Assessment of Tremors

Question 1

What is a tremor

Answer 1

Involuntary, rhythmic, oscillatory movement of a body part

Question 2

Key things to ask in a history

Answer 2

Age of onset
Temporal evolution

Body distribution
Activation conditions
Tremor frequency

Associated signs

• systemic illness
• neurological signs
• soft signs

FHx or sporadic?

Question 3

Investigations to consider

Answer 3

Electrophysiological tests
-surface EMG - document tremor frequency, rhythmicity, morphology

Structural imaging - MRI, CT for lesions

Receptor imaging - dopamine, seretonin transporter imaging (differentiated between ET and PD)

Serum and tissue markers
-metabolic blood tests, infection (Wilsons, thyroid hormone)

Question 4

Activation conditions of a tremor?

Answer 4

Only at rest

Action

• kinetic => simple/intention/task specific?
• postural => position independent/dependent
• isometric tremor

Question 5

Possible differentials

Answer 5

Orthostatic tremor
Resting tremor in PD
Essential tremor - absence of other neurological signs
Dystonic tremor syndrome - tremor + dystonia
Cortical tremor
Functional tremor syndrome - distractability, entrainment