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Medicine (MD/DO)
Other Nervous System Pathology
Essential Tremor

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Essential Tremor

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Essential Tremor

Espresso Trimmer
Essential tremor (ET) is the most common type of tremor in adults. The underlying pathophysiology is not entirely known but several cases are familial. ET typically affects bilateral upper extremities, worsens with stress, and improves with rest and small amounts of alcohol. Management options include beta blockers and primidone.
Most Common Tremor in Adults
Number (1) Foam Finger on Adult

Essential tremor is the most common cause of tremor in adults, and has a worldwide prevalence of 1% with a prevalence of 5% in adults over age 60.

Positive Family History
Positive-sign Family Portrait

Essential tremor often runs in families, and for this reason is sometimes referred to as "familial tremor". A family history is present in 30 to 70% of patients diagnosed with essential tremor.

Bilateral Upper Extremities
Bi-ladders Upper Extremities

Essential tremor most commonly affects both arms. This is in contrast to the tremor seen in Parkinson's disease, in which onset typically begins unilaterally.

Worse with Physical and Psychological Stress
Stressed-out Guy with Increased Trimmers

Exacerbating factors include physical and psychological stress. Maintaining antigravity postures, consuming caffeine, or experiencing significant psychosocial distress (anxiety, depression) can worsen the tremor.

Better with Rest and Alcohol
Lady without Trimmers Relaxing with Martini

Alleviating factors include rest and small amounts of alcohol consumption. It is common for a patient to say that he/she will have a drink if the tremor is particularly symptomatic.

Beta Blockers
Beta-fish with Blocks

Patients whose symptoms are severe enough to cause difficulty in daily activities may be prescribed beta blockers, which have been shown to relieve symptoms of essential tremor. The most common is propranolol.

Prima Donna

Primidone is a barbiturate that is historically used for seizure disorders but can also be effective in essential tremor.


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