Diagnosis and treatment of hand tremor

Sun Ju Chung

doi:10.5124/jkma.2012.55.10.987

Journal List > J Korean Med Assoc > v.55(10) > 1042631

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Chung: Diagnosis and treatment of hand tremor

Continuing Education Column

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2012; 55(10): 987-995.

Published online: 17 October 2012

DOI: https://doi.org/10.5124/jkma.2012.55.10.987

Diagnosis and treatment of hand tremor

Sun Ju Chung, MD

Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Corresponding author: Sun Ju Chung, sjchung@amc.seoul.kr

Received 7 August 2012 Accepted 21 August 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hand tremor is one of the most frequent movement disorders and embarrassing symptoms of a wide spectrum of diseases. Hand tremor can be classified by form in which the hand tremor occurs, the main distinction being whether the hand tremor occurs at rest or is produced by voluntary muscle contractions. Essential tremor is the most common pathologic tremor in humans. The clinical features of essential tremor are heterogeneous across patients. Parkinson's disease is a common disease in the elderly with increasing prevalence over the last decade. Rest tremor is one of the cardinal motor features of Parkinson's disease. Drug-induced hand tremor is also common and should be diagnosed accurately. Hand tremor in Wilson's disease is very important to identify because the disease can be treatable. Here, the diagnosis and treatment of hand tremor were reviewed to provide a practical guide for managing patients with hand tremor.

Keywords: Hand tremor, Essential tremor, Parkinson disease, Drug-induced tremor, Wilson's disease

Figures and Tables

Figure 1

The drawing of an Archimedes spirals by patients with (A) essential tremor, (B) (B) Parkinson's disease, and (C) a normal person.

Figure 2

The handwriting obtained from patients with (A) essential tremor and (B) Parkinson's disease (micrographia).

Figure 3

Brain [¹⁸F] fluorinated-N-3-fluoropropyl-2-β-carboxymethoxy-3-β-(4-iodophenyl)nortropane ([¹⁸F] FP-CIT PET) of patients with (A) essential tremor and (B) Parkinson's disease. The [¹⁸F] FP-CIT PET of a patient with essential tremor shows normal FP-CIT uptake in the bilateral striatum (A). The [¹⁸F] FP-CIT PET of a patient with Parkinson's disease shows asymmetrically decreased FP-CIT uptake in the striatum (B).

Figure 4

Brain computed tomography scans of patients with essential tremor who received bilateral thalamic deep brain stimulation (A) and left thalamotomy (B). The arrow indicates the nucleus ventralis intermedius of the left thalamus with a permanent radiofrequency thermolesion.

Table 1

Classification of tremors

Table 2

The consensus criteria of essential tremor suggested by Movement DIsorder Society

From Deuschl G, et al. Mov Disord 1998;13 Suppl 3:2-23, according to the Creative Commons license [13].

References

1. Raethjen J, Deuschl G. Tremor. Curr Opin Neurol. 2009. 22:400–405.

2. Shibasaki H, Thompson PD. Milestones in myoclonus. Mov Disord. 2011. 26:1142–1148.

3. Ozelius LJ, Lubarr N, Bressman SB. Milestones in dystonia. Mov Disord. 2011. 26:1106–1126.

4. Cardoso F, Seppi K, Mair KJ, Wenning GK, Poewe W. Seminar on choreas. Lancet Neurol. 2006. 5:589–602.

5. Elble R, Deuschl G. Milestones in tremor research. Mov Disord. 2011. 26:1096–1105.

6. Halliday G, Lees A, Stern M. Milestones in Parkinson's disease: clinical and pathologic features. Mov Disord. 2011. 26:1015–1021.

7. Wenning GK, Litvan I, Tolosa E. Milestones in atypical and secondary Parkinsonisms. Mov Disord. 2011. 26:1083–1095.

8. Alty JE, Kempster PA. A practical guide to the differential diagnosis of tremor. Postgrad Med J. 2011. 87:623–629.

9. Louis ED, Ferreira JJ. How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor. Mov Disord. 2010. 25:534–541.

10. Lorenz D, Poremba C, Papengut F, Schreiber S, Deuschl G. The psychosocial burden of essential tremor in an outpatient- and a community-based cohort. Eur J Neurol. 2011. 18:972–979.

11. Dogu O, Louis ED, Sevim S, Kaleagasi H, Aral M. Clinical characteristics of essential tremor in Mersin, Turkey: a population-based door-to-door study. J Neurol. 2005. 252:570–574.

12. Louis ED, Barnes L, Albert SM, Cote L, Schneier FR, Pullman SL, Yu Q. Correlates of functional disability in essential tremor. Mov Disord. 2001. 16:914–920.

13. 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.

14. Fahn S, Tolosa E, Marin C. Jankovic J, Tolosa E, editors. Clinical rating scale for tremor. Parkinson's disease and movement disorders. 1993. 2nd ed. Baltimore: Williiams & Wilkins;271–280.

15. Stoessl AJ, Martin WW, McKeown MJ, Sossi V. Advances in imaging in Parkinson's disease. Lancet Neurol. 2011. 10:987–1001.

