{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:58:49Z","timestamp":1791233929303,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T00:00:00Z","timestamp":1613088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with upper limb action tremor frequently exhibit additional neurological signs of uncertain significance. Clinicians vary in their interpretation, and interrater agreement on the final diagnosis is poor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>A new clinical tool for assessing the presence or absence of clinical signs that are important in axis\u20101 classification of tremor patients is introduced: the Standardized Tremor Elements Assessment (STEA). Interrater agreement is determined, and signs leading to disagreement in the final diagnosis are identified.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Three tremor\u2010focussed and one dystonia\u2010focussed movement disorder specialists rated 59 videos of patients with upper limb action tremor syndromes using STEA. Interrater agreements for final diagnosis and STEA items were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Interrater agreement regarding the final diagnosis was higher within the group of tremor specialists and poor between dystonia and tremor specialists. Greater agreement was found for items characterizing tremor than for signs of dystonia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Clinical signs leading to diagnostic disagreement were identified with STEA, and STEA should therefore be useful in future studies of diagnostic disagreement. The thresholds for considering neurological signs as soft versus significant for ataxia, parkinsonism, dystonia, etc. are critically important in tremor classification and must be studied across movement disorder subspecialties, not simply within a pool of tremor specialists.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mdc3.13150","type":"journal-article","created":{"date-parts":[[2021,1,18]],"date-time":"2021-01-18T13:41:59Z","timestamp":1610977319000},"page":"371-376","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Exploring Interrater Disagreement on Essential Tremor Using a Standardized Tremor Elements Assessment"],"prefix":"10.1002","volume":"8","author":[{"given":"Jos","family":"Becktepe","sequence":"first","affiliation":[{"name":"Department of Neurology University Hospital Schleswig\u2010Holstein, Christian\u2010Albrechts\u2010University  Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"G\u00f6vert","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital Schleswig\u2010Holstein, Christian\u2010Albrechts\u2010University  Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Balint","sequence":"additional","affiliation":[{"name":"Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London  London UK"},{"name":"Department of Neurology University Hospital Heidelberg  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Schlenstedt","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital Schleswig\u2010Holstein, Christian\u2010Albrechts\u2010University  Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8185-286X","authenticated-orcid":false,"given":"Kailash","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodger","family":"Elble","sequence":"additional","affiliation":[{"name":"Department of Neurology Southern Illinois University School of Medicine  Springfield Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4176-9196","authenticated-orcid":false,"given":"G\u00fcnther","family":"Deuschl","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital Schleswig\u2010Holstein, Christian\u2010Albrechts\u2010University  Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,12]]},"reference":[{"issue":"11","key":"e_1_2_8_2_1","first-page":"S21","article-title":"Essential tremor: cinical characteristics","volume":"54","author":"Jankovic J","year":"2000","journal-title":"Neurology"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.10221"},{"issue":"3","key":"e_1_2_8_4_1","first-page":"2","article-title":"Consensus statement of the Movement Disorder Society on tremor. 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