Evaluation of tremor

Last reviewed: 23 Sep 2025
Last updated: 22 Oct 2025

Summary

Differentials

Common

  • Parkinson disease (PD)
  • Dementia with Lewy bodies
  • Enhanced physiologic tremor
  • Hypoglycemia (enhanced physiologic tremor)
  • Thyrotoxicosis (enhanced physiologic tremor)
  • Alcohol withdrawal (enhanced physiologic tremor)
  • Essential tremor or essential tremor plus
  • Drug-induced tremor
Full details

Uncommon

  • Multiple system atrophy
  • Progressive supranuclear palsy (PSP)
  • Cortico basal syndrome
  • Toxin-induced tremor
  • Pheochromocytoma (enhanced physiologic tremor)
  • Cerebellar tremor (multiple sclerosis, trauma, or stroke)
  • Fragile X tremor ataxia syndrome
  • Orthostatic tremor
  • Primary writing tremor
  • Dystonic tremor
  • Wilson disease
  • Holmes tremor (rubral or midbrain tremor)
  • Functional tremor
Full details

Contributors

Authors

Camilla Kilbane, MD, FAAN

Associate Professor Neurology

Center Director Parkinson’s Disease and Movement disorder Center

Institution University Hospitals Cleveland Medical Center / Case Western Reserve University

Cleveland

OH

Disclosures

CK has served as a consultant for Medtronic, including participation on the Data Safety Monitoring Board (DSMB) for the ADAPT-PD trial. CK has participated in the speakers bureau for Teva Pharmaceuticals and has served as an expert witness in one legal case.

Acknowledgements

Dr Camilla Kilbane would like to gratefully acknowledge Professor Kelvin L. Chou and Dr Praveen Dayalui, previous contributors to this topic.

Disclosures

KLC serves as a consultant for Abbott (DBS manufacturer). PD declares that he has no competing interests.

Peer reviewers

Aparna Wagle Shukla, null

Professor

Movement Disorders Division

Department of Neurology

University of Florida

Gainesville

FL

Disclosures

WS has been reimbursed by Merz, ES therapeutics, Sage, Jazz, and Acadia.

Paul Greene, MD

Associate Professor of Clinical Neurology

Yale School of Medicine

New Haven

CT

Disclosures

PG declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Bhatia KP, Bain P, Bajaj N, et al. Consensus statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord. 2018 Jan;33(1):75-87.Full text  Abstract

Shanker V. Essential tremor: diagnosis and management. BMJ. 2019 Aug 5;366:l4485.Full text  Abstract

American College of Radiology. ACR appropriateness criteria: movement disorders and neurodegenerative diseases. 2019 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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