eMedicine Specialties > Neurology > Movement and Neurodegenerative Diseases

Essential Tremor: Follow-up

Author: Deborah A Burke, MD, Consulting Staff, Sub-investigator, Clinician, Movement Disorder/Parkinson's Disease Center, University of South Florida; Investigator, Physician, Roskamp Institute Memory Clinic
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; Clinical Chair, Signature Interdisciplinary Program in Neuroscience; Theresa McClain, MSN, ARNP, Parkinson's Disease and Movement Disorders Center, University of South Florida
Contributor Information and Disclosures

Updated: Oct 26, 2009

Follow-up

Further Outpatient Care

  • Essential tremor is slowly progressive; therefore, medication doses may need to be adjusted over time. Additionally, loss of medication benefit and long-term adverse effects are not uncommon. Adverse effects, including depression and male impotence, should be monitored in patients on propranolol.
  • Ongoing attention to activities of daily living, as well as to social and psychological adaptation, is warranted. Frequency of follow-up must be individualized.
  • Essential tremor is often familial; follow-up with family members may be appropriate. Concerns about disability arising in family members may need to be addressed.
 


More on Essential Tremor

Overview: Essential Tremor
Differential Diagnoses & Workup: Essential Tremor
Treatment & Medication: Essential Tremor
Follow-up: Essential Tremor
References
[ CLOSE WINDOW ]

References

  1. Louis ED, Vonsattel JP. The emerging neuropathology of essential tremor. Mov Disord. Jan 30 2008;23(2):174-82. [Medline].

  2. Shill HA, Adler CH, Sabbagh MN, et al. Pathologic findings in prospectively ascertained essential tremor subjects. Neurology. Apr 15 2008;70(16 Pt 2):1452-5. [Medline].

  3. Louis ED, Zheng W, Mao X, Shungu DC. Blood harmane is correlated with cerebellar metabolism in essential tremor: a pilot study. Neurology. Aug 7 2007;69(6):515-20. [Medline].

  4. Louis ED, Honig LS, Vonsattel JP, Maraganore DM, Borden S, Moskowitz CB. Essential tremor associated with focal nonnigral Lewy bodies: a clinicopathologic study. Arch Neurol. Jun 2005;62(6):1004-7. [Medline].

  5. Louis ED, Vonsattel JP, Honig LS, Ross GW, Lyons KE, Pahwa R. Neuropathologic findings in essential tremor. Neurology. Jun 13 2006;66(11):1756-9. [Medline].

  6. Shin DH, Han BS, Kim HS, Lee PH. Diffusion tensor imaging in patients with essential tremor. AJNR Am J Neuroradiol. Jan 2008;29(1):151-3. [Medline].

  7. Bermejo-Pareja F, Louis ED, Benito-Leon J. Risk of incident dementia in essential tremor: a population-based study. Mov Disord. Aug 15 2007;22(11):1573-80. [Medline].

  8. Benito-Leon J, Louis ED, Bermejo-Pareja F. Elderly-onset essential tremor is associated with dementia. Neurology. May 23 2006;66(10):1500-5. [Medline].

  9. Klebe S, Stolze H, Grensing K, Volkmann J, Wenzelburger R, Deuschl G. Influence of alcohol on gait in patients with essential tremor. Neurology. Jul 12 2005;65(1):96-101. [Medline].

  10. Daniels C, Peller M, Wolff S, et al. Voxel-based morphometry shows no decreases in cerebellar gray matter volume in essential tremor. Neurology. Oct 24 2006;67(8):1452-6. [Medline].

  11. Ross GW, Dickson D, Cersosimo M. Pathological investigation of essential tremor. Neurology. Apr 2004;62(7) S5:A537-A538.

  12. Dogu O, Sevim S, Camdeviren H, et al. Prevalence of essential tremor: door-to-door neurologic exams in Mersin Province, Turkey. Neurology. Dec 23 2003;61(12):1804-6. [Medline].

  13. Louis ED, Benito-Leon J, Ottman R, Bermejo-Pareja F. A population-based study of mortality in essential tremor. Neurology. Nov 20 2007;69(21):1982-9. [Medline].

