOS) in the U.S. has garnered significant scrutiny. To help establish evidence-based benchmarks for epilepsy monitoring unit (EMU) metrics, we evaluated the impact of multiple variables on LOS through a retrospective analysis of 905 consecutive inpatient adult EMU admissions. The most common reasons for admission were event characterization (n=494), medication adjustment (n=189), and presurgical evaluation (n=96). Presurgical evaluations experienced a longer average LOS (aLOS) of 7.1days versus patients admitted for other indications (p\u3c0.001). Patients with symptomatic generalized epilepsy (n=22) had a longer aLOS (6.9days) than patients with other types of epilepsy/events (p\u3c0.001). Patients admitted on two or fewer antiepileptic drugs (AEDs) had a shorter aLOS than patients admitted on three or more AEDs (4.3days vs 6.3days, respectively; p\u3c0.001). A history of previous invasive epilepsy management was associated with a longer aLOS than those without (6.2days vs 4.7days, respectively; p\u3c0.0001). Epilepsy monitoring unit aLOS is influenced by admission indication, epilepsy classification, medication burden, and having had prior invasive management. Multiple variables should be considered when analyzing LOS EMU metrics, arguing against a one size fits all approach

An Objective Measure for Tracking Disease in Traumatic Optic Neuropathy: Ganglion Cell Layer Thickness

Traumatic optic neuropathy (TON) can result from direct or indirect insult to the optic nerve leading to decreased visual function and complete loss of vision. There are often legal implications that may increase the likelihood of malingering in those with occupational injuries or in cases where compensation may be at stake. A motivated patient can imitate ophthalmic disease in measures testing visual acuity, visual field, and visual evoked potentials and electroretinogram which can be consciously suppressed. Using optical coherence tomography (OCT), we have an objective measure of ganglion cell layer (GCL) thickness in TON and we show that this may detect and quantify damage early, as well as detect prognosis before any changes are noted in OCT of the retinal nerve fiber layer (RNFL)