-Essential Tremor (ET) is the most common movement disorder
-It is characterized by high-frequency action tremor of the hands, forearms, head, and voice.
-Family history is often present with autosomal dominant pattern of inheritance
-It is a chronic and slowly progressive disorder
-It is postural and kinetic in nature
–It can present in childhood but often -often starts in the third or fourth decade of life
-Absence of other etiologic factors and neurologic signs: Alcohol, Parkinsonism, medications, hyperthyroidism
Symptoms & Signs
-The tremor typically starts from either hands or forearms
-It is typically bilateral and symmetric but can be asymmetric
-The tremor is not present at rest, but emerges with action.
-Tremor can be postural (occurring with outstretched arms), or kinetic (occurring during action such as writing)
-In severe cases, interferes with activities of daily living, handwriting, vocalization
-Alcohol provides short-lived relief
–Other than the tremor, neurologic examination should be normal
-ET is a clinical diagnosis based on history and physical examination
-Labs to rule out thyroid dysfunction, Wilson disease, electrolyte disturbances
-A DaT scan is normal, whereas it is abnormal in Parkinson’s disease.
If the tremor is mild and non-disabling, treatment may not be required.
Behavioral: Stress reduction, Caffeine avoidance
Occupational therapy: Adaptive utensils
First-line agents: Propranolol, Primidone
Second-line agents: Gabapentin, topiramate, zonisamide
Surgical therapies: Unilateral thalamotomy, DBS (Deep Brain Stimulation) in the ventral intermediate (VIM) nucleus of the thalamus, High-frequency thalamic stimulation
Injections: Botulinum injections
-ET is a slowly progressive disorder and remains mild in the majority of cases.
-Patients with essential tremor have a higher risk of developing Parkinson disease than the general population.