Essential Tremor Flashcards
What is an essential tremor (ET)?
Progressive, mainly symmetrical, rhythmic, involuntary oscillation movement disorder of the hands and forearms (69% of patients) that is usually absent at rest and present during posture and intentional movements.
Other than the hands and forearms, where else can ET affect?
Essential tremor (ET) can also involve the voice (62% of patients), the head (48% of patients), and jaw.
Briefly describe the pathophysiology of ET
The pathophysiology of essential tremor (ET) has not been defined, but various lines of evidence implicate the involvement of the cerebellum, brainstem, and thalamus. Often patients have abnormal cerebellar function.
What are the risk factors for ET?
- Advanced age
- FHx
- White ancestry
- Exposure to environmental toxins
What are the clinical featurs of ET?
- Fine tremor
- Symmetrical
- More prominent on voluntary movement
- Worse when tired, stressed or after caffeine
- Improved by alcohol
- Absent during sleep
How is ET diagnosed?
There are no validated serological, radiological or pathological markers of ET, and, therfore, the diagnosis remains a clinical one.
Briefly describe the treatment for ET
There is no definitive treatment for benign essential tremor. The tremor is not harmful and does not require treatment if not causing functional or psychological problems.
Medications that can be tried to improve symptoms are:
- Propranolol (a non-selective beta blocker)
- Primidone (a barbiturate anti-epileptic medication)
What differentials should be considered for ET?
Benign essential tremor is diagnosed clinically based on the presenting features. It is important to look for features to exclude other causes of a tremor.
The key differential diagnoses of a tremor are:
- Parkinson’s disease
- Multiple sclerosis
- Huntington’s Chorea
- Hyperthyroidism
- Fever
- Medications (e.g. antipsychotics)
