Essential tremor
D Haubenberger, M Hallett - New England Journal of Medicine, 2018 - Mass Medical Soc
D Haubenberger, M Hallett
New England Journal of Medicine, 2018•Mass Medical SocKey Clinical Points Essential Tremor Essential tremor is considered to be a tremor syndrome
characterized by isolated bilateral upper-limb action tremor with a duration of at least 3
years, with or without tremor in other locations, such as head, larynx (voice tremor), or lower
limbs. Essential tremor frequently manifests with additional mild neurologic signs of
diagnostic uncertainty, such as mild ataxia, questionably abnormal posturing of the limbs, or
impaired memory. This presentation is classified as “essential tremor plus.” The diagnosis is …
characterized by isolated bilateral upper-limb action tremor with a duration of at least 3
years, with or without tremor in other locations, such as head, larynx (voice tremor), or lower
limbs. Essential tremor frequently manifests with additional mild neurologic signs of
diagnostic uncertainty, such as mild ataxia, questionably abnormal posturing of the limbs, or
impaired memory. This presentation is classified as “essential tremor plus.” The diagnosis is …
Key Clinical Points
Essential Tremor
- Essential tremor is considered to be a tremor syndrome characterized by isolated bilateral upper-limb action tremor with a duration of at least 3 years, with or without tremor in other locations, such as head, larynx (voice tremor), or lower limbs.
- Essential tremor frequently manifests with additional mild neurologic signs of diagnostic uncertainty, such as mild ataxia, questionably abnormal posturing of the limbs, or impaired memory. This presentation is classified as “essential tremor plus.”
- The diagnosis is generally based on a comprehensive history taking and neurologic examination. Routine laboratory testing, including the measurement of thyrotropin and electrolyte levels and liver and kidney function, is reasonable to rule out abnormalities that can confer a predisposition to enhanced physiologic tremor.
- First-line treatment of essential tremor involves pharmacotherapy with propranolol or primidone.
- Interventional treatment approaches for essential tremor that is refractory to pharmacotherapy and that causes substantial disability include deep-brain stimulation or focused ultrasound thalamotomy guided by magnetic resonance imaging.
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