16. Oh M, Kim JS, Kim JY, Shin KH, Park SH, Kim HO, Moon DH, Oh SJ, Chung SJ, Lee CS. Subregional patterns of preferential striatal dopamine transporter loss differ in Parkinson disease, progressive supranuclear palsy, and multiple-system atrophy. J Nucl Med. 2012. 53:399–406.

17. Deuschl G, Raethjen J, Hellriegel H, Elble R. Treatment of patients with essential tremor. Lancet Neurol. 2011. 10:148–161.

18. Zesiewicz TA, Elble RJ, Louis ED, Gronseth GS, Ondo WG, Dewey RB Jr, Okun MS, Sullivan KL, Weiner WJ. Evidence-based guideline update: treatment of essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2011. 77:1752–1755.

19. Young RR, Growdon JH, Shahani BT. Beta-adrenergic mechanisms in action tremor. N Engl J Med. 1975. 293:950–953.

20. Koller WC, Pahwa PR, Lyons KE, Wilkinson SB. Deep brain stimulation of the Vim nucleus of the thalamus for the treatment of tremor. Neurology. 2000. 55:12 Suppl 6. S29–S33.

21. Schuurman PR, Bosch DA, Bossuyt PM, Bonsel GJ, van Someren EJ, de Bie RM, Merkus MP, Speelman JD. A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med. 2000. 342:461–468.

22. Rosenbaum F, Jankovic J. Focal task-specific tremor and dystonia: categorization of occupational movement disorders. Neurology. 1988. 38:522–527.

23. Soland VL, Bhatia KP, Volonte MA, Marsden CD. Focal task-specific tremors. Mov Disord. 1996. 11:665–670.

24. Hai C, Yu-ping W, Hua W, Ying S. Advances in primary writing tremor. Parkinsonism Relat Disord. 2010. 16:561–565.

25. Hallett M. Parkinson's disease tremor: pathophysiology. Parkinsonism Relat Disord. 2012. 18:Suppl 1. S85–S86.

26. Jankovic J, Schwartz KS, Ondo W. Re-emergent tremor of Parkinson's disease. J Neurol Neurosurg Psychiatry. 1999. 67:646–650.

27. Sung YH, Chung SJ, Kim SR, Lee MC. Factors predicting response to dopaminergic treatment for resting tremor of Parkinson's disease. Mov Disord. 2008. 23:137–140.

28. Bondon-Guitton E, Perez-Lloret S, Bagheri H, Brefel C, Rascol O, Montastruc JL. Drug-induced parkinsonism: a review of 17 years' experience in a regional pharmacovigilance center in France. Mov Disord. 2011. 26:2226–2231.

29. Shin HW, Kim MJ, Kim JS, Lee MC, Chung SJ. Levosulpiride-induced movement disorders. Mov Disord. 2009. 24:2249–2253.

30. Onofrj M, Thomas A, Paci C. Reversible parkinsonism induced by prolonged treatment with valproate. J Neurol. 1998. 245:794–796.

31. Armon C, Shin C, Miller P, Carwile S, Brown E, Edinger JD, Paul RG. Reversible parkinsonism and cognitive impairment with chronic valproate use. Neurology. 1996. 47:626–635.

32. Hauben M, Reich L. Valproate-induced parkinsonism: use of a newer pharmacovigilance tool to investigate the reporting of an unanticipated adverse event with an "old" drug. Mov Disord. 2005. 20:387.

33. Hallett M, Weiner WJ, Kompoliti K. Psychogenic movement disorders. Parkinsonism Relat Disord. 2012. 18:Suppl 1. S155–S157.

34. Schwingenschuh P, Katschnig P, Seiler S, Saifee TA, Aguirregomozcorta M, Cordivari C, Schmidt R, Rothwell JC, Bhatia KP, Edwards MJ. Moving toward "laboratory-supported" criteria for psychogenic tremor. Mov Disord. 2011. 26:2509–2515.

35. Deuschl G. Dystonic tremor. Rev Neurol (Paris). 2003. 159(10 Pt 1):900–905.

36. Milanov I. Clinical and electromyographic examinations of patients with midbrain and cerebellar tremor. Electromyogr Clin Neurophysiol. 2002. 42:105–112.

37. Bain PG, Britton TC, Jenkins IH, Thompson PD, Rothwell JC, Thomas PK, Brooks DJ, Marsden CD. Tremor associated with benign IgM paraproteinaemic neuropathy. Brain. 1996. 119(Pt 3):789–799.

38. Seidel S, Kasprian G, Leutmezer F, Prayer D, Auff E. Disruption of nigrostriatal and cerebellothalamic pathways in dopamine responsive Holmes' tremor. J Neurol Neurosurg Psychiatry. 2009. 80:921–923.

39. Lorincz MT. Neurologic Wilson's disease. Ann N Y Acad Sci. 2010. 1184:173–187.

40. Gouider-Khouja N. Wilson's disease. Parkinsonism Relat Disord. 2009. 15:Suppl 3. S126–S129.

TOOLS

Similar articles