Differential Diagnosis for Tremor Since Childhood

• Single Most Likely Diagnosis
  • Essential Tremor: This is a common movement disorder that can start at any age, including childhood. It is characterized by a tremor that is most noticeable when the affected limb is in use or under stress. The long-standing nature of the tremor since childhood increases the likelihood of this diagnosis.
• Other Likely Diagnoses
  • Physiological Tremor: An enhanced physiological tremor can be seen in individuals with anxiety, stress, or certain metabolic conditions. It's possible that the tremor has been present since childhood and has been exacerbated by various factors over time.
  • Dystonic Tremor: This type of tremor occurs in conjunction with dystonia, a movement disorder that causes involuntary muscle contractions. It could have started in childhood and may be associated with other dystonic symptoms.
• Do Not Miss Diagnoses
  • Wilson's Disease: This is a rare genetic disorder that leads to copper accumulation in the body, affecting the brain and liver. It can cause tremors, among other neurological symptoms, and is crucial to diagnose early due to its potential for severe complications and the availability of treatment.
  • Thyrotoxicosis: Hyperthyroidism can cause tremors, and while less common in children, it's essential to rule out due to the potential for significant morbidity if left untreated.
• Rare Diagnoses
  • Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS): This condition affects some carriers of the fragile X syndrome gene and can cause tremors, ataxia, and other neurological symptoms. It's rare and typically presents later in life but could be considered in the differential for long-standing tremors.
  • Neurodegenerative Disorders: Certain rare neurodegenerative diseases, such as juvenile parkinsonism or other genetic disorders affecting movement, could present with tremors. These are less likely but important to consider due to their implications for management and prognosis.