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TREMOR: DIAGNOSTIC APPROACH
ADE WIJAYA, MD – JUNE 2019
INTRODUCTION
 The most common form of movement disorder
 Alternating and synchronous contractions of reciprocally innervated agonistic and antagonistic muscles
that cause a symmetrical displacement about the midpoint of the movement in both the directions
 5% of the population over the age of 40 years
Deuschl G, Bain P, Brin M. Consensus statement of the movement disorder society on tremor. Ad Hoc Scientific Committee. Mov Disord. 1998;13(Suppl
3):2–23.
CLASSIFICATION
Leehey MA. Tremor: Diagnosis and treatment. Prim Care Case Rev. 2001;4:32–9
Deuschl G, Bain P, Brin M. Consensus statement of the movement disorder society on tremor. Ad Hoc Scientific Committee. Mov Disord. 1998;13(Suppl
3):2–23.
CLASSIFICATION
Puschmann A, Wszolek ZK. Diagnosis and treatment of common forms of tremor. Semin Neurol. 2011;31:65–77.
Gövert F, Deuschl G. Tremor entities and their classification: An update. Curr Opin Neurol. 2015;28:393–9.
Schneider SA, Deuschl G. Medical and surgical treatment of tremors. Neurol Clin. 2015;33:57–75.
Hess CW, Pullman SL. Tremor: Clinical phenomenology and assessment techniques. Tremor Other Hyperkinet Mov (N Y) 2012;2 pii: tre-02-65-365-1.
Edwards MJ, Deuschl G. Tremor syndromes. Continuum (Minneap Minn) 2013;19:1213–24.
ENHANCED PHYSIOLOGICAL TREMOR
Sharma S, Pandey S. Approach to a tremor patient. Annals of Indian Academy of Neurology. 2016 Oct;19(4):433.
Sharma S, Pandey S. Approach to a tremor patient. Annals of Indian Academy of Neurology. 2016 Oct;19(4):433.
Sharma S, Pandey S. Approach to a tremor patient. Annals of Indian Academy of Neurology. 2016 Oct;19(4):4
PHYSICAL EXAMINATION
Sharma S, Pandey S. Approach to a tremor patient. Annals of Indian Academy of Neurology. 2016 Oct;19(4):433.
PHYSICAL EXAMINATION
PHYSICAL EXAMINATION
Sharma S, Pandey S. Approach to a tremor patient. Annals of Indian Academy of Neurology. 2016 Oct;19(4):433.
Sharma S, Pandey S. Approach to a tremor patient. Annals of Indian Academy of Neurology. 2016 Oct;19(4):433.
Elble R, Bain P, Forjaz MJ, Haubenberger D, Testa C, Goetz CG, et al. Task force report: Scales for screening and evaluating tremor: Critique and recommendations. Mov Disord.
Sharma S, Pandey S. Approach to a tremor patient. Annals of Indian Academy of Neurology. 2016 Oct;19(4):433.
SUMMARY
 Common
 Usually minor but can be disabling and treatment resistant
 Approach based on the phenomenological classification
Tremor Diagnostic Approach

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Tremor Diagnostic Approach

  • 1. TREMOR: DIAGNOSTIC APPROACH ADE WIJAYA, MD – JUNE 2019
  • 2. INTRODUCTION  The most common form of movement disorder  Alternating and synchronous contractions of reciprocally innervated agonistic and antagonistic muscles that cause a symmetrical displacement about the midpoint of the movement in both the directions  5% of the population over the age of 40 years Deuschl G, Bain P, Brin M. Consensus statement of the movement disorder society on tremor. Ad Hoc Scientific Committee. Mov Disord. 1998;13(Suppl 3):2–23.
  • 3. CLASSIFICATION Leehey MA. Tremor: Diagnosis and treatment. Prim Care Case Rev. 2001;4:32–9 Deuschl G, Bain P, Brin M. Consensus statement of the movement disorder society on tremor. Ad Hoc Scientific Committee. Mov Disord. 1998;13(Suppl 3):2–23.
  • 4. CLASSIFICATION Puschmann A, Wszolek ZK. Diagnosis and treatment of common forms of tremor. Semin Neurol. 2011;31:65–77. Gövert F, Deuschl G. Tremor entities and their classification: An update. Curr Opin Neurol. 2015;28:393–9. Schneider SA, Deuschl G. Medical and surgical treatment of tremors. Neurol Clin. 2015;33:57–75. Hess CW, Pullman SL. Tremor: Clinical phenomenology and assessment techniques. Tremor Other Hyperkinet Mov (N Y) 2012;2 pii: tre-02-65-365-1. Edwards MJ, Deuschl G. Tremor syndromes. Continuum (Minneap Minn) 2013;19:1213–24.
  • 5. ENHANCED PHYSIOLOGICAL TREMOR Sharma S, Pandey S. Approach to a tremor patient. Annals of Indian Academy of Neurology. 2016 Oct;19(4):433.
  • 6. Sharma S, Pandey S. Approach to a tremor patient. Annals of Indian Academy of Neurology. 2016 Oct;19(4):433.
  • 7. Sharma S, Pandey S. Approach to a tremor patient. Annals of Indian Academy of Neurology. 2016 Oct;19(4):4
  • 8. PHYSICAL EXAMINATION Sharma S, Pandey S. Approach to a tremor patient. Annals of Indian Academy of Neurology. 2016 Oct;19(4):433.
  • 10. PHYSICAL EXAMINATION Sharma S, Pandey S. Approach to a tremor patient. Annals of Indian Academy of Neurology. 2016 Oct;19(4):433.
  • 11. Sharma S, Pandey S. Approach to a tremor patient. Annals of Indian Academy of Neurology. 2016 Oct;19(4):433.
  • 12. Elble R, Bain P, Forjaz MJ, Haubenberger D, Testa C, Goetz CG, et al. Task force report: Scales for screening and evaluating tremor: Critique and recommendations. Mov Disord.
  • 13. Sharma S, Pandey S. Approach to a tremor patient. Annals of Indian Academy of Neurology. 2016 Oct;19(4):433.
  • 14. SUMMARY  Common  Usually minor but can be disabling and treatment resistant  Approach based on the phenomenological classification