essential tremor 2

Essential Tremor: A Progressive Condition

Essential tremor is a progressive condition, meaning it gets worse over time. This progression is usually slow, with the average rate of worsening arm or hand tremors being between 1.5% and 5% per year [2]. The condition starts small, often affecting only the hands at first, but can eventually spread to other parts of the body, such as the arms and head [2].

Key Features

• Progressive: Essential tremor gets worse over time.
• Slow progression: The average rate of worsening arm or hand tremors is between 1.5% and 5% per year.
• Initial symptoms: Typically starts with small tremors in the hands, which can eventually spread to other parts of the body.

References

[2] Essential tremor is usually progressive, meaning it gets worse over time. This is usually a slow process. The average rate that arm or hand tremors get worse is between 1.5% and 5% a year. Essential tremor starts small and usually only affects your hands at first. Over time, usually many years, the tremors may spread to affect your arm and head. [4] Symptoms may be mild at first, and may come and go.

Signs and Symptoms of Essential Tremor

Essential tremor is characterized by involuntary shaking or trembling, especially of the head and hands. The symptoms can vary from person to person, but here are some common signs and symptoms:

• Tremors in hands: Essential tremor typically affects both hands, but one side may show more symptoms.
• Difficulty with tasks: People with essential tremor may have trouble performing tasks that require hand movement, such as writing or using tools.
• Rhythmic shaking: The tremors can be rhythmic and occur when the person is active or holding a fixed posture.
• Shaky voice: Some people with essential tremor may experience a shaky or trembling voice.
• Difficulty with writing or drawing: Essential tremor can make it difficult to write or draw, as the hand movements are affected by the tremors.

These symptoms can be mild at first and may come and go. However, in some cases, the tremors can worsen over time, affecting other parts of the body such as the arms, head, legs, or torso.

References:

• [2] Essential Tremor Symptoms
• [3] Here are signs of essential tremor: Tremors that are most obvious in your hands; Difficulty doing tasks with your hands, such as writing or using tools ...
• [4] Essential Tremor Symptoms Essential tremor occurs during active movement (action tremor) or while holding fixed postures or poses (postural tremor). It is much less likely to occur at rest (resting tremor).
• [7] Essential tremor symptoms include a rhythmic tremor in the hands, arms, head, or voice, which primarily occurs when using the hands.
• [8] Essential tremor symptoms include shaking of hands when used, often at rest. Head and voice may also be affected.

Diagnostic Tests for Essential Tremor

Essential tremor diagnosis primarily involves a physical examination and clinical observation, as there are no specific medical tests to diagnose the condition. However, other tests can be used to rule out other conditions that may cause similar symptoms.

• Physical Examination: A thorough physical examination is essential in diagnosing essential tremor. This includes a review of your medical history, family history, and symptoms.
• Clinical Observation: Your healthcare provider will observe your symptoms, such as tremors during active movement (action tremor) or while holding certain poses or postures (postural tremor).
• Ruling out Other Conditions: Tests can be used to rule out other conditions that may cause similar symptoms. These tests include:
  • Blood and urine tests to check for signs of infections, genetic disorders, or other conditions.
  • Dopamine imaging tests to assess dopamine levels in the brain.
  • Electromyography (EMG) or accelerometry can be used to assess tremor frequency, rhythmicity, and amplitude.

Key Points

• Essential tremor diagnosis is primarily based on clinical observation and ruling out other conditions.
• There are no specific medical tests to diagnose essential tremor.
• Other tests can be used to rule out other conditions that may cause similar symptoms.

Citations:

• [2] - Essential tremor diagnosis requires a physical examination and clinical observation. Other tests can rule out other conditions that may cause tremors.
• [3] - There is currently no diagnostic test available to identify essential tremor.
• [6] - Electromyography or accelerometry can be used to assess tremor frequency, rhythmicity, and amplitude but is not part of the routine evaluation.
• [7] - Tests include: Blood and urine tests, which check for signs of infections, genetic disorders, or other conditions that may be causing symptoms; Dopamine imaging ...

Medications Used to Treat Essential Tremor

Essential tremor can be effectively managed with various medications, which are often used as a first-line treatment option. The main classes of medications used to treat essential tremor include:

• Beta blockers: These medications, such as propranolol (Inderal LA, Inderal XL), are commonly used to treat essential tremor. They work by blocking the effects of adrenaline and can help reduce tremors in about 40% of patients [12].
• Anti-seizure medications: Medications like primidone (Mysoline) and topiramate (Topamax) have been shown to be effective in treating essential tremor, although their efficacy may vary from person to person [5], [12].

Other medications that may be used to treat essential tremor include:

• Botulinum toxin: This medication can be injected into the affected muscles to help reduce tremors.
• Primidone: This anti-seizure medication has been shown to be effective in treating essential tremor, although its efficacy may vary from person to person [12].

It's worth noting that the degree of tremor control provided by medications varies among patients and often depends on the dose of the agents used, tremor severity, and a patient's individual response to the chosen agent [10].

Differential Diagnosis of Essential Tremor

Essential tremor (ET) is a common movement disorder that can be challenging to diagnose, as it shares similar symptoms with other conditions. The differential diagnosis of ET involves ruling out other potential causes of tremors, which are crucial for accurate diagnosis and effective treatment.

Common Differential Diagnoses:

• Exaggerated Physiologic Tremor: This is the most common differential diagnosis, accounting for 9.5% of cases (Source: [2]). It can be caused by various factors, including stress, fatigue, or certain medications.
• Parkinsonian Tremor: This type of tremor is associated with Parkinson's disease and other neurodegenerative disorders, affecting approximately 2.8% of patients (Source: [2]).
• Cerebellar Tremor: A rare condition that affects the cerebellum, accounting for only 0.2% of cases (Source: [2]).
• Dystonic Tremor: This type of tremor is associated with dystonia, a movement disorder characterized by involuntary muscle contractions.
• Drug-Induced Tremor: Certain medications can cause tremors as a side effect.

Key Considerations for Differential Diagnosis:

1. Medical History: A thorough medical history is essential to identify potential underlying conditions that may be contributing to the tremor (Source: [11]).
2. Physical Examination: A careful physical examination can help rule out other neurologic signs and symptoms that may indicate a different diagnosis (Source: [10]).
3. Drug History: A detailed drug history is crucial, as many medications can cause postural and kinetic tremors (Source: [11]).

References:

[2] The most common diagnoses were exaggerated physiologic tremor (9.5 percent), essential tremor (3.0 percent), parkinsonian tremor (2.8 percent), and cerebellar tremor (0.2 percent).

[10] The diagnosis of essential tremor is based upon clinical features and exclusion of alternative diagnosis.

[11] A careful drug history is mandatory in all patients with tremor, as many drugs are capable of producing postural and kinetic tremors.

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