From the Research
Essential tremor is diagnosed primarily through a clinical evaluation by a healthcare provider, focusing on the characteristic tremor pattern and ruling out other causes, with the presence of bilateral action tremor for 3 years and absence of isolated head and voice tremor and absence of task- and position-dependent tremor being necessary for diagnosis, as stated in the most recent study 1. The diagnosis begins with a detailed medical history, including family history since essential tremor often has a genetic component, and questions about alcohol consumption which can temporarily reduce tremor severity.
- A physical and neurological examination follows, where the doctor observes the tremor's characteristics: typically bilateral, affecting hands, head, or voice, and most noticeable during voluntary movements (action tremor) rather than at rest.
- The tremor usually has a frequency of 4-12 Hz and improves with alcohol consumption in about 50% of cases.
- Laboratory tests may be ordered to exclude other conditions, including thyroid function tests, liver function tests, and blood glucose levels.
- Neuroimaging like MRI is not routinely needed but may be used to rule out structural abnormalities if the presentation is atypical.
- Electromyography (EMG) can help characterize the tremor pattern in uncertain cases, as supported by studies 2. The diagnosis is confirmed when the clinical picture is consistent with essential tremor and other potential causes have been excluded, such as Parkinson's disease, which typically presents with a resting tremor and other motor symptoms, and dystonic tremor, physiologic tremor, and drug-induced tremor, which can be differentiated based on phenomenology and physical examination alone, but may require additional clues from a detailed history, as noted in 1, 3.