Essential Tremor

Essential tremor (ET) is the most common movement disorder, affecting approximately 1% of adults and up to 5% of those over age 65. It is characterized by a bilateral kinetic and postural tremor predominantly of the hands.

It is more common in patients with a positive family history (autosomal dominant inheritance, 50–70%). Voice, head and lower extremity tremors may also occur. Although alcohol typically reduces the tremor, this is not used as a chronic treatment.

Diagnosis is clinical; differential diagnosis includes Parkinson disease (resting tremor), enhanced physiological tremor, dystonic tremor and cerebellar tremor. First-line therapy includes propranolol and primidone; topiramate, gabapentin or focused ultrasound thalamotomy and DBS are alternatives in resistant cases.