Epidemiology
- Most common form of tremor
Etiology
- Positive family history
Pathophysiology
Clinical features
- Localization: hands (∼ 90%), head (∼ 30%; “yes-yes” or “no-no” motion), voice (∼ 15%)
- Mostly bilateral postural tremor with a frequency of 5–10 Hz
- Slowly progressive
- Worse with sustained voluntary movement , stress or anxiety, fatigue, and caffeine
- Improves with alcohol consumption
Diagnostics
Tip
Consider an essential tremor in a patient presenting with chronic bilateral hand tremors without further neurological deficits and positive family history.
Treatment
- Only initiated if the tremor causes functional disability.
- First-Line: Propranolol (non-selective beta-blocker) and/or Primidone (anticonvulsant).
- Refractory Cases: Deep brain stimulation (DBS) of the thalamus is an effective surgical option.