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
H. Houston Merritt Associate Professor of Neurology
College of Physicians and Surgeons
Columbia University
New York, NY
Disclosures
SHK has been a consultant for Biogen, Neurocrine, and Praxis.
Ming-Kai Pan, MD, PhD
Associate Professor of Pharmacology
College of Medicine
National Taiwan University
Taipei
Taiwan
Disclosures
MKP has been a consultant of BioPro Scientific, Taiwan.
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
Katherine Longardner, MD
Assistant Clinical Professor
University of California San Diego
San Diego, CA
Disclosures
KL was a paid consultant for Boston Scientific.
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.
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
Ferreira JJ, Mestre TA, Lyons KE, et al. MDS evidence-based review of treatments for essential tremor. Mov Disord. 2019 Jul;34(7):950-8. Abstract
American Academy of Neurology. Update: treatment of essential tremor. Oct 2011 [internet publication].Full text
Pouratian N, Baltuch G, Elias WJ, et al. American Society for Stereotactic and Functional Neurosurgery position statement on magnetic resonance-guided focused ultrasound for the management of essential tremor. Neurosurgery. 2020 Aug 1;87(2):E126-9.Full text Abstract
National Institute for Health and Care Excellence. Unilateral MRI-guided focused ultrasound thalamotomy for treatment-resistant essential tremor. Jun 2018 [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.
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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