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Essential Tremor Description

Essential tremor (ET) is one of the most common tremor disorders in the world, and is characterized by a postural and/or kinetic tremor.

• Postural tremor: This type of tremor occurs when the hands are at rest or held still.
• Kinetic tremor: This type of tremor occurs when the hands are in motion or performing an action.

ET can affect any part of the body, but it most commonly affects the hands, head, trunk, voice, or legs. The symptoms of ET can vary from person to person and may worsen over time if left untreated.

References:

• [4] Essential tremor (ET) is one of the most common tremor disorders in the world, and is characterized by a postural and/or kinetic tremor.
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Essential Tremor Signs and Symptoms

Essential tremor (ET) is a neurological disorder that affects the brain's ability to control muscle movements, leading to involuntary shaking or trembling of certain parts of the body. The signs and symptoms of ET can vary from person to person, but here are some common ones:

• Tremors during active movement: ET typically occurs when you're actively moving your hands, arms, head, or voice.
• Postural tremor: Tremors can also occur while holding fixed postures or poses.
• Resting tremor is less likely: Unlike Parkinson's disease, ET is much less likely to occur at rest (while sitting or lying down).
• Symptoms typically affect both hands: However, one side of the body may show more symptoms than the other.
• Mild symptoms can come and go: In some cases, symptoms may be mild at first and may come and go.

These signs and symptoms are consistent with what is described in search result [4].

Diagnostic Tests for Essential Tremor

Essential tremor diagnosis typically 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.

• Clinical Examination: A thorough physical examination is essential in diagnosing essential tremor. This includes a review of your medical history, family history, and symptoms.
• Ruling Out Other Conditions: Your healthcare provider may suggest tests to rule out other conditions that could be causing the symptoms, such as blood and urine tests, dopamine imaging, or electromyography (EMG) and accelerometry.

Tests Not Typically Used for Essential Tremor Diagnosis

• Imaging Tests: MRI and CT scans are not typically helpful in diagnosing essential tremor.
• Blood and Urine Tests: While these tests can be used to rule out other conditions, they are not specific to essential tremor diagnosis.
• Electromyography (EMG) and Accelerometry: These tests can assess tremor frequency, rhythmicity, and amplitude but are not part of the routine evaluation for essential tremor.

Key Points

• Essential tremor is usually diagnosed based on symptoms and clinical examination.
• Other conditions that may cause similar symptoms need to be ruled out.
• Specific diagnostic tests for essential tremor do not exist.

Citations:

[4] - There is currently no diagnostic test available to identify essential tremor. The diagnosis is usually based upon the symptoms and clinical exam, as well as the absence of other findings that could provide an alternative explanation for the tremors. [5] - One diagnostic tool that doctors may use to test and diagnose a tremor is a drawing task known as a spiral test or an Archimedes spiral test.

Medications Used to Treat Essential Tremor

Essential tremor can be effectively managed with various medications, which are often prescribed based on the severity and frequency of symptoms. The primary goal of medication treatment is to reduce or eliminate tremors, allowing individuals to perform daily activities without discomfort.

• Beta blockers: Beta-adrenergic blockers, such as propranolol (Inderal LA, Inderal XL), are commonly used to treat essential tremor. These medications work by blocking the effects of adrenaline and other stress hormones that can exacerbate tremors.
• Anti-seizure medications: Primidone is another medication often prescribed for essential tremor. It helps reduce muscle activity and alleviate symptoms.

Effectiveness and Considerations

While medications can be highly effective in managing essential tremor, their success rates vary among individuals. Some people may experience complete tremor suppression with available therapies, while others may require higher doses or combination therapy to achieve desired results.

• Variable response: 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].
• Limited efficacy: A 2022 review suggests that propranolol may only be effective in roughly 40% of patients with essential tremor [13].

Additional Treatment Options

If medications don't provide sufficient relief or cause too many side effects, other treatment options like surgery (deep brain stimulation, thalamotomy) and focused ultrasound can be considered. It's essential to discuss these alternatives with a healthcare provider to determine the best course of action for individual needs.

References: [4] Benzodiazepines: People with essential tremor symptoms can benefit from treatment with benzodiazepines, such as clonazepam and alprazolam. [10] 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. [13] While propranolol is used as a first-line treatment option for essential tremor, a 2022 review states that it may only be effective in roughly 40% of patients.

Differential Diagnoses of Essential Tremor

Essential tremor (ET) can be challenging to diagnose, as it shares similar symptoms with other neurological conditions. The following are some differential diagnoses that should be considered when evaluating a patient for ET:

• Drug-induced tremor: Certain medications, such as beta-adrenergic agonists, valproic acid, thyroxin, tricyclic antidepressants, and selective serotonin reuptake inhibitors, can cause postural and kinetic tremors.
• Dystonic tremor: This type of tremor is characterized by involuntary muscle contractions that lead to repetitive movements or postures. It often affects the head, neck, or limbs.
• Multiple System Atrophy (MSA): MSA is a rare neurodegenerative disorder that can cause tremors, among other symptoms. It is essential to rule out MSA in patients with ET-like symptoms.
• Neurologic Effects of Caffeine: High levels of caffeine consumption can lead to tremors, especially in individuals who are sensitive to its effects.
• Parkinson Disease (PD): While PD is a distinct condition from ET, it can sometimes be challenging to differentiate between the two. A thorough evaluation and diagnostic criteria should be used to rule out PD.

These differential diagnoses highlight the importance of a comprehensive evaluation when diagnosing essential tremor. A careful medical history, physical examination, and laboratory tests can help distinguish ET from other conditions with similar symptoms.

References:

• [4] - Differential Diagnoses
• [12] - Conditions to consider in the differential diagnosis of essential tremor include the following: Physiologic ...
• [15] - The most common causes of postural tremor are physiological tremor, essential tremor and drug-induced tremor.