ESSENTIAL TREMOR

Question 1

how does essential tremor present?

Answer 1

Tremor during voluntary movement in hand(s), head, and/or voice.
Does not occur in legs.
Worsens with anxiety/excitement.
No other abnormalities on exam.

Question 2

what is the most common cause of postural (action) tremor?

Answer 2

essential tremor

Question 3

what is the pathogenesis of essential tremor?

Answer 3

poorly understood; neuropathology likely localized in brainstem and cerebellum; neurodegen changes

Question 4

Criteria for diagnosis of essential tremor?

Answer 4

1. isolated action tremor of one or both upper limbs, without other motor abnormalities
2. duration of at least 3 yrs
3. with or without tremor in other locations (head, voice, legs)
4. absence of other neuro signs

Question 5

treatment for mild essential tremor?

Answer 5

propranolol, alprazolam, or primidone

Question 6

treatment for persistent functional or psychological disability from essential tremor?

Answer 6

propranolol, primidone, OR combination

Question 7

treatment for essential tremor when sx continue despite trx? what meds do you try first? and what is the last resort?

Answer 7

topiramate or gabapentin first.
If fails, then botulinum toxin A for head or vocal cords, or deep brain stimulation/thalamotomy for affected limb.

Question 8

what is the prognosis for essential tremor?

Answer 8

gradually worsens with time, can be present for years and lead to disability with writing, using tools, holding drinks, or speech.