  14. Louis ED, Barnes LF, Ford B, Pullman SL, Yu Q. Ethnic differences in essential tremor. Arch Neurol. May 2000;57(5):723-7. [Medline].

  15. Tan EK, Lum SY, Prakash KM. Clinical features of childhood onset essential tremor. Eur J Neurol. Dec 2006;13(12):1302-5. [Medline].

  16. Louis ED, Dogu O. Does age of onset in essential tremor have a bimodal distribution? Data from a tertiary referral setting and a population-based study. Neuroepidemiology. 2007;29(3-4):208-12. [Medline].

  17. Louis ED, Ottman R. Study of possible factors associated with age of onset in essential tremor. Mov Disord. Nov 2006;21(11):1980-6. [Medline].

  18. [Best Evidence] Thawani SP, Schupf N, Louis ED. Essential tremor is associated with dementia: prospective population-based study in New York. Neurology. Aug 25 2009;73(8):621-5. [Medline].

  19. Chatterjee A, Jurewicz EC, Applegate LM, Louis ED. Personality in essential tremor: further evidence of non-motor manifestations of the disease. J Neurol Neurosurg Psychiatry. Jul 2004;75(7):958-61. [Medline].

  20. Miller KM, Okun MS, Fernandez HF, Jacobson CE 4th, Rodriguez RL, Bowers D. Depression symptoms in movement disorders: comparing Parkinson's disease, dystonia, and essential tremor. Mov Disord. Apr 15 2007;22(5):666-72. [Medline].

  21. Benito-Leon J, Louis ED, Bermejo-Pareja F. Reported hearing impairment in essential tremor: a population-based case-control study. Neuroepidemiology. 2007;29(3-4):213-7. [Medline].

  22. Ondo W, Jankovic J, Schwartz K, Almaguer M, Simpson RK. Unilateral thalamic deep brain stimulation for refractory essential tremor and Parkinson's disease tremor. Neurology. Oct 1998;51(4):1063-9. [Medline].

  23. Stolze H, Petersen G, Raethjen J, Wenzelburger R, Deuschl G. The gait disorder of advanced essential tremor. Brain. Nov 2001;124:2278-86. [Medline].

  24. Ma S, Davis TL, Blair MA, et al. Familial essential tremor with apparent autosomal dominant inheritance: should we also consider other inheritance modes?. Mov Disord. Sep 2006;21(9):1368-74. [Medline].

  25. Deng H, Le W, Jankovic J. Genetics of essential tremor. Brain. Jun 2007;130:1456-64. [Medline].

  26. Shatunov A, Sambuughin N, Jankovic J, et al. Genomewide scans in North American families reveal genetic linkage of essential tremor to a region on chromosome 6p23. Brain. Sep 2006;129:2318-31. [Medline].

  27. Higgins JJ, Lombardi RQ, Pucilowska J, Jankovic J, Tan EK, Rooney JP. A variant in the HS1-BP3 gene is associated with familial essential tremor. Neurology. Feb 8 2005;64(3):417-21. [Medline].

  28. Walter AR, Bower JH, Ahlskog JE et al. Increased risk of essential tremor in first-degree relative of patients with Parkinson's disease. Mov Disord. Aug 15 2007;22(11).

  29. Doep F. Plotkin M, Siegel L. Brain parenchyma sonography and 123I-FP-CIT SPECT in Parkinson's disease and essential tremor. Mov. Disord. Dec 7 1007;23(3):(405-410).

  30. Stockner H, Sojer M, K KS, et al. Midbrain sonography in patients with essential tremor. Mov Disord. Feb 15 2007;22(3):414-7. [Medline].

  31. Benabid AL, Pollak P, Gao D, et al. Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders. J Neurosurg. Feb 1996;84(2):203-14. [Medline].

  32. Goldman MS, Ahlskog JE, Kelly PJ. The symptomatic and functional outcome of stereotactic thalamotomy for medically intractable essential tremor. J Neurosurg. Jun 1992;76(6):924-8. [Medline].

