Essential tremor: diagnosis and management

Abstract

Essential tremor is one of the most common movement disorders in adults and can affect both children and adults. An updated consensus statement in 2018 redefined essential tremor as an isolated action tremor present in bilateral upper extremities for at least three years. Tremor may also be present in other locations, commonly the neck or the vocal cords. Patients with additional neurologic symptoms are now categorized as “essential tremor plus.” Additional clinical features associated with the condition include but are not limited to cognitive impairment, psychiatric disorders, and hearing loss. When treatment is needed, propranolol and primidone are considered first line treatments. Patients who are severely affected are often offered deep brain stimulation. Although the ventral intermediate nucleus of the thalamus is the traditional surgical target, the caudal zona incerta is also being studied as a possible superior alternative. Magnetic resonance imaging guided high intensity focused ultrasound is a newer surgical alternative that may be ideal for patients with substantial medical comorbidities. Current research explores novel oral treatments, chemodenervation, and noninvasive neuromodulation for treatment of essential tremor.

Clinical characteristics of patients with essential tremor or essential tremor plus

“…The new classification is valuable for promoting the view that ET syndrome is full of heterogeneity (among ET syndrome patients, ET‐plus group has additional symptoms and signs) and is no longer the mono‐symptomatic condition. However, by the process of reclassifying, we noticed that soft signs may need to be more clearly defined and standardized (eg, whether RBD should be regarded as soft signs; how to unify assessment criteria for soft signs) as mentioned by other researchers . As our study revealed, there was still significant heterogeneity in ET‐plus group.…”

“…Essential tremor (ET) is the most prevalent movement disorders affecting about 1%‐5% of the population above the age of 60 years worldwide . ET is characterized by upper limb action tremor and can also be combined with midline tremor and other motor symptoms such as gait and balance impairment . In recent years, ET is linked to a variety of non‐motor symptoms, such as cognitive deficiency, psychiatric symptoms, hearing loss, and olfactory changes .…”

“…ET is characterized by upper limb action tremor and can also be combined with midline tremor and other motor symptoms such as gait and balance impairment . In recent years, ET is linked to a variety of non‐motor symptoms, such as cognitive deficiency, psychiatric symptoms, hearing loss, and olfactory changes . As a result, the view that ET is a benign and mono‐symptomatic disease has been altered; on the contrary, ET has been recognized as a heterogeneous syndrome …”

Intramuscular Stimulation of Muscle Afferents Attains Prolonged Tremor Reduction in Essential Tremor Patients

“…The main tremor management approach in ET is medication. First line treatments with established efficacy are propranolol and primidone [4], although the average reduction of tremor using these medications is only approximately 50%, and one in three patients ends up discontinuing treatment [4], [5]. For these cases, there are second-line therapies, such as deep brain stimulation (DBS) or high-intensity focused ultrasound (HIFU) [6].…”

Non‐motor symptoms are associated with midline tremor in essential tremor

“…Essential tremor (ET) syndrome is a prevalent movement disorder in adults, characterized by simple kinetic and/or postural tremor of the arms, with or without various combinations of midline tremors (MT)—such as the neck, voice, and facial tremors 1 . Although motor symptoms are the most manifested in ET syndrome, the manifestation of non‐motor symptoms (NMS), including cognition deficiency, psychiatry symptoms, sleep disruption, and sensory abnormalities, has recently been reported in ET syndrome 2 .…”