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Tremor: Phenomenology, Etiology, Diagnosis, and Treatment

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Movement Disorders Curricula

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Abstract

Tremor is an involuntary rhythmic, oscillatory movement produced by synchronous or alternating contractions of antagonist muscles. Tremor is the most common movement disorder and one of the most common neurological symptoms. A wide variety of etiologies can cause tremor, with essential tremor being the most common. Parkinson’s disease, multiple sclerosis, and drug-induced tremors are other etiologies commonly seen in clinical practice. The diagnosis of the specific etiology of tremor is based on the clinical characteristics of the tremor as well as associated symptoms. The phenomenology of tremor including whether the tremor is present at rest, with posture or with action, allows classification of tremor. Imaging studies, while not in themselves diagnostic, can help rule out structural etiologies. Dopamine transporter imaging is a recent modality that can help distinguish essential tremor from parkinsonism. The treatment of tremor is based on etiology and, where possible, treatment of the underlying disease state. Deep brain stimulation of the thalamus can be an effective treatment modality in intractable cases of tremor.

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Authors and Affiliations

  1. Movement Disorders Program, Palm Beach Neuroscience Institute, 901 Village Blvd., Suite 702, West Palm Beach, FL, 33409, USA

    Arif Dalvi MD, MBA

  2. Department of Neurology, Parkinson’s Disease and Movement Disorder Center, University of Kansas Medical Center, 3599 Rainbow Blvd, MS 2012, Kansas City, KS, 66160, USA

    Rajesh Pahwa MD & Kelly E. Lyons PhD

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  1. Arif Dalvi MD, MBA
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  2. Rajesh Pahwa MD
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  3. Kelly E. Lyons PhD
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Correspondence to Kelly E. Lyons PhD .

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Editors and Affiliations

  1. Faculty of Medicine, Transilvania University, Brasov, Romania

    Cristian Falup-Pecurariu

  2. Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Lisbon, Portugal

    Joaquim Ferreira

  3. National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain

    Pablo Martinez-Martin

  4. Centre of Excellence, King’s College London, National Parkinson Foundation Centre of Excellence King’s College, London, United Kingdom

    Kallol Ray Chaudhuri

1 Electronic Supplementary Material

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Essential tremor. Note postural and intention tremor more prominent in the left hand. Spiral drawing shows marked tremor in the left hand (MP4 89122 kb)

Cervical dystonia with essential tremor. Note postural tremor more prominent in the left hand and directional component to head tremor most prominent when the patient bends forward (MP4 64153 kb)

Parkinson’s disease tremor. Note typical rest tremor best seen when the hand is resting on a table. When the hands are outstretched the tremor subsides but a reemergent tremor is seen soon thereafter. There is no significant intention tremor. Slight bradykinesia is noted in the right hand. The rest tremor is also seen when the patient walks (MP4 88938 kb)

DBS for essential tremor. The patient has a unilateral left VIM DBS implanted. The right hand tremor is well controlled with the left DBS turned on. There is a significant improvement with activities such as eating and drinking with the DBS on, as is seen in the latter part of the video (MP4 78642 kb)

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Dalvi, A., Pahwa, R., Lyons, K.E. (2017). Tremor: Phenomenology, Etiology, Diagnosis, and Treatment. In: Falup-Pecurariu, C., Ferreira, J., Martinez-Martin, P., Chaudhuri, K. (eds) Movement Disorders Curricula. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1628-9_29

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