Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Tremor differential diagnosis
Introduction
Overview
Overview
Tremor must be differentiated from diseases that cause involuntary movement: myoclonus, clonus, asterixis, and epilepsia partialis continua. The cause of tremor must also be differentiated from other conditions that cause tremor: essential tremor, physiological tremor, Parkinson’s disease, cerebellar tremor, orthostatic tremor.
Differentiating Tremor from other Diseases
Differentiating Tremor from other Diseases
- Tremor must be differentiated from diseases that cause involuntary movement: [1]
- Myoclonus: Brief muscle twitches, limited to single limb or to adjacent parts.EEG shows association with spike-wave complexes.
- Clonus: Rhythmic movement aggravated by muscle stretching.
- Asterixis: On electromyographic, flapping/abduction of the upper extremities is indicated as prolong absence of EMG activity.
- Epilepsia partialis continua: Regular jerks of the arm/hand.
- Differentiating the cause of tremor from other diseases on the basis of the type of tremor, associated signs, and symptoms.[2][3][4]
| Common Cause of Tremor | Differentiating Feature of Tremor | Main Feature of Disease |
|---|---|---|
| Essential tremor | Postural Tremor – Frequency 4–12 Hz, Bilateral onset | gait ataxia, vestibulo-cerebellar involvement, reduced by alcohol, family history, stress/fatigue can increase tremor amplitude, increases with voluntary movements |
| Parkinson’s disease | Resting Tremor – Unilateral onset | Bradykinesia, micrographia, stooped posture, ataxia, rigidity, imbalance, depression, apathy, decreases with voluntary movements |
| Physiologic Tremor | Postural tremor – High frequency 8–10 Hz, low amplitude, irregular oscillations | Tremor occurs while maintaining a posture and mostly disappears if eyes are closed or a load is placed on the muscles. Subtle innate tremor normally present in the general population. |
| Enhanced Physiologic Tremor | Increased amplitude | Physiologic tremor enhanced due to fatigue, sleep deprivation, drugs, endocrine disorders, caffeine, stress. |
| Cerebellar Tremor | Intention tremor – Low frequency <4 Hz | Occurs in multiple sclerosis, stroke, brainstem tumor, or cerebellar trauma. May feature ataxia, dysmetria, dysdiadochokinesia, and dysarthria. |
| Drug Induced Tremor | Can enhance rest, action, postural tremors | Amiodarone, bronchodilators, lithium, metoclopramide, neuroleptics, theophylline, valproate |
| Orthostatic Tremor | Essential tremor variant, high frequency 14 Hz-18 Hz | Occurs in the legs on standing and is relieved by sitting down |
| Holmes tremor | Combination of rest, action, and postural tremors, Frequency 2Hz-5Hz | Mostly due to vascular lesion in mesencephalic, thalamic or both regions. |
References
References
- ↑ Bhidayasiri R (2005). “Differential diagnosis of common tremor syndromes”. Postgrad Med J. 81 (962): 756–62. doi:10.1136/pgmj.2005.032979. PMC 1743400. PMID 16344298.
- ↑ Deuschl G, Elble R (2009). “Essential tremor–neurodegenerative or nondegenerative disease towards a working definition of ET”. Mov Disord. 24 (14): 2033–41. doi:10.1002/mds.22755. PMID 19750493.
- ↑ Smaga S (2003). “Tremor”. Am Fam Physician. 68 (8): 1545–52. PMID 14596441.
- ↑ Crawford P, Zimmerman EE (2011). “Differentiation and diagnosis of tremor”. Am Fam Physician. 83 (6): 697–702. PMID 21404980.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]