The tremor is typically 4-12 Hz and most commonly affects the hands and arms. Tremor is most apparent when the arms are held outstretched, and it is increased at the end of a goal-directed activity such as finger-to-nose testing. Essential tremor of the head may occur and is typically manifested as a vertical ("yes-yes") or horizontal ("no-no") tremor with or without associated voice tremors. Face and leg tremors may also be present but are less common. Tremors are often bilateral, but may be asymmetric in severity or unilateral.
People with essential tremor typically do not have associated neurologic problems and may report that their tremor is improved with alcohol intake. The tremor tends to progress and can lead to significant functional disability for some patients.
G25.0 – Essential tremor
609558009 – Essential Tremor
Differential Diagnosis & Pitfalls
- Parkinson disease
- Dystonia (eg, torsion, drug-induced)
- Cerebellar dysfunction, especially from chronic toxin exposure, such as alcohol, mercury, lead, arsenic, or medications (especially beta-agonists, thyroid, theophylline, dopamine agonists, lithium, amphetamines, valproate, neuroleptics, tricyclics)
- Drug withdrawal (including alcohol, opioid)
- Rubral (Holmes) tremor, most commonly due to stroke or multiple sclerosis
- Wilson disease
- Hepatocerebral degeneration
- Exaggerated physiologic tremor, due to anxiety, stress, fatigue, or caffeine
- Functional (conversion) disorder
- Peripheral neuropathy (Charcot-Marie-Tooth disease, Roussy-Levy syndrome, chronic inflammatory demyelinating polyneuropathy)