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Essential Tremor

Aka: Essential Tremor
  1. Epidemiology
    1. Age of onset 20-60 years (bimodal distribution)
      1. Likely has onset for most patients in ages 20-30 years but is mild initially
      2. Later presentation at age 60-70 years coincides with the natural progression in severity
    2. Most common pathologic Tremor cause in world
    3. Incidence over age 60 years: 50 cases per 1000
    4. Causes
      1. Genetic (Autosomal dominant inheritance)
      2. Sporadic
  2. Symptoms and Signs
    1. Postural Tremor (Subset of Action Tremor)
      1. Initially presents as postural distal arm Tremor
      2. Usually bilateral (may be unilateral initially)
      3. May progress to Rest Tremor if severe
      4. Slowly progressive
    2. Frequency at 4-11 Hz
      1. Slower frequencies proximally
      2. Higher frequencies distally
    3. Distribution
      1. Hands (most commonly affected)
        1. Wrist flexion-extension movement
      2. Head
        1. Forward flexion and extension (Nodding 'Yes')
        2. Lateral rotation (Shaking head 'No')
      3. Can also affect head, voice, Tongue and legs
    4. Provocative
      1. Stress or Fatigue
      2. CNS Stimulant medications
      3. Ask patient to hold hands out in front of them
      4. Ask patient to draw spiral
        1. Archimedes Spiral drawn (spiral with wavy hands)
    5. Palliative
      1. Small amounts of Alcohol
      2. Rest
  3. Differential Diagnosis
    1. See Tremor
    2. See Postural Tremor
    3. Parkinson's Disease
      1. Rest Tremor affecting extremities
  4. Labs: Not indicated unless atypical case
    1. Serum Chemistry Panel including glucose
    2. Complete Blood Count
    3. Thyroid Stimulating Hormone (TSH)
  5. Management
    1. General Measures
      1. Wrist weights
    2. Beta Blocker
      1. Propranolol (Inderal) 80-320 mg qd
      2. Metoprolol (Lopressor)
      3. Nadolol (Corgard)
    3. Anticonvulsant
      1. Primidone (Mysoline) 25-750 mg qd
    4. Other Agents
      1. Calcium Channel Blockers
      2. Carbonic Anhydrase Inhibitors
      3. Gabapentin (Neurontin)
      4. Topiramate
      5. Benzodiazepines
      6. Botulinum toxin
    5. Experimental Agents
      1. Nimodipine
      2. Mirtazapine
    6. Surgical management in very severe cases
      1. Thalamotomy
      2. Thalamic Stimulation
  6. Prognosis
    1. Indicators of better medication response
      1. Very low amplitude rapid Tremor
      2. Hand Tremor (contrast with head and voice Tremor)
    2. Morbidity associated with impact on job functioning and social embarrassment
      1. Up to 25% of patients change career or retire early due to Essential Tremor
  7. References
    1. Louis (2001) N Engl J Med 345(12): 887-91
    2. Pahwa (2003) Am J Med 115:134-42

Essential Tremor (C0270736)

Definition (MSH) A relatively common disorder characterized by a fairly specific pattern of tremors which are most prominent in the upper extremities and neck, inducing titubations of the head. The tremor is usually mild, but when severe may be disabling. An autosomal dominant pattern of inheritance may occur in some families (i.e., familial tremor). (Mov Disord 1988;13(1):5-10)
Concepts Disease or Syndrome (T047)
MSH D020329
ICD10 G25.0
SnomedCT 632009, 192839001
English BENIGN ESSENTIAL TREMOR SYNDROME, PRESENILE TREMOR SYNDROME, Tremor, essential, Tremor, physiological, Benign essential tremor (disorder), benign essential tremor, Essential Tremor, Essential tremor (hereditary), TREMOR ESSENTIAL, Benign Essential Tremor, Benign Essential Tremors, Essential Tremor, Benign, Essential Tremors, Benign, Tremor, Benign Essential, Tremors, Benign Essential, Essential Tremors, Tremor, Essential, Tremors, Essential, Essential Tremor [Disease/Finding], essential tremors, essential benign tremor, essential tremor, benign essential tremor syndrome, benign essential tremors, essential benign tremors, physiological tremor, tremor essential, Benign essential tremor, Essential tremor, Essential tremor (finding), essential; tremor, tremor; essential, Benign essential tremor (disorder) [Ambiguous]
Dutch benigne essentiële tremor, essentiële tremor (erfelijk), essentieel; tremor, tremor; essentieel, essentiële tremor, Benigne essentiële tremor, Essentiële tremor, Tremor, essentiële
French Tremblement familial bénin, Tremblement essentiel (héréditaire), Tremblement essentiel
German gutartiger essentieller Tremor, essentieller Tremor (hereditaer), essentieller Tremor, Essentieller Tremor, Benigner essentieller Tremor
Italian Tremore essenziale (ereditario), Tremore essenziale benigno, Tremore essenziale
Portuguese Tremor essencial (hereditário), Tremor essencial benigno, Tremor essencial, Tremor Essencial Benigno, Tremor Essencial
Spanish Temblor esencial benigno, Temblor esencial (hereditario), temblor esencial (hallazgo), temblor esencial benigno (concepto no activo), temblor esencial benigno (trastorno), temblor esencial benigno, temblor esencial, Temblor esencial, Temblor Esencial Benigno, Temblor Esencial
Japanese 本態性振戦（遺伝性）, ﾎﾝﾀｲｾｲｼﾝｾﾝ, ﾎﾝﾀｲｾｲｼﾝｾﾝｲﾃﾞﾝｾｲ, ﾘｮｳｾｲﾎﾝﾀｲｾｲｼﾝｾﾝ, 振戦-遺伝性本態性, 振戦-本態性-良性, 振戦-本態性-遺伝性, 遺伝性本態性振戦, 本態性振戦-良性, 良性本態性振戦, 本態性振戦, 家族性振戦, 振戦-遺伝性家族性, 振戦-家族性, 遺伝性家族性振戦, 振戦-本態性
Swedish Essentiell tremor
Czech esenciální tremor, benigní esenciální třes, Esenciální tremor, Esenciální tremor (hereditární), Benigní esenciální tremor
Finnish Essentiaalinen vapina
Russian TREMOR ESSENTSIAL'NYI, TREMOR DOBROKACHESTVENNYI ESSENTSIAL'NYI, TREMOR SEMEINYI, ТРЕМОР ДОБРОКАЧЕСТВЕННЫЙ ЭССЕНЦИАЛЬНЫЙ, ТРЕМОР СЕМЕЙНЫЙ, ТРЕМОР ЭССЕНЦИАЛЬНЫЙ
Korean 본태성 떨림
Polish Drżenie samoistne
Hungarian Essentialis tremor, Essentialis tremor (öröklött), Jóindulatú essentialis tremor
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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