Tremor differential diagnosis
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Tremor must be differentiated from diseases that cause involuntary movement: myoclonus, clonus, asterixis, and epilepsia partialis continua. The cause of tremor must also be differentiated from other conditions that cause tremor: essential tremor, physiological tremor, Parkinson's disease, cerebellar tremor, orthostatic tremor.
Differentiating Tremor from other Diseases
- Tremor must be differentiated from diseases that cause involuntary movement: 
- Myoclonus: Brief muscle twitches, limited to single limb or to adjacent parts.EEG shows association with spike-wave complexes.
- Clonus: Rhythmic movement aggravated by muscle stretching.
- Asterixis: On electromyographic, flapping/abduction of the upper extremities is indicated as prolong absence of EMG activity.
- Epilepsia partialis continua: Regular jerks of the arm/hand.
- Differentiating the cause of tremor from other diseases on the basis of the type of tremor, associated signs, and symptoms.
|Common Cause of Tremor||Differentiating Feature of Tremor||Main Feature of Disease|
|Essential tremor||Postural Tremor - Frequency 4–12 Hz, Bilateral onset||gait ataxia, vestibulo-cerebellar involvement, reduced by alcohol, family history, stress/fatigue can increase tremor amplitude, increases with voluntary movements|
|Parkinson’s disease||Resting Tremor - Unilateral onset||Bradykinesia, micrographia, stooped posture, ataxia, rigidity, imbalance, depression, apathy, decreases with voluntary movements|
|Physiologic Tremor||Postural tremor - High frequency 8–10 Hz, low amplitude, irregular oscillations||Tremor occurs while maintaining a posture and mostly disappears if eyes are closed or a load is placed on the muscles. Subtle innate tremor normally present in the general population.|
|Enhanced Physiologic Tremor||Increased amplitude||Physiologic tremor enhanced due to fatigue, sleep deprivation, drugs, endocrine disorders, caffeine, stress.|
|Cerebellar Tremor||Intention tremor - Low frequency <4 Hz||Occurs in multiple sclerosis, stroke, brainstem tumor, or cerebellar trauma. May feature ataxia, dysmetria, dysdiadochokinesia, and dysarthria.|
|Drug Induced Tremor||Can enhance rest, action, postural tremors||Amiodarone, bronchodilators, lithium, metoclopramide, neuroleptics, theophylline, valproate|
|Orthostatic Tremor||Essential tremor variant, high frequency 14 Hz-18 Hz||Occurs in the legs on standing and is relieved by sitting down|
|Holmes tremor||Combination of rest, action, and postural tremors, Frequency 2Hz-5Hz||Mostly due to vascular lesion in mesencephalic, thalamic or both regions.|
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