Essential Tremors

Question 1

Definition of essential tremor

Answer 1

Progressive, mainly symmetrical, rhythmic, involuntary oscillation movement disorder of the hands and forearms primarily, that is usually absent at rest and present during posture and intentional movements

Is WITHOUT other neurological signs and symptoms

Question 2

Aetiology and risk factors for Essential tremors

Answer 2

Unknown aetiology
Risk factors:
• Ageing
• Genetics
• Environmental toxins

Question 3

Pathophysiology of essential tremors

Answer 3

No well defined pathophysiology
But evidence shows involvement of the cerebellum, brainstem and thalamus
• Essential tremors are suppressed by medicines that affect the GABA-Eric system (e.g alcohol, benzodiazepines, gabapentin)
• Early onset ET commonly associated with family history
• Late onset ET seems to have faster tremor progression and higher risk of dementia

Question 4

History and Examination of Essential tremors

Answer 4

• Postural and/or kinetic tremor: bilateral upper limb action tremor with absence of other neurological signs (e.g normal muscle tone, no Parkinson’s history etc)
• Problems with fine motor skills: May have progressive functional decline where ADLs become more difficult (writing, dressing, using straws etc)
• Head or voice tremor
• Gets better with alcohol, benzos etc

Question 5

Investigations for essential tremors

Answer 5

Clinical diagnosis

Question 6

Treatment if no dysfunction or embarrassment

Answer 6

Observation

Question 7

Treatment if dysfunction or embarrassment

Answer 7

1) Medical treatment: Can give Propanalol (start at lower dose and increase until tremor is controlled). Contraindicated in bradycardia or asthma
2) Deep brain stimulation

Question 8

Prevention and prognosis of essential tremors

Answer 8

Avoid environmental toxins such as lead, mercury, pesticides etc

Persistent and progressive condition. No cure, but treatment can improve quality of life