Differential diagnosis of tremor

  • Günther Deuschl
Part of the Journal of Neural Transmission. Supplementa book series (NEURAL SUPPL, volume 56)


The differential diagnosis of tremor is based on the clinical distinction of rest, postural and intention tremor and the presence of additional clinical signs and data from the medical history. The most common pathological tremors are essential tremor and the tremors of Parkinson’s disease. Among the patients with essential tremor those with intention tremor are often misdiagnosed as cerebellar tremors. Patients with monosymptomatic resting tremors represent a special subgroup of Parkinson’s disease. Primary orthostatic tremor and dystonic tremor are rare clinical syndromes which have recently been well defined. Holmes’ tremors are defined by their low frequency and the occurence of resting and intention tremor. Palatal tremor can be separated into two subgroups. Psychogenic tremor can be diagnosed on the basis of clinical criteria. The gold standard of tremor differential diagnosis is still based on clinical criteria.


Essential Tremor Postural Tremor Action Tremor Physiologic Tremor Intention Tremor 
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  1. Bain PG, Findley LJ, Thompson PD, Gresty MA, Rothwell JC, Harding AE, Marsden CD (1994) A study of hereditary essential tremor. Brain 117: 805–824PubMedCrossRefGoogle Scholar
  2. Bain PG, Britton TC, Jenkins IH, Thompson PD, Rothwell JC, Thomas PK, Brooks DJ, Marsden CD (1996) Tremor associated with benign IgM paraproteinaemic neuropathy. Brain 119: 789–799PubMedCrossRefGoogle Scholar
  3. Brooks DJ (1993) PET studies on the early and differential diagnosis of Parkinson’s disease. Neurology 43Google Scholar
  4. Dalakas MC, Teravainen H, Engel WK (1984) Tremor as a feature of chronic relapsing and dysgammaglobulinemic polyneuropathies. Incidence and management. Arch Neurol 41: 711–714PubMedCrossRefGoogle Scholar
  5. Deuschl G, Mischke G, Schenck E, Schulte-Mönting J, Lucking CH (1990) Symptomatic and essential rhythmic palatal myoclonus. Brain 113: 1645–1672PubMedCrossRefGoogle Scholar
  6. Deuschl G, Toro C, Valls SJ, Zeffiro T, Zee DS, Hallett M (1994) Symptomatic and essential palatal tremor. 1. Clinical, physiological and MRI analysis. Brain 117: 775–788PubMedCrossRefGoogle Scholar
  7. Deuschl G, Krack P, Lauk M, Timmer J (1996) Clinical electrophysiology of tremor. J Clin Neurophysiol 13: 110–122PubMedCrossRefGoogle Scholar
  8. Deuschl G, Bain P, Brin M (1998) Tremor: Consensus-statement of the Movement Disorder Society. Mov Disord 13 (Suppl) 3: 2–23Google Scholar
  9. Findley LJ, Koller WC (1995) Handbook of tremor disorders. Marcel Dekker, New YorkGoogle Scholar
  10. Holmes G (1904) On certain tremors in organic cerebral lesions. Brain 27: 327–375CrossRefGoogle Scholar
  11. Ikeda A, Kakigi R, Funai N, Neshige R, Kuroda Y, Shibasaki H (1990) Cortical tremor: a variant of cortical reflex myoclonus. Neurology 40: 1561–1565PubMedCrossRefGoogle Scholar
  12. Jankovic J, Van der Linden C (1988) Dystonia and tremor induced by peripheral trauma: predisposing factors. J Neurol Neurosurg Psychiatry 51: 1512–1519PubMedCrossRefGoogle Scholar
  13. Koller WC, Busenbark K, Miner K (1994) The relationship of essential tremor to other movement disorders: report on 678 patients. Essential Tremor Study Group. Ann Neurol 35: 717–723CrossRefGoogle Scholar
  14. Krack P, Deuschl G (1998) Tremor. In: Hopf H, Diener GD H C, Reichmann H (eds) Handbuch der Neurologie. Thieme, StuttgartGoogle Scholar
  15. Miwa H, Hatori K, Kondo T, Imai H, Mizuno Y (1996) Thalamic tremor: case reports and implications of the tremor-generating mechanism. Neurology 46: 75–79PubMedCrossRefGoogle Scholar
  16. Rivest J, Marsden CD (1990) Trunk and head tremor as isolated manifestations of dystonia. Mov Disord 5: 60–65PubMedCrossRefGoogle Scholar
  17. Rosenbaum F, Jankovic J (1988) Focal task-specific tremor and dystonia: categorization of occupational movement disorders. Neurology 38: 522–527PubMedCrossRefGoogle Scholar
  18. Shibasaki H (1995) Myoclonus. Curr Opin Neurol 8: 331–334PubMedCrossRefGoogle Scholar
  19. Silfverskiöld BP (1986) Rhythmic myoclonias including spinal myoclonus. In: Fahn S, Marsden CD, Van Woert M (eds) Advances in neurology. Raven Press, New York, pp 275–285Google Scholar
  20. Spieker S, Jentgens C, Boose A, Dichgans J (1995) Reliability, specificity and sensitivity of long-term tremor recordings. Electroencephalogr Clin Neurophysiol 97: 326–331PubMedCrossRefGoogle Scholar
  21. Thomas JE, Reagan TJ, Klass DW (1977) Epilepsia partialis continua. Arch Neurol 34: 266–275PubMedCrossRefGoogle Scholar
  22. Young RR, Shahani BT (1986) Asterixis: one type of negative myoclonus. In: Fahn S, Marsden CD, Van Woert M (eds), Myoclonus. Raven Press, New York, pp 137–156Google Scholar

Copyright information

© Springer-Verlag Wien 1999

Authors and Affiliations

  • Günther Deuschl
    • 1
  1. 1.Department of NeurologyChristian-Albrechts-University KielKielFederal Republic of Germany

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