From the Guidelines
Tremors are classified into three main types: resting, postural, and kinetic, each with distinct characteristics and associations with various neurological conditions, as outlined in the movement disorders and neurodegenerative diseases criteria 1.
Types of Tremors
- Resting tremors occur when the affected body part is completely supported against gravity and not actively moving, typically disappearing with voluntary movement, and are characteristic of Parkinson's disease, often presenting as a "pill-rolling" motion between the thumb and forefinger.
- Postural tremors appear when maintaining a position against gravity, such as holding arms outstretched, and are commonly seen in essential tremor.
- Kinetic tremors occur during voluntary movement of a body part, becoming most noticeable during goal-directed movements like bringing a finger to the nose or drinking from a cup, and are often associated with cerebellar disorders, multiple sclerosis, or certain medications.
Clinical Significance
Understanding the specific type of tremor is crucial for accurate diagnosis and appropriate treatment, as each type may respond differently to medications such as beta-blockers for essential tremor, dopaminergic agents for Parkinson's tremor, or specific treatments for underlying conditions causing kinetic tremors, as discussed in the context of Parkinsonian syndromes and movement disorders 1.
Diagnostic Considerations
Correctly diagnosing a Parkinsonian syndrome on clinical features alone can be quite challenging, and imaging remains an essential diagnostic tool in the evaluation of a patient presenting with Parkinsonian symptoms, including various types of tremors 1.
From the Research
Types of Tremors
- Resting tremor: occurs in a body part that is relaxed and completely supported against gravity 2
- Action tremor: occurs with voluntary contraction of a muscle and can be further subdivided into:
Characteristics of Tremors
- Resting tremor is typically asymmetric and becomes less prominent with voluntary movement, often seen in Parkinson's disease 2, 3, 5
- Postural and kinetic tremors are often symmetric and may be seen in essential tremor 3, 4, 5
- Essential tremor may respond to low alcohol consumption and may have a family history 3
Diagnosis and Treatment
- Diagnosis of tremor is based on clinical information obtained from a thorough history and physical examination 2, 5
- Treatment of tremor depends on the type and underlying cause, and may include medications such as primidone, beta-blockers, and dopaminergic agents, as well as surgical options like deep brain stimulation 3, 4, 5, 6