Systematic clinical approach for diagnosing upper limb tremor

Jaron van de Wardt, A. M. Madelein van der Stouwe*, Michiel Dirkx, Jan Willem J. Elting, Bart Post, Marina A. J. Tijssen, Rick C. Helmich

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

17 Citations (Scopus)
62 Downloads (Pure)

Abstract

Tremor is the most common movement disorder worldwide, but diagnosis is challenging. In 2018, the task force on tremor of the International Parkinson and Movement Disorder Society published a consensus statement that proposes a tremor classification along two independent axes: a clinical tremor syndrome and its underlying aetiology. In line with this statement, we here propose a stepwise diagnostic approach that leads to the correct clinical and aetiological classification of upper limb tremor. We also describe the typical clinical signs of each clinical tremor syndrome. A key feature of our algorithm is the distinction between isolated and combined tremor syndromes, in which tremor is accompanied by bradykinesia, cerebellar signs, dystonia, peripheral neuropathy or brainstem signs. This distinction subsequently informs the selection of appropriate diagnostic tests, such as neurophysiology, laboratory testing, structural and dopaminergic imaging and genetic testing. We highlight treatable metabolic causes of tremor, as well as drugs and toxins that can provoke tremor. The stepwise approach facilitates appropriate diagnostic testing and avoids unnecessary investigations. We expect that the approach offered in this article will reduce diagnostic uncertainty and increase the diagnostic yield in patients with tremor.

Original languageEnglish
Pages (from-to)822-830
Number of pages9
JournalJOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
Volume91
Issue number8
DOIs
Publication statusPublished - Aug-2020

Keywords

  • MOVEMENT-DISORDERS
  • CONSENSUS STATEMENT
  • PARKINSONS-DISEASE
  • DYSTONIA
  • PREVALENCE
  • FREQUENCY
  • AMPLITUDE
  • SPECT
  • CLASSIFICATION
  • PHENOMENOLOGY

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