Synonyms:
Benign essential tremor
Clinical features:
Postural and action tremor, present during the following activities:
- Pouring water, using a spoon to drink water, drinking water, finger-to-nose maneuver, and drawing a spiral
Head titubation may occur
Findings on Investigations:
MRI brain: usually normal
DAT SPECT (123I-FP-CIT SPECT) “DaTscan”:
- Images presynaptic dopamine transporters
- Helps differentiate between PD (abnormal, reduced in putamen) and essential tremor (normal)
Investigations to consider:
- Thyroid Function Tests TFT
- If < 40 y.o. serum ceruloplasmin: <20 mg per decilitre +/-slit lamp examination
- DAT SPECT (123I-FP-CIT SPECT) “DaTSCAN”: if atypical or to distinguish between esstential tremor and Parkinson disease
Treatment:
1st line:
- Propranolol BID or prn, especially long acting
- Primidone start at low dose
2nd line:
- Topiramate TPM P.O.
- Alprazolam P.O., lorazepam.
- Gabapentin GBP, Nimodipine P.O., Theophylline
Consider, selected cases:
- Deep brain stimulation:
- Contralateral thalamus
Surgery:
- Thalamotomy