Essential tremor

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By Claudia M Testa MD PhD

Essential tremor is also known as or subsumes Benign tremor, Familial tremor, and Heredofamilial tremor. -ed.

Essential tremor is the most common movement disorder in adults. Most people with essential tremor have not been diagnosed by a physician even though many report functional disability. This clinical summary discusses the clinical presentation, differential diagnosis, pathophysiology, and treatment of essential tremor. Recent publications pertaining to the diagnosis, genetics, and treatment of essential tremor are reviewed. There is an ongoing effort to update the classification of tremor that may impact essential tremor clinical diagnosis. Unfortunately, there are no new treatments, and available medications are frequently inadequate. Thalamic deep brain stimulation is effective in most patients, and new stereotactic surgical sites are being explored. There is considerable evidence that essential tremor is a clinically defined tremor syndrome with multiple etiologies; this probably explains much of the difficulty in identifying underlying causes and developing new treatments.

Key Points

  • Classic essential tremor is a primary tremor syndrome.
  • The extent of nontremor symptoms possible within essential tremor is disputed but at least includes mild changes in balance, and in some patients, mood and cognitive changes.
  • Parkinson disease, dystonia and other tremorogenic conditions are frequently misdiagnosed as essential tremor.
  • Abnormal oscillation in the cerebellothalamocortical pathway produces tremor, but the structural, biochemical, and genetic mechanisms of essential tremor are uncertain.
  • Pharmacotherapeutic options (eg, primidone and propranolol) are limited and vary in efficacy; ventrolateral thalamic and subthalamic deep brain stimulation is an effective therapeutic option for patients with disabling tremor that responds inadequately to pharmacotherapy.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited