Which Scale Best Detects Treatment Response of Tremor in Parkinsonism?

Dávid Pintér, Maria João Forjaz, Pablo Martinez-Martin, Carmen Rodriguez-Blazquez, Alba Ayala, Annamária Juhász, Márk Harmat, József Janszky, Norbert Kovács

Research output: Contribution to journalArticle


Background: Several scales are available for rating the severity of tremor at present. However, the sensitivity to change of these instruments has remained to be clarified. Objective: To compare the sensitivity of the Fahn-Tolosa-Marin Tremor Rating Scale, the Part III of the Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the MDS-UPDRS Tremor Scale to the effects of various antitremor treatments. Methods: Enrolling subjects with Parkinsonism associated with tremor, we analyzed two scenarios: (1) tremor changes associated with acute levodopa challenge (n = 287) and (2) a 12-month outcome of different treatment options (n = 512) including deep brain stimulation (n = 146), levodopa/carbidopa intestinal gel infusion (n = 30), and initiating (n = 63) or adjusting oral antiParkinsonian medication (n = 273). Changes in tremor scales were assessed by effect size values (Cohen's d and eta-square). Results: Part B of the Fahn-Tolosa-Marin Tremor Rating Scale was the most sensitive to acute levodopa challenge (Cohen's d =-1.04, η2 = 0.12). However, Part A of the Fahn-Tolosa-Marin Tremor Rating Scale showed the highest effect size, which was a small one (Cohen's d =-0.33, η2 = 0.03), for detecting a treatment-related change in the severity of tremor during long-term follow-up. Conclusions: The Fahn-Tolosa-Marin Tremor Rating Scale has a better ability to capture changes due to levodopa challenge or antiParkinsonian treatment than MDS-UPDRS Part III or MDS-UPDRS Tremor Scale.

Original languageEnglish
Pages (from-to)275-282
Number of pages8
JournalJournal of Parkinson's Disease
Issue number1
Publication statusPublished - Jan 1 2020


  • Parkinsonism
  • rating scales
  • treatment response
  • tremor

ASJC Scopus subject areas

  • Clinical Neurology
  • Cellular and Molecular Neuroscience

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    Pintér, D., Forjaz, M. J., Martinez-Martin, P., Rodriguez-Blazquez, C., Ayala, A., Juhász, A., Harmat, M., Janszky, J., & Kovács, N. (2020). Which Scale Best Detects Treatment Response of Tremor in Parkinsonism? Journal of Parkinson's Disease, 10(1), 275-282. https://doi.org/10.3233/JPD-191800