Essential tremor: diagnosis and management
Open accessAbstract
Essential tremor is one of the most common movement disorders in adults and can affect both children and adults. An updated consensus statement in 2018 redefined essential tremor as an isolated action tremor present in bilateral upper extremities for at least three years. Tremor may also be present in other locations, commonly the neck or the vocal cords. Patients with additional neurologic symptoms are now categorized as “essential tremor plus.” Additional clinical features associated with the condition include but are not limited to cognitive impairment, psychiatric disorders, and hearing loss. When treatment is needed, propranolol and primidone are considered first line treatments. Patients who are severely affected are often offered deep brain stimulation. Although the ventral intermediate nucleus of the thalamus is the traditional surgical target, the caudal zona incerta is also being studied as a possible superior alternative. Magnetic resonance imaging guided high intensity focused ultrasound is a newer surgical alternative that may be ideal for patients with substantial medical comorbidities. Current research explores novel oral treatments, chemodenervation, and noninvasive neuromodulation for treatment of essential tremor.
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In essential tremor, propranolol or primidone is first-line therapy and reduces hand tremor by 50% during clinical tests.
“In ET, propranolol or primidone is the first-line therapy against tremor, reducing hand tremor by 50% during clinical tests (27, 28).”
From A Review on Wearable Technologies for Tremor Suppression (2021) · cites this paper as [28]
Cites
MR-guided focused ultrasound thalamotomy for essential tremor: a proof-of-concept study
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Thalamic deep brain stimulation for management of essential tremor
Lee, J. Y. K., & Kondziolka, D. (2005) · Journal of Neurosurgery · doi:10.3171/jns.2005.103.3.0400 · Cited by 97 · see citing works
A noninvasive handheld assistive device to accommodate essential tremor: A pilot study
Pathak, A., Redmond, J. A., Allen, M., & Chou, K. L. (2014) · Movement Disorders · doi:10.1002/mds.25796 · Cited by 54 · see citing works
Embarrassment in essential tremor: Prevalence, clinical correlates and therapeutic implications
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Peripheral electrical stimulation to reduce pathological tremor: a review
Pascual-Valdunciel, A., Hoo, G. W., Avrillon, S., Barroso, F. O., Goldman, J. G., Hernandez-Pavon, J. C., & Pons, J. L. (2021) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-021-00811-9 · Cited by 66 · see citing works
“Introduction Tremor, defined as an involuntary movement of a body part or limb due to pathological neural oscillations that are projected to muscles [1], can be a hallmark of essential tremor (ET) and Parkinson’s disease (PD) and can have a debilitating effect on patients with these diagnoses.”
BackgroundInfluentialA Review on Wearable Technologies for Tremor Suppression
Lora-Millan, J. S., Delgado-Oleas, G., Benito-León, J., & Rocon, E. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.700600 · Cited by 62 · see citing works
Pascual-Valdunciel, A., Gonzalez-Sanchez, M., Muceli, S., Adan-Barrientos, B., Escobar-Segura, V., Perez-Sanchez, J. R., Jung, M. K., Schneider, A., Hoffmann, K.-P., Moreno, J. C., et al. (2021) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2020.3015572 · Cited by 37 · see citing works
“using these medications is only approximately 50%, and one in three patients ends up discontinuing treatment [4], [5].”
Background
- Authors
- Shanker, V.
- Affiliations
- Icahn School of Medicine at Mount Sinai (US)
- Corresponding author
- Shanker, Vicki
- ORCID
- Shanker, Vicki
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2019-08-05
- Volume
- 366
- Pages
- l4485
- ISSN
- 1756-1833 (ISSN-L)
- 0959-8138
- OpenAlex
- W2964480588
- Cited by
- 182
- References
- 6
- Citations by year
- 2026: 14 · 2025: 35 · 2024: 32 · 2023: 43 · 2022: 29 · 2021: 18 · 2020: 10 · 2019: 1
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Neurology › Botulinum Toxin and Related Neurological Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Neurological and metabolic disorders
- Keywords
- essential tremor, movement disorders, propranolol, primidone, deep brain stimulation, ventral intermediate nucleus, caudal zona incerta, chemodenervation, non-invasive neuromodulation, cognitive impairment, hearing loss, diagnostic criteria
- MeSH terms
- Extracorporeal Shockwave Therapy, Adrenergic beta-Antagonists, Anticonvulsants, Humans, Nerve Block, Antipsychotic Agents, Essential Tremor, Deep Brain Stimulation
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