Summary
Definition
History and exam
Key diagnostic factors
- postural and/or kinetic tremor
- problems with fine motor tasks
Other diagnostic factors
- abatement of tremor after consumption of alcohol, benzodiazepines, barbiturates, or gabapentin
- head or voice tremor
- rest tremor
Risk factors
- advanced age
- family history
- white ancestry
- exposure to environmental toxins
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests 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
Emerging tests
- tremor stability index
Treatment algorithm
no dysfunction or embarrassment
dysfunction or embarrassment
Contributors
Authors
Sheng-Han Kuo, MD
Assistant Professor of Neurology
College of Physicians and Surgeons
Columbia University
New York
NY
Disclosures
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
Tapei
Taiwan
Disclosures
M-KP has been a member of the Tremor Study Group and the International Parkinson and Movement Disorder Society.
Acknowledgements
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.
Disclosures
ZM has directed various educational programs, 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
Mainz
Germany
Disclosures
RW declares that he has no competing interests.
Cory Toth, BSc, MD, FRCP(C)
Assistant Professor of Neurosciences
Hotchkiss Brain Institute
University of Calgary
Alberta
Canada
Disclosures
CT declares that he has no competing interests.
References
Key articles
Rajput AH, Offord KP, Beard CM, et al. Essential tremor in Rochester, Minnesota: a 45-year study. J Neurol Neurosurg Psychiatry. 1984 May;47(5):466-70.Full text Abstract
Louis ED. Etiology of essential tremor: should we be searching for environmental causes? Mov Disord. 2001 Sep;16(5):822-9. Abstract
Benito-Leon J, Louis ED. Clinical update: diagnosis and treatment of essential tremor. Lancet. 2007 Apr 7;369(9568):1152-4. Abstract
Zesiewicz TA, Elble RJ, Louis ED, et al. Evidence-based guideline update: treatment of essential tremor: report of the Quality Standards subcommittee of the American Academy of Neurology. Neurology. 2011 Nov 8;77(19):1752-5.Full text Abstract
Sydow O, Thobois S, Alesch F, et al. Multicentre European study of thalamic stimulation in essential tremor: a six year follow up. J Neurol Neurosurg Psychiatry. 2003 Oct;74(10):1387-91.Full text Abstract
Elias WJ, Lipsman N, Ondo WG, et al. A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med. 2016 Aug 25;375(8):730-9.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Parkinson disease
- Dystonia
- Wilson disease
More DifferentialsGuidelines
- American Society for Stereotactic and Functional Neurosurgery position statement on magnetic resonance-guided focused ultrasound for the management of essential tremor
- Transcranial magnetic resonance guided focused ultrasound thalamotomy for treatment of medication-refractory essential tremor
More GuidelinesPatient information
Essential tremor
More Patient information
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