Tremor overview

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Overview

Historical Perspective

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Pathophysiology

Causes

Differentiating Tremor from other Diseases

Epidemiology and Demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

Overview

Tremor is an involuntary, rhythmic, oscillatory movement, it is the most common involuntary movement disorder. Essential tremor, Parkinson's disease and enhanced physiologic tremor are the common causes of tremor to present in a primary care setting. Essential tremor is the most common. Other causes are caffeine intake, excessive alcohol, hypoglycemia, stress, anxiety, depression, fatigue, Wilson's disease, hyperthyroidism, multiple sclerosis, normal aging. Tremor can be classified into resting and action. Action tremor is further divided into postural, kinetic (simple or intentional), isometric and task-specific tremor. It is thought that tremor is the result of a combination of different mechanisms that could result in oscillatory/rhythmic movement. These mechanisms are mechanical oscillations, reflex oscillations, central oscillations, and cerebellar oscillation. Tremor must be differentiated from diseases that cause involuntary movement: myoclonus, clonus, asterixis, and epilepsia partialis continua. Essential tremor and Parkinson's disease worsens with time, treatment helps minimizing symptoms. Physiologic tremor does not worsen with age.

Historical Perspective

  • James Parkinson, identified the tremor as "involuntary tremulous motion in parts not in action," in his essay on the shaking palsy, in 1817.
  • Orthostatic tremor was first described by Kenneth M Heilman in 1984.
  • Pietro Burresi in 1874, used the term essential tremor.

Classification

Tremor may be classified into:

  • Resting or Action tremor.
  • Action tremor further includes postural, kinetic (simple or intentional), isometric and task-specific tremor.

Pathophysiology

Causes

Differentiating Tremor from other Diseases

Epidemiology and Demographics

Risk Factors

Common risk factors include:

Screening

  • There is insufficient evidence to recommend routine screening for tremor.

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

  • There are no x-ray findings associated with tremor.

Echocardiography and Ultrasound

CT

MRI

Treatment

Medical Therapy

Surgery

References