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Essential Tremor

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  1. Epidemiology
    1. Age of onset 20-60 years (bimodal distribution)
    2. Most common 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
      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 draw spiral
        1. Archimedes Spiral drawn (spiral with wavy hands)
    5. Palliative
      1. Small amounts of Alcohol
      2. Rest
  3. Differential Diagnosis
    1. Parkinson's Disease
      1. Rest Tremor affecting extremities
  4. Labs: Not indicated unless atypical case
    1. 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: Indicators of better medication response
    1. Very low amplitude rapid Tremor
    2. Hand Tremor (contrast with head and voice Tremor)
  7. References
    1. Pahwa (2003) Am J Med 115:134

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)
ConceptsDisease or Syndrome (T047)
ICD9333.1
MSHD020329
EnglishBenign Essential Tremor, BENIGN ESSENTIAL TREMOR SYNDROME, Benign Essential Tremors, Essential Tremor, Essential Tremors, PRESENILE TREMOR SYNDROME
Spanishtemblor esencial, temblor esencial benigno
Parent ConceptsMovement Disorders (C0026650), Static Tremor (C0234378), Ambiguous concept (C1274012), Finding by site (C1290906)
SourcesDXP, MSH, MTHICD9, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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