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Essential tremor
Other Resources UpToDate PubMed

Essential tremor

Contributors: Jamie Adams MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed


Essential tremor is the most common neurologic disorder causing a postural and/or action tremor. It may be familial or sporadic in nature. It is termed familial when there is a family history; inheritance pattern is most often autosomal dominant. Incidence increases with age and is most commonly seen in older adults, but essential tremor can start at any age.

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

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Parkinson disease
  • Dystonia (eg, Torsion dystonia, Drug-induced dystonia)
  • Cerebellar dysfunction, especially from chronic toxin exposure, such as Alcohol use disorder, Mercury poisoning, Lead poisoning, Arsenic poisoning or medications (especially beta-agonists, Exogenous thyroid hormone abuse, theophylline, dopamine agonists, lithium, Sympathomimetic toxicity, valproate, neuroleptics, tricyclics)
  • Drug withdrawal (including Alcohol withdrawal syndrome, Opioid withdrawal syndrome)
  • Rubral (Holmes) tremor, most commonly due to Cerebral stroke or Multiple sclerosis
  • Wilson disease
  • Hepatocerebral degeneration
  • Exaggerated physiologic tremor, due to Generalized anxiety disorder, stress, fatigue, or caffeine
  • Functional (conversion) disorder
  • Hyperthyroidism
  • Hypoglycemia
  • Pheochromocytoma
  • Corticosteroids
  • Peripheral neuropathy (Charcot-Marie-Tooth disease, Roussy-Levy syndrome, Chronic inflammatory demyelinating polyneuropathy)

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Last Reviewed:11/21/2016
Last Updated:01/16/2022
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Essential tremor
A medical illustration showing key findings of Essential tremor : Intention tremor, Postural tremor
Copyright © 2024 VisualDx®. All rights reserved.