Tremor I: diagnosis and treatment
Tremor is involuntary, rhythmic contractions in the body parts and the diagnosis is based on careful assessment by medical history and physical examination. Tremor may be either physiologic or pathologic and can be classified as postural, rest and action tremors. This classification helps in determining the cause of tremor types. The most common disorders with tremor will be discussed in this review. Besides detailed questioning of the tremor; daily activities, drug, alcohol use and metabolic diseases should be asked while interviewing the patient. Physical examination should include careful inspection in different positions. Presence of other neurologic findings should also be checked for. Essential tremor is the most common tremor disorder, with a prevalence of 1-6 %. Mild and non-disability tremors don’t always warrant therapy. The treatment of tremor primarily involves pharmacotherapy. The most frequently used drugs are propranolol and primidon. If there is no history of alcohol and/or drug use in kinetic tremor, patients should be referred for evaluation of cerebral or cerebellar lesions. Management of tremor can be difficult because of different possible causes. However, differential diagnosis is possible with medical history and physical examination only. Therefore, detailed evaluation in primary care is essential for the diagnosis and treatment of tremor.