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Semin Neurol 2011; 31(1): 065-077
DOI: 10.1055/s-0031-1271312
© Thieme Medical Publishers

Diagnosis and Treatment of Common Forms of Tremor

Andreas Puschmann1 , 2 , Zbigniew K. Wszolek1
  • 1Department of Neurology, Mayo Clinic, Jacksonville, Florida
  • 2Department for Geriatric Psychiatry, Lund University, Lund, Sweden
Further Information

Publication History

Publication Date:
14 February 2011 (online)

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ABSTRACT

Tremor is the most common movement disorder presenting to an outpatient neurology practice and is defined as a rhythmical, involuntary oscillatory movement of a body part. The authors review the clinical examination, classification, and diagnosis of tremor. The pathophysiology of the more common forms of tremor is outlined, and treatment options are discussed. Essential tremor is characterized primarily by postural and action tremors, may be a neurodegenerative disorder with pathologic changes in the cerebellum, and can be treated with a wide range of pharmacologic and nonpharmacologic methods. Tremor at rest is typical for Parkinson's disease, but may arise independently of a dopaminergic deficit. Enhanced physiologic tremor, intention tremor, and dystonic tremor are discussed. Further differential diagnoses described in this review include drug- or toxin-induced tremor, neuropathic tremor, psychogenic tremor, orthostatic tremor, palatal tremor, tremor in Wilson's disease, and tremor secondary to cerebral lesions, such as Holmes' tremor (midbrain tremor). An individualized approach to treatment of tremor patients is important, taking into account the degree of disability, including social embarrassment, which the tremor causes in the patient's life.

KEYWORDS

Tremor - essential tremor - Parkinson's disease - dystonia - pathophysiology

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Andreas PuschmannM.D. 

Department for Geriatric Psychiatry, Lund University, Getingevägen 4

221 85 Lund, Sweden

Email: Andreas.Puschmann@med.lu.se