common pitfall = PD diagnosed compared to essential tremor

Causes

• Physiological

• Benign essential tremor

• senility

• anxiety - increase hyperventilation

• hyperthyroidism

• toxicity

• drugs

• PD

• drug induced Parkinsonism

• Cerebellar disease

• Cerebral tumour (frontal lobe)

• Alzheimer dementia

• Wilsn syndrome

• Miscellaneous

Classification

Resting

• Parkinsonian

• ‘pill rolling’

• decreases on finger - nose

• distract patient - examine other hand or get to turn head side-side

Action/postural tremor

• fine trmor

• arms outstrected and fingers apart

• essential

• senile

• phsyuiological…

• phaeochromocytoma

Intention tremor

• cerebellar disease

• finger-nose-finger

Flapping

• metablic

• not strictly a tremor

• Uraemia

Essential Tremor

• most common

• autosomal dominant (variable penetration)

• often begins early adult life

• slight termor in both hands

• may involve head, chin, tongue

• interfere with wiring, handling cups of teas

• most marked when arms held out

• exacerbated by anxiety

• may affect speech

• relieved by etoh

• can swing arm and gait noral

• Triad

  • family history

  • little diability

  • noraml gait

Managmenet

• none/reassurance

• propranolol (10-20mg bd)

• intermittent bdz