It is time to remove the ‘benign’ from the essential tremor label

In recent years, studies of essential tremor (ET) have demonstrated that the disease is associated with functionally-relevant cognitive abnormalities, a mood disturbance and other psychiatric co-morbidities, a functionally significant gait disorder, hearing deficits, and a variety of types of tremor. The tremor has been shown to be progressive in nature and quite disabling for a large number of sufferers. Also, recent clinical–epidemiological studies have linked prevalent ET to other neurodegenerative diseases and at least one study has demonstrated an increased risk of mortality in an ET cohort. While many of these studies are derived from clinic-based samples, population-based studies have also substantiated these findings, suggesting that even in the general population, the disease is associated with disability and with co-morbidity. Based on these available studies, it would seem inaccurate to append the word “benign” to ET. Not unlike the word “essential” itself, the word “benign” is an antiquated and outdated term that reflects an era where little was understood about ET. Historically, the general doctors who frequently encountered the disorder would educate patients that it was a benign, non-progressive condition not associated with any co-morbidity or risk of long-term worry. This notion, conceived by prior generations of physicians, is now known to be inaccurate. It is therefore our recommendation that the medical community open the dialog to consider formally discontinuing this nosology (“benign essential tremor”) and to adopt the use of the term “essential tremor.” Use of the word “benign” is a mischaracterization of the disease course, and could be prove misleading especially in the evolving doctor–patient relationship. In those cases with currently-mild tremor, the nosology “mild essential tremor” would be a more accurate reflection of disease.