From the Research
Intention tremor in a 20-year-old male is most commonly caused by multiple sclerosis, cerebellar lesions, or Wilson's disease, and a comprehensive workup including neurological examination, brain MRI, copper studies, and possibly genetic testing is essential for early diagnosis and treatment. The causes of intention tremor can be diverse, but multiple sclerosis, which involves demyelination of nerves in the central nervous system, is a significant consideration 1. Cerebellar lesions, resulting from trauma, stroke, tumors, or infections affecting the cerebellum, which coordinates movement, are another potential cause. Wilson's disease, a genetic disorder causing copper accumulation in tissues, requires prompt diagnosis as it's treatable with medications like penicillamine or trientine (typical dose 750-1500 mg daily in divided doses) 2.
Other potential causes of intention tremor include:
- Drug or alcohol toxicity
- Essential tremor with early onset
- Rare genetic disorders like Fragile X-associated tremor/ataxia syndrome
- Certain medications, particularly valproic acid, lithium, and some antipsychotics, which can also induce intention tremors 3, 4.
Given the potential complexity and variability of intention tremor, a thorough evaluation is necessary to determine the underlying cause. This evaluation should start with a detailed tremor history followed by a focused neurologic examination, which should attend to the many subtleties of tremor phenomenology 2, 4. The clinician should then formulate two sets of diagnoses: disorders in which action tremor is the predominant tremor versus those in which resting tremor is the predominant tremor.
In the context of multiple sclerosis, upper limb intention tremor is a significant concern, and current evidence suggests that while various noninvasive and pharmacologic interventions may offer temporary benefits, more studies are required to determine the most effective and sustainable treatments 5. Therefore, referral to a neurologist for specialized care and consideration of the latest therapeutic options is crucial for managing intention tremor and improving the patient's quality of life.