Diagnostic Uncertainties in Tremor

Abstract

The approach and diagnosis of patients with tremor may be challenging for clinicians. According to the most recent consensus statement by the Task Force on Tremor of the International Parkinson Movement Disorder Society, the differentiation between action (i.e., kinetic, postural, intention), resting, and other task- and position-specific tremors is crucial to this goal. In addition, patients with tremor must be carefully examined for other relevant features, including the topography of the tremor, since it can involve different body areas and possibly associate with neurological signs of uncertain significance. Following the characterization of major clinical features, it may be useful to define, whenever possible, a particular tremor syndrome and to narrow down the spectrum of possible etiologies. First, it is important to distinguish between physiological and pathological tremor, and, in the latter case, to differentiate between the underlying pathological conditions. A correct approach to tremor is particularly relevant for appropriate referral, counseling, prognosis definition, and therapeutic management of patients. The purpose of this review is to outline the possible diagnostic uncertainties that may be encountered in clinical practice in the approach to patients with tremor. In addition to an emphasis on a clinical approach, this review discusses the important ancillary role of neurophysiology and innovative technologies, neuroimaging, and genetics in the diagnostic process.

MR-guided focused ultrasound thalamotomy for lithium-induced tremor: a case report and literature review

“…Unfortunately, this was not possible for our patient, whose psychiatric health is dependent on lithium. Furthermore, no neurophysiological studies were conducted, which would have enhanced diagnostic accuracy ( 24 ). Another limitation of the study is the possible presence of bradykinesia preoperatively.…”

“…He was unable to effectively perform his job and had significantly affected psychosocial function. Based on the presence of the temporal relationship with lithium and the absence of a strong family history of tremor, a predominantly high frequency and low amplitude postural and action tremors accompanied by jerky episodes that cause poor dexterity ( 22 – 24 ), he was diagnosed with drug-induced tremor.…”

Bedside clinical assessment of patients with common upper limb tremor and algorithmic approach

“…Each position should be tested for at least 10 s (Supplementary Video 1) (with consent from the patient for publication). Clinicians should decide the position where tremor has maximal severity and categorize patients into predominant rest or action tremor groups that can help narrow down the differential diagnosis [5,10]. Supplementary Figure 1.…”

“…According to the 2018 Consensus Statement from the Task Force on Tremor of the International Parkinson and Movement Disorders Society, tremor is currently classified along 2 axes: clinical features that determine tremor syndromes in Axis 1, and underlying etiology in Axis 2 [ 1 ]. Careful history-taking and comprehensive physical examination of tremor characteristics and additional neurological signs are essential for the syndromic identification for Axis 1 [ 4 , 5 ]. The clinical phenotypes of various tremor syndromes are complex and overlapped, often making the diagnosis challenging [ 6 , 7 , 8 ].…”

“…identification for Axis 1 [4,5]. The clinical phenotypes of various tremor syndromes are complex and overlapped, often making the diagnosis challenging [6][7][8].…”