- Essential Tremor an often inherited autosomal dominant tremor affecting up to 5% of the general population.
- Onset may be as early as the 1st and 2nd decade of life but the tremor is delayed until after the age of 60.
- Inherited in an autosomal dominant fashion
PERTINENT HISTORICAL FINDINGS/ CLINICAL SYMPTOMS
- Mild postural and action tremor in the hands, indistinguishable from an enhanced physiologic tremor resulting in little functional impairment for many years.
- 50% of patients report improvement or complete amelioration of symptoms following ingestion of ethanol.
PERTINENT PHYSICAL EXAM FINDINGS
- Tremor at rest which increases with emotional stress.
- On finger to nose, tremor increases as target is approached.
- Parkinson’s Disease
- Metabolic disorders: hyperthyroidism, hypoglycemia
- Drug induced: caffeine, amphetamines, lithium, antidepressants
- Drug withdrawal: alcohol, benzodiazepines
- Fever, sepsis
- Anxiety, stress
- No abnormalities noted on CT or MRI
- No serum abnormalities noted
- Treatment does not influence the course of illness and should only be considered when tremor interferes with function.
- Non-cardioselective β-adrenergic blocker: propranolol or primidone
- If disability is substantial, thalamic deep brain stimulation or thalamotomy can be of benefit.
EMERGENCY MANAGEMENT (when applicable)
- Not applicable
PATIENT EDUCATION/ MAINTENANCE – PREVENTION
- Stress reeducation.
- Patient reassurance.
Dr. Zachary Lahlou