  33. Pahwa R, Lyons KL, Wilkinson SB, et al. Bilateral thalamic stimulation for the treatment of essential tremor. Neurology. Oct 22 1999;53(7):1447-50. [Medline].

  34. Tasker RR. Deep brain stimulation is preferable to thalamotomy for tremor suppression. Surg Neurol. Feb 1998;49(2):145-53; discussion 153-4. [Medline].

  35. Taha JM, Janszen MA, Favre J. Thalamic deep brain stimulation for the treatment of head, voice, and bilateral limb tremor. J Neurosurg. Jul 1999;91(1):68-72. [Medline].

  36. Schuurman PR, Bosch DA, Bossuyt PM, et al. A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med. Feb 17 2000;342(7):461-8. [Medline].

  37. Kondziolka D, Ong JG, Lee JY, Moore RY, Flickinger JC, Lunsford LD. Gamma Knife thalamotomy for essential tremor. J Neurosurg. Jan 2008;108(1):111-7. [Medline].

  38. Agundez JA, Jimenez-Jimenez FJ, Tejeda R, et al. CYP2D6 polymorphism is not associated with essential tremor. Eur Neurol. 1997;38(2):99-104. [Medline].

  39. Bain PG, Findley LJ, Thompson PD, et al. A study of hereditary essential tremor. Brain. Aug 1994;117 (Pt 4):805-24. [Medline].

  40. Boecker H, Wills AJ, Ceballos-Baumann A, et al. The effect of ethanol on alcohol-responsive essential tremor: a positron emission tomography study. Ann Neurol. May 1996;39(5):650-8. [Medline].

  41. Brin MF, Koller W. Epidemiology and genetics of essential tremor. Mov Disord. 1998;13 Suppl 3:55-63. [Medline].

  42. Bucher SF, Seelos KC, Dodel RC, Reiser M, Oertel WH. Activation mapping in essential tremor with functional magnetic resonance imaging. Ann Neurol. Jan 1997;41(1):32-40. [Medline].

  43. Busenbark K, Barnes P, Lyons K, Ince D, Villagra F, Koller WC. Accuracy of reported family histories of essential tremor. Neurology. Jul 1996;47(1):264-5. [Medline].

  44. Chouinard S, Louis ED, Fahn S. Agreement among movement disorder specialists on the clinical diagnosis of essential tremor. Mov Disord. Nov 1997;12(6):973-6. [Medline].

  45. Cleeves L, Findley LJ. Beta-adrenoreceptor mechanisms in essential tremor: a comparative single dose study of the effect of a non-selective and a beta-2 selective adrenoreceptor antagonist. J Neurol Neurosurg Psychiatry. Sep 1984;47(9):976-82. [Medline].

  46. Critchley M. Observations on Essential (Heredofamilial) Tremor. Brain. 1949;72:113-139.

  47. Deeb J. Gannon K. Shah M, et al. Comparison of datscan imaging and smell testing in essential tremor and Parkinson disease. Jr Neurol, Neurosurg. & Psych. Sept 2007;78(9):1018-1019.

  48. Deuschl G, Bain P, Brin M. Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee. Mov Disord. 1998;13 Suppl 3:2-23. [Medline].

  49. Elble RJ, Dubinsky RM, Ala T. Alzheimer's disease and essential tremor finally meet. Mov Disord. Aug 15 2007;22(11):1525-7. [Medline].

  50. Factor SA, Friedman JH. The emerging role of clozapine in the treatment of movement disorders. Mov Disord. Jul 1997;12(4):483-96. [Medline].

  51. Findley LJ. Expanding clinical dimensions of essential tremor. J Neurol Neurosurg Psychiatry. Jul 2004;75(7):948-9. [Medline].

  52. Findley LJ, Shah M. Muhammed N, et al. Olfactory tests distinguish essential from parkinsonian tremor. Evidence of enhanced detection and age resistance in familial essential tremor. J Neurol Neurosurg Psych. Jan 2006;77(1):140.

  53. Gironell A, Kulisevsky J, Barbanoj M, Lopez-Villegas D, Hernandez G, Pascual-Sedano B. A randomized placebo-controlled comparative trial of gabapentin and propranolol in essential tremor. Arch Neurol. Apr 1999;56(4):475-80. [Medline].

