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A practical guide to the differential diagnosis of tremor


Alty, JE and Kempster, PA, A practical guide to the differential diagnosis of tremor, Postgraduate Medical Journal, 87, (1031) pp. 623-9. ISSN 0032-5473 (2011) [Contribution to Refereed Journal]

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DOI: doi:10.1136/pgmj.2009.089623


Tremor is, by definition, a rhythmic oscillation of a body part. It is the most prevalent movement disorder in clinical medicine, so doctors working in many specialities and in general practice can expect to encounter it. Most tremors can be classified on the basis of four observable clinical characteristics: anatomical pattern; the relative prominence of the tremor at rest, on maintaining a posture, and with action; tremor frequency; and tremor amplitude. A resting tremor suggests Parkinson's disease, and the diagnosis then depends on a judgement about whether the patient has other signs of parkinsonism. The most common causes of postural tremor are physiological tremor, essential tremor and drug-induced tremor. The differential diagnosis may also include dystonic tremor and psychogenic tremor, while metabolic tremor caused by thyrotoxicosis should be considered in any recent-onset postural tremor. Wilson's disease and fragile X-associated tremor/ataxia syndrome are rarer conditions that may present with tremor and are very important to identify. There is a small but genuine diagnostic grey zone between Parkinson's disease and more benign tremor disorders such as essential tremor and dystonic tremor, in which resting and postural tremor coexist with mild or equivocal non-tremor parkinsonian signs. The authors review clinical features and investigational techniques that may help to discriminate this group of hard-to-classify tremors.

Item Details

Item Type:Contribution to Refereed Journal
Keywords:tremor, essential, dystonic, parkinson's, drug-induced
Research Division:Biomedical and Clinical Sciences
Research Group:Neurosciences
Research Field:Central nervous system
Objective Division:Health
Objective Group:Clinical health
Objective Field:Diagnosis of human diseases and conditions
UTAS Author:Alty, JE (Associate Professor Jane Alty)
ID Code:145422
Year Published:2011
Web of Science® Times Cited:15
Deposited By:Wicking Dementia Research and Education Centre
Deposited On:2021-07-21
Last Modified:2021-08-05

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