From the Research
The diagnostic workup for intention tremor in children should begin with a thorough neurological examination and detailed history, focusing on onset, progression, family history, and associated symptoms, as outlined in the study by 1. Initial testing should include brain MRI to evaluate for structural abnormalities, particularly in the cerebellum, brainstem, or cerebellar pathways. Additional investigations may include:
- Metabolic screening
- Genetic testing for conditions like Friedreich's ataxia or spinocerebellar ataxias
- Copper and ceruloplasmin levels to rule out Wilson's disease
- Thyroid function tests
- In some cases, lumbar puncture, as suggested by 2 and 3.
Management is primarily directed at the underlying cause when identified. For symptomatic treatment, propranolol (starting at 0.5-1 mg/kg/day divided into 2-3 doses, maximum 2-4 mg/kg/day) is often the first-line medication, as supported by the evidence-based review by 4. Alternative options include:
- Primidone (starting at 12.5-25 mg daily, gradually increasing as needed)
- Topiramate (starting at 1-3 mg/kg/day)
- Clonazepam (0.01-0.03 mg/kg/day), as mentioned in 5 and 4.
Physical and occupational therapy are crucial components of treatment, focusing on improving coordination, adaptive techniques, and use of weighted devices to stabilize movements. Speech therapy may be necessary if speech is affected. Regular follow-up is essential to monitor treatment efficacy and disease progression, with medication adjustments based on response and side effects. The approach should be multidisciplinary, involving neurologists, therapists, and sometimes geneticists, as intention tremor often indicates cerebellar dysfunction and may be part of a broader neurological condition, as noted in 2 and 1.