Tremor

Tremor, particularly of the upper limbs, is common. Although patients with a new tremor commonly think of neurodegenerative problems like (idiopathic) Parkinson’s Disease, Parkinson’s disease is an uncommon cause of an isolated tremor.

Neurologists assess tremor by considering the history - including the impact on daily life, handwriting and hobbies. Examination considers the contexts in which the tremor occurs (at rest, during action, or varying with distance from the body), as well as its distribution in the body (limbs, head, neck and symmetry) as well as considering the presence or absence of other features such as stiffness (rigidity) and the speed of movement. Diagnostic uncertainty may remain after the time of a first assessment, so re-assessment after an interval is a common strategy in the journey to a diagnosis.

The commonest diagnoses made by neurologists following the assessment of a patient presenting mainly with a tremor are:

• physiological tremor;
• essential tremor;
• functional tremor;
• idiopathic Parkinson’s disease (where tremor co-occurs with other findings such as slow movement and rigidity); and
• tremor as part of another neurodegenerative disorder.

Since the majority of the factors relevant to the diagnosis are seldom obvious to the patient, neurologists play a key role in the diagnosis of the basis of a tremor. Once a diagnosis is made, a management plan can be formulated and most of these can be implemented in the community via general practitioners and sometime specialist community clinics.