  54. Gorman WP, Cooper R, Pocock P, Campbell MJ. A comparison of primidone, propranolol, and placebo in essential tremor, using quantitative analysis. J Neurol Neurosurg Psychiatry. Jan 1986;49(1):64-8. [Medline].

  55. Gulcher JR, Jonsson P, Kong A, et al. Mapping of a familial essential tremor gene, FET1, to chromosome 3q13. Nat Genet. Sep 1997;17(1):84-7. [Medline].

  56. Hallett M. Overview of human tremor physiology. Mov Disord. 1998;13 Suppl 3:43-8. [Medline].

  57. Higgins JJ, Loveless JM, Jankovic J, Patel PI. Evidence that a gene for essential tremor maps to chromosome 2p in four families. Mov Disord. Nov 1998;13(6):972-7. [Medline].

  58. Higgins JJ, Pho LT, Nee LE. A gene (ETM) for essential tremor maps to chromosome 2p22-p25. Mov Disord. Nov 1997;12(6):859-64. [Medline].

  59. Hua SE, Lenz FA, Zirh TA, Reich SG, Dougherty PM. Thalamic neuronal activity correlated with essential tremor. J Neurol Neurosurg Psychiatry. Feb 1998;64(2):273-6. [Medline].

  60. Hubble JP, Busenbark KL, Pahwa R, Lyons K, Koller WC. Clinical expression of essential tremor: effects of gender and age. Mov Disord. Nov 1997;12(6):969-72. [Medline].

  61. Hulihan J, Connor GS, Shu-Chen W, et al. Topiramate in essential tremor: pooled data from a double-blind, placebo-controlled, crossover trial. American Academy of Neurology 2003 Abstracts: P04.068. Class II. Neurology. 2003.

  62. Jankovic J, Beach J, Pandolfo M, Patel PI. Familial essential tremor in 4 kindreds. Prospects for genetic mapping. Arch Neurol. Mar 1997;54(3):289-94. [Medline].

  63. Jankovic J, Schwartz K, Clemence W, Aswad A, Mordaunt J. A randomized, double-blind, placebo-controlled study to evaluate botulinum toxin type A in essential hand tremor. Mov Disord. May 1996;11(3):250-6. [Medline].

  64. Koller W, Pahwa R, Busenbark K, et al. High-frequency unilateral thalamic stimulation in the treatment of essential and parkinsonian tremor. Ann Neurol. Sep 1997;42(3):292-9. [Medline].

  65. Koller WC. Dose-response relationship of propranolol in the treatment of essential tremor. Arch Neurol. Jan 1986;43(1):42-3. [Medline].

  66. Koller WC. Long-acting propranolol in essential tremor. Neurology. Jan 1985;35(1):108-10. [Medline].

  67. Koller WC, Royse VL. Efficacy of primidone in essential tremor. Neurology. Jan 1986;36(1):121-4. [Medline].

  68. Koller WC, Royse VL. Time course of a single oral dose of propranolol in essential tremor. Neurology. Oct 1985;35(10):1494-8. [Medline].

  69. Koller WC, Vetere-Overfield B. Acute and chronic effects of propranolol and primidone in essential tremor. Neurology. Dec 1989;39(12):1587-8. [Medline].

  70. Lorenz D, Frederiksen H, Moises H, Kopper F, Deuschl G, Christensen K. High concordance for essential tremor in monozygotic twins of old age. Neurology. Jan 27 2004;62(2):208-11. [Medline].

  71. Louis ED, Ford B, Bismuth B. Reliability between two observers using a protocol for diagnosing essential tremor. Mov Disord. Mar 1998;13(2):287-93. [Medline].

  72. Louis ED, Ford B, Lee H, Andrews H, Cameron G. Diagnostic criteria for essential tremor: a population perspective. Arch Neurol. Jun 1998;55(6):823-8. [Medline].

  73. Louis ED, Ford B, Pullman SL. Prevalence of asymptomatic tremor in relatives of patients with essential tremor. Arch Neurol. Feb 1997;54(2):197-200. [Medline].

