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Differential diagnosis of common tremor syndromes

Correspondence to:
Correspondence to:
Dr R Bhidayasiri
Department of Neurology, Reed Neurological Research Institute, UCLA Medical Center, 710 Westwood Plaza, Los Angeles, CA 90095, USA; rbh{at}ucla.edu

Tremor is one of the most common involuntary movement disorders seen in clinical practice. In addition to the detailed history, the differential diagnosis is mainly clinical based on the distinction at rest, postural and intention, activation condition, frequency, and topographical distribution. The causes of tremor are heterogeneous and it can present alone (for example, essential tremor) or as a part of a neurological syndrome (for example, multiple sclerosis). Essential tremor and the tremor of Parkinson’s disease are the most common tremors encountered in clinical practice. This article focuses on a practical approach to these different forms of tremor and how to distinguish them clinically. Evidence supporting various strategies used in the differentiation is then presented, followed by a review of formal guidelines or recommendations when they exist.

Abbreviations: EMG, electromyography; EEG, electroencephalography; EPC, epilepsia partialis continua; PD, Parkinson’s disease; ET, essential tremor; PET, positron emission tomography; DAT, dopamine transporter; DBS, deep brain stimulation; VIM, ventral intermedius nucleus

Keywords: tremor; essential tremor; parkinsonian tremor; psychogenic tremor; differential diagnosis