Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- tremor postural e/ou cinético
- problemas de motricidade fina
Outros fatores diagnósticos
- diminuição do tremor após o consumo de álcool, benzodiazepínicos, barbitúricos ou gabapentina
- tremor na cabeça ou voz
- tremor de repouso
Fatores de risco
- idade avançada
- história familiar
- ascendência branca
- exposição a toxinas ambientais
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- diagnóstico clínico
Investigações a serem consideradas
- tomografia computadorizada (TC) ou ressonância nuclear magnética (RNM) do crânio
- ceruloplasmina sérica
- cobre urinário de 24 horas
- testes da função tireoidiana
- estudos fisiológicos de tremores
- TC por emissão de fóton único (SPECT) do crânio
Novos exames
- índice de estabilidade do tremor
Algoritmo de tratamento
sem disfunção ou constrangimento
disfunção ou constrangimento
Colaboradores
Autores
Sheng-Han Kuo, MD
H. Houston Merritt Associate Professor of Neurology
College of Physicians and Surgeons
Columbia University
New York, NY
Declarações
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 programmes, 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
National Institute for Health and Care Excellence. Unilateral MRI-guided focused ultrasound thalamotomy for treatment-resistant essential tremor. Jun 2018 [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
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Doença de Parkinson
- Distonia
- Doença de Wilson
More DifferentialsGuidelines
- Suspected neurological conditions: recognition and referral
- American Society for Stereotactic and Functional Neurosurgery position statement on magnetic resonance-guided focused ultrasound for the management of essential tremor
More GuidelinesPatient information
Tremor essencial
More Patient information
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