Essential Tremor.

  • Essential Tremor an often inherited autosomal dominant tremor affecting up to 5% of the general population.

 ETIOLOGY/ PATHOGENESIS

  • 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.

 DIFFERENTIAL DIAGNOSIS

  • Parkinson’s Disease
  • Metabolic disorders: hyperthyroidism, hypoglycemia
  • Drug induced: caffeine, amphetamines, lithium, antidepressants
  • Drug withdrawal: alcohol, benzodiazepines
  • Fever, sepsis
  • Anxiety, stress

 DIAGNOSTIC EVALUATIONS

  • No abnormalities noted on CT or MRI
  • No serum abnormalities noted

 MEDICAL MANAGEMENT

  • 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

 SURGICAL MANAGEMENT

  • 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.

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Dr. Zachary Lahlou

One thought on “Essential Tremor.

  1. Pingback: Essential Tremor. | Dr. Zachary Lahlou

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