Tremor-Assessment

Tremor is an involuntary , rhythmic , oscillatory movement of a body part. Tremor results from contractions of agonist and antagonist muscles entrained by a signal pattern originating from an oscillator in the CNS ( International Parkinson and Movement Disorder Society )

Background- Most common movement disorder Generally affects the upper extremities but can also affect the head , chin , voice or legs It can manifest as an isolated symptom or as a sign of another neurological pathology Diverse etiology e.g◘ essential tremor - 50 % have + ve FH but no single gene identified◘ part of genetic disorder e.g Wilson's dis◘ degenerative disorders as Parkinson's disease◘ metabolic disturbance as thyroid , para-thyroid , liver dis , hypoglycemia◘ peripheral neuropathies e.g Charcot-Marie-Tooth ◘ drug induced◘ toxins◘ psychogenic / functional disorders It is possible to see patients with more than 1 type of tremor ( e.g mixed rest and action tremor components ) Most common tremors seen in primary care are◘ enhanced physiological tremor◘ essential tremor ( most common pathological tremor )◘ parkinsonian tremor Most patients have mild symptoms and can be reassured

Management of tremor will depend on the underlying cause. Identification of tremor type is valuable for diagnosis...