Blood Harmane (1-Methyl-9H-Pyrido[3,4-b]indole) and Mercury in Essential Tremor: A Population-Based, Environmental Epidemiology Study in the Faroe Islands

Elan D. Louis*, Eina H. Eliasen, Monica Ferrer, Daniella Iglesias Hernandez, Shahin Gaini, Wendy Jiang, Wei Zheng, Flemming Nielsen, Maria Skaalum Petersen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


Background: Essential tremor (ET) is among the most prevalent neurological diseases. Its environmental determinants are poorly understood. Harmane (1-methyl-9H-pyrido[3, 4-b]indole), a dietary tremor-producing neurotoxin, has been linked to ET in a few studies in New York and Madrid. Mercury, also a tremor-producing neurotoxin, has not been studied in ET. The Faroe Islands have been the focus of epidemiological investigations of numerous neurological disorders. Objective: In this population-based, case-control study, we directly measured blood harmane concentrations (HA) and blood mercury concentrations (Hg) in ET cases and controls. Methods: In total, 1,328 Faroese adults were screened; 26 ET cases were identified whose (HA) and (Hg) were compared to 197 controls. Results: Although there were no statistically significant differences between diagnostic groups, median (HA) was 2.7× higher in definite ET (4.13 g-10/mL) and 1.5× higher in probable ET (2.28 g-10/mL) than controls (1.53 g-10/mL). Small sample size was a limitation. For definite ET versus controls, p = 0.126. (Hg) were similar between groups. Conclusions: We demonstrated marginally elevated (HA) in definite and probable ET. These data are similar to those previously published and possibly extend etiological links between this neurotoxin and ET to a third locale. The study did not support a link between mercury and ET.

Original languageEnglish
Issue number3
Pages (from-to)272-280
Publication statusPublished - 2020


  • Case-control study
  • Environmental epidemiology
  • Essential tremor
  • Faroe Islands
  • Harmane
  • Mercury
  • Neurotoxin
  • Population based design

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