Diagnosis and Treatment of Common Forms of Tremor

Abstract

Tremor is the most common movement disorder presenting to an outpatient neurology practice and is defined as a rhythmical, involuntary oscillatory movement of a body part. The authors review the clinical examination, classification, and diagnosis of tremor. The pathophysiology of the more common forms of tremor is outlined, and treatment options are discussed. Essential tremor is characterized primarily by postural and action tremors, may be a neurodegenerative disorder with pathologic changes in the cerebellum, and can be treated with a wide range of pharmacologic and nonpharmacologic methods. Tremor at rest is typical for Parkinson’s disease, but may arise independently of a dopaminergic deficit. Enhanced physiologic tremor, intention tremor, and dystonic tremor are discussed. Further differential diagnoses described in this review include drug- or toxin-induced tremor, neuropathic tremor, psychogenic tremor, orthostatic tremor, palatal tremor, tremor in Wilson’s disease, and tremor secondary to cerebral lesions, such as Holmes’ tremor (midbrain tremor). An individualized approach to treatment of tremor patients is important, taking into account the degree of disability, including social embarrassment, which the tremor causes in the patient’s life.

Can anxiety increase tremors in patients with Parkinson’s disease? An experimental model

“…Therefore, tremor in patients with PD could be potentiated in anxiogenic situations. Physiologic tremors primarily occur in cases of anxiety and stress, and the use of beta-blockers can be indicated in more severe cases and before important events 24 .…”

“…Furthermore, the cerebellum and locus coeruleus are a part of this complex mechanism of the motor system 24 . It is of note that these areas are also directly associated with mood symptoms 25 and anxiety in PD 26 , thereby corroborating the influence of non-motor symptoms in tremors.…”

A Review of Clinical Approach to a Patient with Tremor Disorder

“…Hereby, in Table 2, we present a list of a number of drugs notorious for causing tremors [12,20,21].…”

Deep Brain Stimulation in Posttraumatic Tremor: A Series of Cases and Literature Review

“…Typically, postural and intention tremor prevail, which is unilateral and in most cases occurs in the upper limbs [3]. Sometimes it is referred to in the literature as Holmes' tremor because it presents with similar clinical characteristics [2,4]; however, the latter has been traditionally defined as being associated with a mid-brain lesion [5]. …”