Tremor & Essential Tremor

Contributed by Leo Verhagen, MD, PhD
Associate Professor of Neurological Sciences
Rush University Medical Center
Chicago, IL, USA

 

2019 Updates Contributed by:

Susanne A. Schneider, MD
Consultant Neurologist

LMU University Hospital Muenchen
Munich, Germany


Susan Fox, MRCP (UK), PhD
Professor of Neurology
University of Toronto, Toronto Western Hospital
Toronto, ON, Canada

 

Tremor

Tremor is an involuntary, rhythmic, oscillatory movement of a body part. Tremor results from contractions of agonist and antagonist muscles entrained by a signal pattern originating from an oscillator in the central nervous system. Resting tremor occurs in a body part that is not activated and completely supported against gravity. Action tremor refers to tremor occurring with voluntary muscle contraction and is subdivided into postural tremor, isometric tremor and kinetic tremor. The latter is further subdivided into simple kinetic, intention tremor, and task specific tremor, such as writing tremor.

The etiology of tremor is diverse, and includes essential tremor (with 50% having a positive FH but no single gene identified); as part of genetic disorders eg Wilson’s disease;  degenerative such as Parkinson’s disease, Metabolic diseases (such as thyroid-, parathyroid-, liver disease and hypoglycemia); peripheral neuropathies (eg associated with Charcot-Marie-Tooth; drug-induced (including narcoleptics, tricyclics, lithium, cocaine, alcohol, adrenaline, bronchodilators, theophylline, caffeine, steroids, valproate, amiodarone, thyroid hormones, vincristine); toxins (heavy metals)  and psychogenic/functional disorders.

The original consensus criteria proposed by MDS from 1998 were recently revised to better overcome inconsistencies, particularly with regard to essential tremor (ET), tremor associated with dystonia or other additional neurological abnormalities, and focal tremors. The new consensus proposes classification has two main axes: clinical features (Axis 1) and etiology (Axis 2).

Clinically, a syndrome consisting only of tremor is called an isolated tremor syndrome. On the other hand, a syndrome of consisting of tremor and other systemic or neurological signs is called a combined tremor syndrome.

Etiologically, tremor can be classified into physiological tremor, enhanced physiological tremor, essential tremor syndromes (including classical ET), dystonic tremor, parkinsonian tremor, cerebellar tremor (often associated with multiple sclerosis), Holmes’ tremor (a.k.a. rubral tremor), palatal tremor, neuropathic tremor, toxic or drug-induced tremor, and psychogenic tremor.

 


 

Essential Tremor


Contributed by Hubert Fernandez, MD
Head, Movement Disorders
Department of Neurology
Cleveland Clinic
Cleveland, Ohio USA

Updated 2019: Contributed by Susan A. Schneider, MD
Consultant Neurologist
University Hospital Munchen
Pullach, Germany

Essential tremor (ET) is the most common tremor syndrome seen in adults. Essential tremor is an isolated tremor syndrome of bilateral upper limb action tremor with at least 3 years’ duration, as recently defined by the MDS Task Force for Tremor. Tremor in other locations (e.g., head, voice, or lower limbs) may (or may not) be present. But there are no other neurological signs, such as dystonia, ataxia, or parkinsonism. To further clarify and to delineate ET from other tremors, exclusion criteria were also formulated: Thus, isolated focal tremors (voice, head), orthostatic tremor with a frequency >12 Hz, task- and position-specific tremors and sudden onset and step-wise deterioration do not fall into the category of ET.

The characteristic tremor seen in ET is postural and action tremors, with a frequency of 4-7 Hz. These tremors may begin insidiously early in life, with an increment in tremor severity over the years. The disability in ET is associated with impairment of voluntary activities that occur as a result of the tremor. Patients commonly complain of tremors when eating, drinking and writing, spilling over food and drinks and developing a progressively illegible handwriting. The most commonly affected body parts include hands, head and voice, but may also be seen in the legs, trunk and face.

Despite being mainly a postural tremor, kinetic tremor may be present and sometimes a resting tremor of lesser severity may be appreciated. The tremor in ET is exacerbated by conditions as stress, exercise and fatigue, caffeine, certain medications and improves with relaxation and small doses of alcohol. Patients frequently have a family history.

The most common treatments for ET include: beta blockers such as proporanolol, primidone and topiramate. Sometimes, in medication-refractory tremor, deep brain stimulation of the VIM nucleus of the thalamus is considered.

 

Click here to view videos depicting tremor and essential tremor (Members Only)


Read the Consensus Statement on the classification of tremors by MDS (January 2018)

 

 

Find reference(s) to tremor here:

Education

Journal CME
Receive CME credit on a Journal article specific to tremor
 

International Congress

Abstracts
Search abstracts on PD submitted to the International Congress (Hong Kong)

Scientific Program
View the Final Program to find topics regarding PD at the International Congress (Hong Kong)

Teaching and Themed Courses
Order streaming content of the Teaching Courses or Themed Courses from past Congresses
 

Announcements

Find conferences pertaining to tremor and essential tremor scheduled in 2019

Supported and Endorsed Meetings
Find meetings supported and endorsed by MDS pertaining to tremor and essential tremor
 

Publications

Movement Disorders Journal
Find articles on tremor from the MDS Journal

Movement Disorders Clinical Practice
Movement Disorders Clinical Practice is an online journal committed to publishing high-quality, peer reviewed articles related to clinical aspects of movement disorders.

Video Library
Search for video on tremor in the Movement Disorders Journal supplements (Members Only)

Reviews & Position Papers
View complete collection of Evidence-Based Medicine review and task force papers published in the Movement Disorders Journal

Moving Along
Find articles on tremor in the Moving Along newsletter
 

Patient Education

  Read essential facts about
  essential tremor for patients. 
  Download patient leaflets
  about essential tremor in
  multiple languages.

Top

We use cookies to give you the best possible experience with our website. These cookies are also used to ensure we show you content that is relevant to you. If you continue without changing your settings, you are agreeing to our use of cookies to improve your user experience. You can click the cookie settings link on our website to change your cookie settings at any time. Note: The MDS site uses related multiple domains, including mds.movementdisorders.org and mds.execinc.com. This cookie policy only covers the primary movementdisorders.org and mdscongress.org domain. Please refer to the MDS Privacy Policy for information on how to configure cookies for all other domains on the MDS site.
Cookie PolicyPrivacy Notice