Essential tremor-plus: a controversial new concept

Elan D. Louis, Martin Bares, Julian Benito-Leon, Stanley Fahn, Steven J. Frucht, Joseph Jankovic, William G. Ondo, Pramod K. Pal, Eng King Tan

Research output: Contribution to journalReview articlepeer-review

87 Scopus citations


In addition to redefining essential tremor (ET), the 2018 consensus statement of the Movement Disorder Society on tremor coined a new term: essential tremor-plus (ET-plus). This term is uncertainly defined as tremor with the characteristics of ET, with additional neurological signs of uncertain clinical significance. If ET-plus had been defined on the basis of a difference in underlying pathology or an appreciable difference in prognosis, it would have a valid, scientific rationale, as does the term Parkinson-plus. However, there is no such evidence, so the basis for the term is questionable. In fact, ET-plus might only represent a state condition (ie, patients with ET might develop these additional clinical features when the disease is at a more advanced stage). We caution against coining new terms that are not supported by a firm scientific basis and encourage research into the creation of essential tremor subsets that are defined with respect to differences in underlying causes or pathophysiology.

Original languageEnglish
Pages (from-to)266-270
Number of pages5
JournalThe Lancet Neurology
Issue number3
StatePublished - Mar 2020
Externally publishedYes


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