Essential tremor is characterised by a progressive tremor of the upper extremities, present in posture and action, without other neurological signs or symptoms.
The prevalence and incidence increases with age, but the condition can appear in early adulthood in those who have a family history.
Most people are only mildly affected. Those who seek medical care are disabled to some extent and often socially handicapped by the tremor.
There is no cure, but there are treatments that provide relief and improve quality of life. These include drug therapies and surgical procedures.
Progressive, mainly symmetrical, rhythmic, involuntary oscillation movement disorder of the hands and forearms (69% of patients) that is usually absent at rest and present during posture and intentional movements.
History and exam
Key diagnostic factors
- presence of risk 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
- resting tremor
- advanced age
- family history
- white ancestry
- exposure to environmental toxins
1st investigations to order
- clinical diagnosis
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
- tremor stability index
no dysfunction or embarrassment
dysfunction or embarrassment
- Parkinson's disease
- Wilson's disease
- 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
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