Tremor: Phenomenology, Etiology, Diagnosis, and Treatment
Tremor is an involuntary rhythmic, oscillatory movement produced by synchronous or alternating contractions of antagonist muscles. Tremor is the most common movement disorder and one of the most common neurological symptoms. A wide variety of etiologies c
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Arif Dalvi, Rajesh Pahwa, and Kelly E. Lyons
Tremor is an involuntary rhythmic, oscillatory movement produced by synchronous or alternating contractions of antagonist muscles. Tremor is one of the most common movement disorders and also one of the most common neurological symptoms. A wide variety of etiologies can cause tremor, with essential tremor being the most common. Parkinson’s disease, multiple sclerosis, and drug-induced tremors are other etiologies commonly seen in clinical practice. Diagnosis of the specific etiology of tremor is based on the clinical characteristics of the tremor as well as associated symptoms. The phenomenology of tremor including whether the tremor is present at rest, with posture or with action, allows classification of tremor. Imaging Electronic supplementary material The online version of this chapter (doi:10.1007/978-3-7091-1628-9_29) contains supplementary material, which is available to authorized users. A. Dalvi, MD, MBA Movement Disorders Program, Palm Beach Neuroscience Institute, 901 Village Blvd., Suite 702, West Palm Beach, FL 33409, USA e-mail: [email protected] R. Pahwa, MD • K.E. Lyons, PhD (*) Department of Neurology, Parkinson’s Disease and Movement Disorder Center, University of Kansas Medical Center, 3599 Rainbow Blvd, MS 2012, Kansas City, KS 66160, USA e-mail: [email protected]; [email protected]
studies, while not in themselves diagnostic, can help rule out structural etiologies. Dopamine transporter imaging is a recent modality that can help distinguish essential tremor from parkinsonism. The treatment of tremor is based on etiology and, where possible, treatment of the underlying disease state. Deep brain stimulation of the thalamus can be an effective treatment modality in cases of medication- resistant tremor.
29.1 Phenomenology of Tremor Tremor is one of the most common movement disorders and essential tremor is the most prevalent pathological tremor in adults [1, 2]. Tremor is defined as an involuntary rhythmic, oscillatory movement produced by synchronous or alternating contractions of reciprocally innervated antagonist muscles [3, 4]. The hands are most commonly involved although the legs, voice and head may also be affected. Tremors can be classified by their distribution and frequency, as well as by the “state of activity.” The state of activity refers to whether the tremor occurs at rest or with action [3, 5, 6]. The following definitions are often applied: 1. Rest tremor is observed when the affected body part is supported against gravity and is not voluntarily activated.
© Springer-Verlag Wien 2017 C. Falup-Pecurariu et al. (eds.), Movement Disorders Curricula, DOI 10.1007/978-3-7091-1628-9_29
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2. Action tremor is observed during voluntary contraction of muscles and has the following subtypes: (a) Postural tremor occurs during voluntary maintenance of a position against gravity (e.g., holding hands outstretched in front of the body). (b) Kinetic tremor occurs during any aspect of voluntary movement. It can be p
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