From the Research
Essential tremor is diagnosed primarily through clinical evaluation, as there is no specific test that confirms the condition, and a therapeutic trial of propranolol or primidone may be used as both a diagnostic tool and treatment, as improvement with these medications supports the diagnosis of essential tremor 1.
Diagnosis of Essential Tremor
The diagnosis of essential tremor begins with observing the characteristic action tremor that occurs during voluntary movement, most commonly affecting the hands, but sometimes also the head, voice, or other body parts. The tremor is typically bilateral, though it may be asymmetric, and worsens with stress, caffeine, and certain medications.
- Family history is important as essential tremor often has a genetic component with about 50% of cases showing familial patterns.
- To confirm the diagnosis, your doctor may order blood tests to rule out thyroid disorders or metabolic problems, and sometimes brain imaging like MRI to exclude structural abnormalities.
Diagnostic Criteria
The diagnosis is strengthened by the absence of other neurological symptoms typically seen in conditions like Parkinson's disease, such as rigidity or bradykinesia.
- A detailed history with open-ended questions and focused questions encompassing medical history, social history, and family history is key for establishing the diagnosis.
- 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 are necessary for diagnosis.
Treatment Options
Early diagnosis allows for proper management through medication, lifestyle modifications, and in severe cases, consideration of surgical options like deep brain stimulation.
- Propranolol and primidone are considered first-line treatments for essential tremor, with topiramate, atenolol, and alprazolam being possibly useful alternatives 2, 3.
- Patients who are severely affected are often offered deep brain stimulation, with the ventral intermediate nucleus of the thalamus being the traditional surgical target, and the caudal zona incerta being studied as a possible superior alternative 4.