Essential tremor

Question 1

What is essential tremor?

Answer 1

“Progressive, mainly symmetrical, rhythmic, involuntary oscillation movement disorder of the hands and forearms that is usually absent at rest and present during posture and intentional movements”
- Most common form of tremor
- Bimodal Distributions → teens and elderly patients

Question 2

What are the risk factors for essential tremor?

Answer 2

Positive family history (autosomal dominant inheritance) 

Question 3

What presenting symptoms of essential tremor can be found in the history?

Answer 3

1. Bilateral upper limb action tremor → with absence of other neurological signs
2. Worse with sustained voluntary movement (ie. worse when arms outstretched), stress or anxiety
3. Involves → hands (90%), head (30%), voice (15%)
4. May be accompanied by an intention tremor or resting tremor
5. Improves with alcohol consumption

Question 4

What investigation is used to diagnose essential tremor?

Answer 4

Clinical diagnosis

Question 5

How is essential tremor managed?

Answer 5

1. If no dysfunction (mild case) → observation
2. If dysfunction → propranolol or primidone (anticonvulsant) as 1st line. Gabapentin (anticonvulsant) 2nd line. Deep Brain Stimulation (DBS) if drugs have no effect.