From the Guidelines
Tremors in young individuals are most likely caused by essential tremor, which typically presents as a bilateral, postural tremor affecting the hands and sometimes the head, and can be diagnosed and managed based on clinical evaluation and laboratory tests, as suggested by the most recent and highest quality study 1.
Etiology of Tremor in Young Individuals
The etiology of tremor in young individuals can be diverse, including:
- Essential tremor: the most common cause, characterized by a bilateral, postural tremor affecting the hands and sometimes the head, which worsens with movement and stress.
- Physiologic tremor: exacerbated by anxiety, caffeine, medications, or hyperthyroidism.
- Drug-induced tremors: from medications like SSRIs, stimulants, lithium, or valproate.
- Wilson's disease: characterized by copper accumulation, liver dysfunction, and neurological symptoms.
- Dystonic tremor: associated with abnormal posturing.
- Psychogenic tremor: variable and distractible.
- Cerebellar tremor: intention tremor with past pointing.
Evaluation and Management
Evaluation should include a thorough history focusing on medication use, family history, and associated symptoms, along with a physical examination assessing tremor characteristics. Laboratory tests may include liver function, thyroid studies, and copper metabolism studies when Wilson's disease is suspected. Treatment depends on the underlying cause, ranging from lifestyle modifications and beta-blockers for essential tremor to specific interventions for identified metabolic or neurological conditions, as recommended by recent studies 1. Some other potential causes of tremor in young individuals, such as movement disorders associated with viral encephalitis, are less common and can be identified based on specific clinical features and laboratory tests, as described in other studies 1. However, these causes are less relevant to the diagnosis and management of tremor in young individuals, and the most recent and highest quality study 1 should be prioritized in clinical decision-making.
From the Research
Etiology of Tremor in Young People
The etiology of tremor in young people can be diverse, with various underlying causes.
- Primary tremors, such as essential tremor, can occur without any underlying neurologic or systemic disease 2.
- Secondary tremors can be caused by underlying neurologic or systemic diseases, medications, or other factors 2, 3.
Types of Tremors
There are several types of tremors that can affect young people, including:
- Enhanced physiologic tremor, which can be caused by anxiety, medication use, caffeine intake, or fatigue 3.
- Essential tremor, which is the most common pathologic tremor and can be transmitted in an autosomal-dominant fashion 3, 4.
- Parkinsonian tremor, which is typically unilateral and occurs at rest 3.
- Cerebellar, dystonic, and drug- or metabolic-induced tremors, which can also occur in young people 3, 5.
Diagnosis and Evaluation
The diagnosis and evaluation of tremor in young people should start with a detailed tremor history and a focused neurologic examination 5.
- The evaluation should attend to the many subtleties of tremor phenomenology, including the activation condition, topographic distribution, and frequency of the tremor 3, 5.
- The clinician should formulate two sets of diagnoses: disorders in which action tremor is the predominant tremor versus those in which resting tremor is the predominant tremor 5.