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Tremors

Common Tremors
Parkinsonian Tremor
  • Asymmetric, rest tremor
    • It typically begins on one side before the other and predominates on that side throughout the progression of the illness and it is most prominent at rest and resolves with action.
    • Typically a rest tremor with pill-rolling circular motion of the index finger and thumb.
    • Resolves with action.
  • Parkinson's tremor is high amplitude but slow frequency (4 – 6 Hz).
Essential Tremor
  • Symmetric, kinetic tremor.
    • Effects both sides equally (although there is still often some asymmetry) and it worsens with particular actions (eg, writing or eating).
    • Action (eg, bringing a spoonful of soup towards the mouth) amplifies the tremor.
    • Alcohol characteristically dampens the tremor.
    • As a major differentiator from parkinsonism, muscle tone is normal in essential tremor (it rigid with parkinsonism).
  • Essential tremor is mid amplitude and is also mid frequency (5 – 8 Hz).
Enhanced Physiologic Tremor
  • Symmetric and invariable.
    • It effects both sides equally and does not change throughout rest and activity.
    • On exam, it's notable that on finger to nose testing, the tremor is the same throughout the action: there is no intentional component. Essential tremor, instead, will typically accentuate as the patient reaches the tip of the examiner's finger.
    • Stress and caffeine accentuate the tremor.
  • Enhanced physiologic tremor is low amplitude but high frequency (8 – 12 Hz).