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