Benign essential tremor

Question 1

What is essential tremor?

Answer 1

A progressive tremor affecting predominantly the upper limb

Question 2

Where may be affected by essential tremor?

Answer 2

Most commonly affects the hands
Head tremor
Jaw tremor
Vocal tremor

Question 3

What are the features of essential tremor?

Answer 3

Fine tremor
Symmetrical
More prominent with voluntary movement
Worse when tired, stressed or after caffeine
Improved by alcohol
Absent during sleep

Question 4

What is the diagnostic criteria for essential tremor?

Answer 4

Isolated tremor of bilateral upper limb
At least 3 years duration
With or without tremor in other locations
Absence of other neurological signs

Question 5

What investigations can be used in the diagnosis of essential tremor?

Answer 5

Essential tremor is a clinical diagnosis. The following investigations can be used to exclude other causes:
- 24 hour urinary copper
- TFTs
- U&Es
- LFTs
- Serum caeruloplasmin
- MRI head
- DAT scan

Question 6

What are the differential diagnoses of essential tremor?

Answer 6

Parkinson’s disease
Multiple sclerosis
Huntington’s chorea
Hyperthyroidism
Fever
Dopamine antagonists

Question 7

What is the management of essential tremor?

Answer 7

First line - propranolol or primidone (anti-epileptic)

Second line - gabapentin, benzodiazepines