First, the FTM assesses postural tremor in the limbs-extended-forward posture, kinetic tremor in the finger-nose-finger reaching task, and rest tremor while both upper limbs are relaxed on the patient's lap, all of which are performed while the patient is seated. There are 2 main differences in how upper limb tremor is assessed using these scales. 4 The reliability of the water-pouring task was not assessed. Large numbers of raters, rating a small sample of patients, found good intra-rater reliability and fair inter-rater reliability for the tremor location/severity items but only fair intra-rater reliability and poor inter-rater reliability for spiral drawing and handwriting ratings. 3 The reliability of FTM is less established. 2īoth expert and novice raters perform TETRAS with excellent inter-rater and intra-rater reliability. 1 The Essential Tremor Rating Assessment Scale (TETRAS) is a more recently validated scale that was designed specifically for the assessment of tremor severity in patients with ET. The most commonly used scale in large trials has been the Fahn-Tolosa-Marin Clinical Rating Scale for Tremor (FTM). TETRAS has 2 main advantages over FTM in the assessment of tremor severity: (1) the absence of a ceiling effect in patients with severe ET, and (2) the inclusion of wing-beating tremor.Ĭlinical trials for essential tremor (ET) have employed dozens of different scales and assessments as measures of primary efficacy. Test-retest reliabilities of the other TETRAS and FTM ratings were excellent, and both scales had good sensitivity to treatment effect. 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. Rest tremor, exclusive to FTM, correlated poorly with postural and kinetic tremor and had very poor test-retest reliability. However, FTM exhibited a ceiling effect for severe tremor. ResultsįTM ratings of postural and kinetic tremor correlated strongly with those of TETRAS.
#FAHN TOLOSA MARIN TREMOR RATING SCALE PDF FILE TRIAL#
Upper limb postural and kinetic tremor items from both scales were compared using blinded, video-recorded examinations of patients with moderate-to-severe ET who participated in a trial of focused ultrasound thalamotomy. However, there is no direct comparison of these scales in any clinical trial. 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. The Essential Tremor Rating Assessment Scale (TETRAS) is a validated clinical scale designed specifically for the assessment of ET severity. 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).
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