Diagnosis and Management of Tremor

Abstract

Tremor is the most common involuntary movement disorder. It is differentiated from other involuntary movement disorders, such as chorea, athetosis, ballismus, tics, and myoclonus, by its repetitive, stereotyped, movements of a regular amplitude and frequency. Tremor can be defined as an involuntary, rhythmic, periodic, mechanical oscillation of a body part. Since small-amplitude tremors may not be visible to the naked eye and may only be detectable by sensitive recording devices, amplitude of the tremor is therefore not critical to the definition. Accurate diagnosis of tremor is important because appropriate treatment depends on the accuracy of the clinical diagnosis. This article reviews the classification and management of tremor.

Approach to a tremor patient

“…However, it is important to remember that there are a few other causes of rest tremor, which have been highlighted in Figure 1. [31415] Certain patients develop only a rest tremor, which persists beyond 2 years without development of other cardinal signs of PD [Figure 1]. [116] The term “monosymptomatic rest tremor (mRT)” has been used to describe these patients.…”

“…These drugs include antipsychotics, antiemetics (metoclopramide), and antivertigo medications (prochlorperazine). [1314] Certain nondopamine receptor-blocking drugs can also produce rest tremor. These are valproate, calcium channel blockers (cinnarizine, flunarizine), selective serotonin reuptake inhibitors, lithium, tetrabenazine, and amiodarone [Figure 1].…”

“…These are valproate, calcium channel blockers (cinnarizine, flunarizine), selective serotonin reuptake inhibitors, lithium, tetrabenazine, and amiodarone [Figure 1]. [1314]…”

“…This increased sympathetic activity can be brought about by certain diseases or drugs [Table 2]. [1347814] The tremor is typically a fine postural or kinetic tremor in the hands and fingers. It is symmetrical and has low amplitude and high frequency (7–12 Hz).…”

“…It typically occurs on exposure to neuroleptic (dopamine receptor-blocking agents) drugs and can resemble a Parkinsonian rest tremor. [1314] However, it tends to be more symmetrical than Parkinsonian rest tremor. [3] Usually, this tremor is nonprogressive and responds to drug withdrawal or reduction in dose.…”