Tremor

Question 1

What is essential tremor?

Answer 1

Tremor that is present at action and rest without any other neurological symptoms

Question 2

What are the characteristics of a tremor observed in a patient with essential tremor?

Answer 2

A bilateral upper limb action tremor, with absence of other neurological signs, such as dystonia, ataxia, or parkinsonism

Clinical diagnosis

• Most common action tremor (rarely present at rest)
• Symmetrical
• slowly progressive course
• Moderate but
  
  • normally problems in tasks that require fine motor control
• may present at other locations (voice, head etc.)

Question 3

What are risk factors for the development of essential tremor?

Answer 3

• advanced age
• familial history
• white ancestry
• and exposure to environmental toxins.

Question 4

How would an essential tremor change with conume of alcochol or other CNS depressing drugs? (alcohol, benzodiazepines, barbiturates, and gabapentin)

Answer 4

Normally is better

Question 5

What are possible treatments for essential tremor?

Answer 5

Only in severe cases to improve functionality and social embarressment

• Consider
  
  • propanolol
  • primidone
• 2nd line
  
  • Gabapentin
  • benzos

Question 6

What is enhanced physiological tremor?

Answer 6

Physiologic tremor is a rhythmic oscillation with a frequency of 8 to 12 Hz, determined largely by the mechanical properties of the oscillating limb.

–> might be enhanced in certrain conditions

Question 7

What is a typical presentation of enhanced physiological tremor?

Answer 7

anxious appearance;

fine high-frequency postural and kinetic tremor that occurs in arms, legs, and voice but not the head

Question 8

What is a postural tremor?

Answer 8

A postural tremor occurs when holding a position against gravity, such as holding your arm or leg outstretched

Question 9

What is a typical histroy of enhanced physiological tremor?

Answer 9

tremor noticed in situations of stress, anxiety, or excessive caffeine use;

absence of neurological disease

Question 10

What are other organic causes for essential tremor?

Answer 10

RED FLAGS

• Hypoglycaemia
• Thyrotoxicosis
• Alcohol withdrawl

Question 11

What is essential tremor plus?

Answer 11

Essential tremor with suble neurological signs like

• impaired tandem gait
• subtle body posturing suggestive of dystonia
• or mild memory impairment

Question 12

Which investigations would you order in a person with suspected esential tremor?

Answer 12

To rule out organic causes of enhanced physiological tremor

• Thyroid function test
• Metabloic pannel
  
  • To exclude abnormal sodium, calcium, glucose levels
• Low serum ceruloplasmin (<180 mg/L [18 mg/dL]) suggests Wilson’s disease.

Question 13

Which drugs can induce action tremors?

Answer 13

• Action Tremors
  
  • Anti-depressants (SSRI; TCAs)
  • anti-eleptic (sodium valporate)
  • Cardiac drugs (amiodarone)
  • Immunosupressants
  • ß-agonist (salbutamol)
    *

Question 14

Which drugs can induce rest tremors?

Answer 14

Rest tremors

• Dopamine receptor blocker (neuroleptics)
• anti-emetics (metaclopramide)
• CCB

Question 15

What is micurition?

Answer 15

Urination