Essential tremor

Last reviewed: 24 Apr 2022
Last updated: 08 Mar 2022

Summary

Definition

History and exam

Key diagnostic 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
  • rest 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

ACUTE

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.

  • Differentials

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

    • 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 Guidelines
  • Patient leaflets

    Essential tremor

    More Patient leaflets
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