Essential Tremor Clinical Presentation

  • Author: Deborah A Burke, MD; Chief Editor: Selim R Benbadis, MD   more...
 
Updated: Jan 12, 2012
 

History

The following characteristics can be noted in patients with essential tremor:

  • A family history of essential tremor is noted in 50-60% of cases
  • Tremor usually begins in one upper extremity and soon affects the other; essential tremor rarely extends from the upper extremity to the ipsilateral leg
  • A mild degree of asymmetry is not unusual
  • In about 30% of cases, tremor involves the cranial musculature; the head is involved most frequently, followed by voice, jaw, and face
  • Tremor may be intermittent initially, emerging only during periods of emotional activation
  • Over time the tremor becomes persistent
  • At any point in time, the frequency of the tremor is relatively fixed
  • The amplitude of the tremor is highly variable, depending on the state of emotional activation; tremor amplitude is worsened by emotion, hunger, fatigue, and temperature extremes
  • The baseline tremor amplitude slowly increases over several years
  • A degree of voluntary control is typical, and the tremor may be suppressed by skilled manual tasks
  • The tremor resolves during sleep
  • Ethanol intake temporarily reduces tremor amplitude in an estimated 50-70% of cases

Visible tremor is generally pathologic, but distinguishing between essential tremor and enhanced physiologic tremor can be difficult. Causes of enhanced physiologic tremor, including medications, stimulants such as caffeine, hyperthyroidism, fever, and anxiety, should be excluded.

Like a previous population-based study from Spain, a community-based cohort study from New York by Thawani et al found an association between essential tremor and dementia. In cross-sectional analyses, dementia was present in 31 of 124 subjects with essential tremor versus 198 of 2,161 controls (25% vs 9.2%). In prospective analyses, dementia developed in 17 of 93 subjects with essential tremor versus 171 of 1,963 controls (18.3% vs 8.7%).[24]

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Physical Examination

Essential tremor generally is considered to be monosymptomatic (tremor only), although some patients have abnormalities in gait and balance. If patients have such abnormalities, the diagnosis should be carefully considered, because most patients with essential tremor do not have gait abnormalities.

The tremor is characteristically postural (occurring with voluntary maintenance of a position against gravity) and kinetic (occurring during voluntary movement). It usually resolves when the body part relaxes. Other characteristics of essential tremor include the following:

  • Both upper extremities are typically affected
  • Mild asymmetry is not uncommon
  • Tremor also may affect the head, voice, and lips
  • Tone and reflexes are normal
  • Parkinsonian features such as bradykinesia and rigidity are absent

There are data calling into question the tenet that essential tremor is truly monosymptomatic. Findings associated with essential tremor include changes in cognition, personality,[25] mood,[26] hearing,[27, 28] and motor symptoms associated with cerebellar outflow.[29]

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Contributor Information and Disclosures
Author

Deborah A Burke, MD  Clinician, Sub-Investigator, Movement Disorder/Parkinson's Disease Center, University of South Florida College of Medicine; Investigator, Physician, Roskamp Institute Memory Clinic

Deborah A Burke, MD is a member of the following medical societies: American Academy of Neurology and Movement Disorders Society

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Hauser, MD, MBA  Professor of Neurology, Molecular Pharmacology and Physiology, Director, Parkinson's Disease and Movement Disorders Center, University of South Florida College of Medicine; Clinical Chair, Signature Interdisciplinary Program in Neuroscience

Robert A Hauser, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Society of Neuroimaging, and Movement Disorders Society

Disclosure: Adamas Pharmaceuticals Consulting fee Consulting

Theresa A McClain, RN, MSN, ARNP-BC  Advanced Registered Nurse Practitioner and Investigator, Parkinson's Disease and Movement Disorders Center, University of South Florida College of Medicine

Theresa A McClain, RN, MSN, ARNP-BC is a member of the following medical societies: Sigma Theta Tau International

Disclosure: Teva Consulting fee Consulting; GSK Consulting fee Consulting; Valeant Pharm Consulting fee Consulting; Solvay Consulting fee Consulting; Shering Plough Consulting fee Consulting

Chief Editor

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Additional Contributors

Nestor Galvez-Jimenez, MD, MSc, MHA Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida

Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, and Movement Disorders Society

Disclosure: Nothing to disclose.

Daniel H Jacobs MD, FAAN, Associate Professor of Neurology, University of Florida College of Medicine; Director for Stroke Services, Orlando Regional Medical Center

Daniel H Jacobs is a member of the following medical societies: American Academy of Neurology, American Society of Neurorehabilitation, and Society for Neuroscience

Disclosure: Teva Pharmaceutical Grant/research funds Consulting; Biogen Idex Grant/research funds Independent contractor; Serono EMD Royalty Speaking and teaching; Pfizer Royalty Speaking and teaching; Berlex Royalty Speaking and teaching

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

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