Essential tremor

Last reviewed: 6 Jan 2023
Last updated: 08 Mar 2022



History and exam

Key diagnostic factors

  • presence of risk factors
  • postural and/or kinetic tremor
  • problems with fine motor tasks
More key diagnostic factors

Other diagnostic factors

  • abatement of tremor after consumption of alcohol, benzodiazepines, barbiturates, or gabapentin
  • head or voice tremor
  • resting tremor
Other diagnostic factors

Risk factors

  • advanced age
  • family history
  • white ancestry
  • exposure to environmental toxins
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • CT or MRI scan of the head
  • serum ceruloplasmin
  • 24-hour urine copper
  • thyroid function tests
  • tremor physiology studies
  • single-photon emission CT (SPECT) scan of the head
More investigations to consider

Emerging tests

  • tremor stability index

Treatment algorithm


no dysfunction or embarrassment

dysfunction or embarrassment



Sheng-Han Kuo, MD

Assistant Professor of Neurology

College of Physicians and Surgeons

Columbia University

New York



S-HK is an author of a number of references cited in this topic.

Ming-Kai Pan, MD, PhD

Assistant Professor of Neurology

College of Medicine

National Taiwan University




M-KP has been a member of the Tremor Study Group and the International Parkinson and Movement Disorder Society.


Dr Sheng-Han Kuo and Dr Ming-Kai Pan would like to gratefully acknowledge Dr Zoltan Mari, Dr Martin Kronenbuerger, Dr Adam Burdick, and Dr Kelly D. Foote, previous contributors to this topic.


ZM has directed various educational programmes, accredited (CME) by Johns Hopkins University, and has accepted honoraria for consulting. MK, AB, and KDF declare that they have no competing interests.

Peer reviewers

Roger Weis, MD

Pediatric Neurologist

Kinderneurologisches Zentrum Mainz




RW declares that he has no competing interests.

Cory Toth, BSc, MD, FRCP(C)

Assistant Professor of Neurosciences

Hotchkiss Brain Institute

University of Calgary




CT declares that he has no competing interests.

  • Differentials

    • Parkinson's disease
    • Dystonia
    • Wilson's disease
    More Differentials
  • Guidelines

    • Transcranial magnetic resonance guided focused ultrasound thalamotomy for treatment of medication-refractory essential tremor
    • American Society for Stereotactic and Functional Neurosurgery position statement on magnetic resonance-guided focused ultrasound for the management of essential tremor
    More Guidelines
  • Patient leaflets

    Essential tremor

    More Patient leaflets
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