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Essential tremor

Medicine > Neurosciences

Background knowledge 🧠

Definition

  • Essential Tremor (ET) is a neurological disorder characterised by involuntary, rhythmic shaking (tremor), most commonly affecting the hands, head, voice, and legs.

Epidemiology

  • One of the most common movement disorders.

  • Can occur at any age but is more prevalent in people aged 40 and older.

Pathophysiology

xxx

Aetiology

  • The exact cause is unknown.

  • Genetic factors: A familial pattern is seen in about half of the cases, suggesting a genetic component.

Clinical Features 🌡️

Clinical Features

  • Tremor that worsens with movement or when maintaining a posture.

  • Typically a bilateral and symmetric action tremor of the hands and forearms.

  • Head and voice tremors are also common.

  • Does not usually cause other health problems, but can interfere with daily activities.

Investigations 🧪

Tests

  • Clinical diagnosis based on history and physical examination.

  • No specific diagnostic tests, but tests may be conducted to rule out other causes of tremor.

  • Family history is important in assessing the likelihood of ET.

Management 🥼

Management

  • No cure; treatment is aimed at relieving symptoms.
  • First-line pharmacotherapy includes propranolol (a beta-blocker) and primidone (an anticonvulsant).
  • Other medications may include gabapentin and topiramate.
  • Deep brain stimulation (DBS) surgery may be considered in severe cases.

Complications

xxx

Prognosis

  • A progressive disorder, but the rate of progression can vary.

  • Does not affect life expectancy but can worsen quality of life.

Key Points

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Definition:

  • Essential Tremor (ET) is a neurological disorder characterized by involuntary, rhythmic shaking (tremor), most commonly affecting the hands, head, voice, and legs.

Epidemiology:

  • One of the most common movement disorders.
  • Can occur at any age but is more prevalent in people aged 40 and older.

Etiology:

  • The exact cause is unknown.
  • Genetic factors: A familial pattern is seen in about half of the cases, suggesting a genetic component.

Clinical Features:

  • Tremor that worsens with movement or when maintaining a posture.
  • Typically a bilateral and symmetric action tremor of the hands and forearms.
  • Head and voice tremors are also common.
  • Does not usually cause other health problems, but can interfere with daily activities.

Diagnosis:

  • Clinical diagnosis based on history and physical examination.
  • No specific diagnostic tests, but tests may be conducted to rule out other causes of tremor.
  • Family history is important in assessing the likelihood of ET.

Management:

  • No cure; treatment is aimed at relieving symptoms.
  • First-line pharmacotherapy includes propranolol (a beta-blocker) and primidone (an anticonvulsant).
  • Other medications may include gabapentin and topiramate.
  • Deep brain stimulation (DBS) surgery may be considered in severe cases.

Differential Diagnosis:

  • Distinguishing ET from other types of tremor, like Parkinson’s disease tremor, is crucial.
  • Parkinson’s disease tremor is typically a resting tremor, in contrast to the action tremor of ET.

Prognosis:

  • A progressive disorder, but the rate of progression can vary.
  • Does not affect life expectancy but can worsen quality of life.

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Neurosciences