![]() ![]() 3 A similar error exists in a Neurosurgical Focus article, 5 in which the maximum CRST and Part A score was noted as 160 and 32, instead of 156 and 88, respectively.Īlthough available digitally, 6 the original CRST forms may be challenging to access. The confusion may result from two scoring boxes placed near the handwriting section (scored only for the dominant hand) in the original article. However, to keep in line with the existing literature, we have been forced to use the original 156-point scale in our prospective trials.Ī version of the CRST with a 160-point maximum score as stated by Sinai and colleagues 1 and Xiong and colleagues in their response letter 4 has never existed. In our clinical practice we have been using a modified version of the CRST omitting the "face (P)" item with a maximum score of 152 instead of 156. In fact, face tremor cannot be assessed while holding a posture. Another inaccuracy of this version is the presence of a box for the "voice (P)" item in the scorecard, although it was not referred to in the text and calculations. In the second version, 3 the "face (P)" score was written in the text but the assessment method while posture holding was not specified. 2, 3 The first version 2 did not contain the "face (P)" item either in the description or in the calculations part however, a scoring box was provided for it in the scorecard. There are several noteworthy inaccuracies in the original CRST papers. 2 In 1993, a revised version of the CRST was published adding two items to part A (face postural and orthostatic tremor) and social activities to Part C, thus resulting in a maximum possible score of 156. The maximum possible scores of the first version of CRST are 80, 36, and 28 for Parts A, B, and C, respectively thus the maximum possible total score is 144. Part C assesses the functional disability and includes speaking, eating, drinking, hygiene, dressing, writing, and working.Įach item is rated on a scale from 0 to 4. ![]() Part B assesses kinetic tremor of the upper limbs during writing (only dominant hand), three drawing tasks, and water pouring (both hands). 2 Part A quantifies tremor at rest (R) and/or on action (postural or kinetic ) of the following body sites: 1) face (R) 2) tongue (R/P) 3) voice (K) 4) head (R/P) 5) trunk (R/P) 6 and 7) right and left upper limbs (R/P/K) and 8 and 9) right and left lower limbs (R/P/K). 2020 133:417-424).įirst published in 1988, the CRST was developed by Fahn, Tolosa, and Marin, and contains three parts. Magnetic resonance–guided focused ultrasound thalamotomy for essential tremor: a 5-year single-center experience. TO THE EDITOR: We read with great interest the article of Sinai and colleagues 1 and we would like to clarify some issues related to the Clinical Rating Scale for Tremor (CRST), one of the most commonly used tremor assessment scales ( Sinai A, Nassar M, Eran A, et al. ![]()
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