Essential Tremor

Associated pages:
Parkinson’s Disease

FACTS

Summary: symmetric, postural and action tremor of hands and head, improved with alcohol, no rigidity or bradykinesia
Feature
Essential Tremor
Parkinsonian Tremor
Cerebellar Tremor
When
Action / Postural
Rest
Intention (during goal-directed movement)
Amplitude
Fine to medium
Coarse
Broad, irregular
Frequency
6–12 Hz (faster)
4–6 Hz
2–4 Hz (slow)
Distribution
Hands, head, voice
Hands, chin, legs
Limb (often unilateral), truncal
Alcohol effect
Improves
No effect
No effect
Tone
Normal
Increased (rigidity)
Normal or hypotonic
Gait
Normal
Shuffling
Ataxic
DBS Target
VIM
GPi, STN
-

HPI

universal ROS
  • family history of tremor
  • sides
  • present at rest or with movement?
  • does alcohol make it better?
  • When first noticed: ________
  • Gradual vs sudden onset
  • Progressive vs stable
  • Family history of tremor: ☐ Yes ☐ No
  • (rule out PD): Any stiffness, slowness, difficulty starting movements, voice changes, changes in handwriting, gait, or balance
  • Any thyroid disease, anxiety disorders, or liver/kidney disease?
  • Any exposure to toxins (lead, mercury, etc.)?
  • What medications or supplements are you taking? (Include beta-agonists, SSRIs, lithium, valproate, caffeine, steroids, etc.)
 

PHYSICAL EXAM

  • Action tremor (increases with goal-directed movement)

IMAGING

none
A/P
Medical Management
1) Beta blockers: propranolol is most effective (50%)
2) AEDs: primidone reduces by 50%
DBS:
- VIM of thalamus is the typical target