  74. Louis ED, Ottman R. How familial is familial tremor? The genetic epidemiology of essential tremor. Neurology. May 1996;46(5):1200-5. [Medline].

  75. Louis ED, Ottman R, Hauser WA. How common is the most common adult movement disorder? estimates of the prevalence of essential tremor throughout the world. Mov Disord. Jan 1998;13(1):5-10. [Medline].

  76. Louis ED, Shungu DC, Chan S, Mao X, Jurewicz EC, Watner D. Metabolic abnormality in the cerebellum in patients with essential tremor: a proton magnetic resonance spectroscopic imaging study. Neurosci Lett. Nov 15 2002;333(1):17-20. [Medline].

  77. Louis ED, Vonsattel JP, Honig LS, et al. Essential tremor associated with pathologic changes in the cerebellum. Arch Neurol. Aug 2006;63(8):1189-93. [Medline].

  78. Louis ED, Wendt KJ, Pullman SL, Ford B. Is essential tremor symmetric? Observational data from a community-based study of essential tremor. Arch Neurol. Dec 1998;55(12):1553-9. [Medline].

  79. Louis ED, Zheng W, Jurewicz EC, et al. Elevation of blood beta-carboline alkaloids in essential tremor. Neurology. Dec 24 2002;59(12):1940-4. [Medline].

  80. Ogawa N, Takayama H, Yamamoto M. Comparative studies on the effects of beta-adrenergic blockers in essential tremor. J Neurol. Oct 1987;235(1):31-3. [Medline].

  81. Ondo WG, Hunter C, Moore W. A double-blind placebo-controlled trial of botulinum toxin B for sialorrhea in Parkinson's disease. Neurology. Jan 13 2004;62(1):37-40. [Medline].

  82. Ondo WG, Sutton L, Dat Vuong K, Lai D, Jankovic J. Hearing impairment in essential tremor. Neurology. Oct 28 2003;61(8):1093-7. [Medline].

  83. Pact V, Giduz T. Mirtazapine treats resting tremor, essential tremor, and levodopa-induced dyskinesias. Neurology. Sep 22 1999;53(5):1154. [Medline].

  84. Rajput A, Robinson CA, Rajput AH. Essential tremor course and disability: A clinicopathologic study of 20 cases. Neurology. Mar 23 2004;62(6):932-6. [Medline].

  85. Schrag A, Muenchau A, Bhatia KP, Quinn NP, Marsden CD. Overdiagnosis of essential tremor. Lancet. May 1 1999;353(9163):1498-9. [Medline].

  86. Wasielewski PG, Burns JM, Koller WC. Pharmacologic treatment of tremor. Mov Disord. 1998;13 Suppl 3:90-100. [Medline].

  87. Zirh A, Reich SG, Dougherty PM, Lenz FA. Stereotactic thalamotomy in the treatment of essential tremor of the upper extremity: reassessment including a blinded measure of outcome. J Neurol Neurosurg Psychiatry. Jun 1999;66(6):772-5. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

essential tremor, essential tremor treatment, movement disorder, benign essential tremor, familial tremor, senile tremor

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Deborah A Burke, MD, Consulting Staff, Sub-investigator, Clinician, Movement Disorder/Parkinson's Disease Center, University of South Florida; 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; 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: Allergan Sales, LLC Honoraria Speaking and teaching; Boehringer Ingelheim  Honoraria Consulting; Genzyme Corporation Honoraria Consulting; GlaxoSmithKline Honoraria Consulting; IMPAX Laboratories, Inc. Honoraria Consulting; Novartis Pharmaceuticals Corp. Honoraria Consulting; Schering Plough  Consulting; Solvay Pharmeceuticals Honoraria Consulting; Teva Neuroscience Honoraria Speaking and teaching

Theresa McClain, MSN, ARNP, Parkinson's Disease and Movement Disorders Center, University of South Florida
Theresa McClain, MSN, ARNP 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

Medical Editor

Daniel H Jacobs, MD, Associate Professor of Neurology, University of Central Florida College of Medicine
Daniel H Jacobs, MD 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

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
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: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
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: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.