Isolated Tremor

Scope

These guidelines cover isolated tremor, there is a separate guideline for Suspected Parkinson's Disease.

Assessment

Signs and Symptoms

Tremor is the most common of all movement disorders, occurring from time to time in most normal individuals in the form of exaggerated physiologic tremor.

Essential Tremor is the most common neurologic disorder that causes postural or action tremor, with an estimated prevalence worldwide of up to 5 percent of the population.

The incidence of Essential Tremor (ET) increases with age, although it often affects young individuals, especially when it is familial.

It varies from a low amplitude, high frequency postural tremor of the hands to a much larger amplitude, postural and action tremor that is activated by particular postures and actions.

Essential Tremor (ET) most often affects the hands and arms and can be asymmetric. It can also affect the head, voice, chin, trunk, and legs.

History and Examination

Pertinent details of the tremor:

  • Unilateral / Bilateral
  • Predominantly at rest or predominantly on action
  • Exacerbating or relieving factors
  • Presence of Family History
  • Response to alcohol if applicable

Investigations

Thyroid function test

Management

At triage, you may be requested to:

  • initiate a trial of treatment rather than immediately appoint for neurology review
  • re-refer as Suspected Parkinson's Disease, in keeping with the relevant referral guidance

Referral

Referral Criteria

  • Results of thyroid function testing ('normal' will suffice)
  • Pertinent details of the tremor:
    • Unilateral / Bilateral
    • Predominantly at rest or predominantly on action
    • Exacerbating or relieving factors
    • Presence of Family History
    • Response to alcohol if applicable
  • Details of treatment attempted (particularly propranolol / primidone where tremor is consistent with Essential Tremor)
    • Dose
    • Duration of therapy
    • Response – effective / partially effective / ineffective
    • Any side effects

Referral Instructions

e-Referral Service

  • Specialty: Neurology
  • Clinic Type: Parkinsons/Movements Disorders or Not Otherwise Specified
  • Service: DRSS-South Devon & Torbay-Neurology- Devon CCG - 15N

Referral Form

DRSS referral form

Torbay and South Devon seeking advice form

Supporting Information

Pathway Group

This guideline has been signed off by Dr Alex Rowe - GP and Clinical Lead for Planned Care South Devon and Torbay CCG.

Author: D Lashley, Consultant Neurologist, PHNT / Dr G Lenden Clinical lead DRSS Western

Publication date: January 2017

 

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