Objective: To identify nystagmus in patients with essential tremor (ET).

Background: ET often affects the hands resulting in postural and kinetic tremor. The head, leg, tongue, trunk and vocal cords may also be involved. The prevalence of nystagmus in the general population was estimated to be 24 per 10,000. Microsaccadic oscillations and limb tremors were reported in mother and daughter.

Methods: In movement disorders clinic, patients with ET and nystagmus were identified. Exclusion criteria were any other disorders or medications that may induce nystagmus, including primidone and clonazepam. Nystagmus and tremor were graded clinically on a scale of 0-4. Video recording of abnormal movements were carried out after obtaining consent.

Results: Nine patients with ET and nystagmus were identified (7 men, 2 women; average age of 37 years; range 25-60 years, average duration of tremor was 13 years with range of 3-25 years). Two patients were brothers, four had family history of tremor. All patients had hand tremor and nystagmus. One patient had head tremor, two had tongue tremor, and three had leg tremor. Two patients were on propranolol, one patient was on metformin and simvastatin. MRI of the brain was unremarkable in all patients. Six patients were video recorded, nystagmus was jerky horizontal with a mild to moderate in severity (scale 2-3) at 45° with frequency at 5-6 Hz. Two patients had reduction of nystagmus and tremor with propranolol.

Conclusions: Nystagmus can be seen in some ET patients and it is probably an essential tremor of the eye. A case controlled study is indicated.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/nystagmus-in-essential-tremor/