The diagnosis may be strongly influenced by the presence of another case of essential tremor in the family, but in all cases the diagnosis is based on precise clinical criteria and requires a neurological examination.
Essential tremor is a fairly rapid tremor that occurs during the maintenance of posture (holding a glass) and action (eating, writing). The diagnosis is clinical. In the majority of cases, the patient’s history and examination enable a distinction to be made between other disorders such as Parkinson’s disease. There are no specific biological or imaging tests for essential tremor.
It is important to look for other causes of tremor, drugs such as betamimetics used to treat asthma, toxic substances such as alcohol or hyperthyroidism, etc.
The main clinical differences make it possible to rule out a diagnosis of Parkinson’s disease and to support the clinician in his clinical assessment.
| Criteria |
Parkinson’s disease
|
Essential tremor |
|
Type of tremor
|
Resting tremor | Intentional and postural |
| Age |
> 60 years old
|
All ages |
|
Family history
|
None
|
Present in 60% of cases |
| Alcohol |
No effect
|
Reduces tremor |
|
Tremor characteristics
|
Unilateral
|
Bilateral |
|
Characteristics of tremor
|
Slow, at rest, disappears with action
|
Faster, bilateral, absent at rest, appears with posture and action |
|
Other differential signs
|
Decreased arm swing
Rigidity of limbs, slowness |
Normal |
Essential tremor is a progressive disease. As the disease progresses, the tremor becomes more bothersome in everyday activities. The amplitude of the tremor increases and it interferes much more with voluntary movements, making it very difficult to perform fine gestures, eating, DIY, writing, etc. Instability when walking (shaky walking), neck tremor and voice tremor may appear. This development increases the disability of patients in their personal and professional lives.