ALL

• Most common form of tremor

• Bimodal distribution: teens and 6th decade of life (common in elderly patients)

positive family history (50–70%; autosomal dominant inheritance) or sporadic; benign form

• Localization: hands (∼ 90%), head (∼ 30%; "yes-yes” or "no-no” motion), voice (∼ 15%)

• Mostly bilateral postural tremor with a frequency of 5–10 Hz

  • Slowly progressive

  • Worse with sustained voluntary movement , stress or anxiety, fatigue, and caffeine

  • Improves with alcohol consumption

• The essential tremor may be accompanied by an intention tremor and/or a resting tremor .

usually a clinical diagnosis of exclusion

• Drugs of choice: propranolol or primidone

• Alternatives (if propranolol and primidone are unresponsive or contraindicated)

  • Other beta blockers (e.g., atenolol, sotalol)

  • Other anticonvulsants (e.g., gabapentin, topiramate) including certain benzodiazepines (e.g., alprazolam, clonazepam)

• In drug-resistant cases

  • Deep brain stimulation (DBS)

  • Thalamotomy

Consider an essential tremor in a patient presenting with chronic bilateral hand tremors without further neurological deficits and positive family history.