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Semin Neurol 2023; 43(01): 156-165
DOI: 10.1055/s-0043-1763508
Review Article

Diagnostic Uncertainties in Tremor

Luca Marsili
1   Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
,
Matteo Bologna
2   Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
3   IRCCS Neuromed, Pozzilli, Isernia, Italy
,
Abhimanyu Mahajan 
4   Rush Parkinson's Disease and Movement Disorders Program, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
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Abstract

The approach and diagnosis of patients with tremor may be challenging for clinicians. According to the most recent consensus statement by the Task Force on Tremor of the International Parkinson Movement Disorder Society, the differentiation between action (i.e., kinetic, postural, intention), resting, and other task- and position-specific tremors is crucial to this goal. In addition, patients with tremor must be carefully examined for other relevant features, including the topography of the tremor, since it can involve different body areas and possibly associate with neurological signs of uncertain significance. Following the characterization of major clinical features, it may be useful to define, whenever possible, a particular tremor syndrome and to narrow down the spectrum of possible etiologies. First, it is important to distinguish between physiological and pathological tremor, and, in the latter case, to differentiate between the underlying pathological conditions. A correct approach to tremor is particularly relevant for appropriate referral, counseling, prognosis definition, and therapeutic management of patients. The purpose of this review is to outline the possible diagnostic uncertainties that may be encountered in clinical practice in the approach to patients with tremor. In addition to an emphasis on a clinical approach, this review discusses the important ancillary role of neurophysiology and innovative technologies, neuroimaging, and genetics in the diagnostic process.

Keywords

tremor - diagnosis - consensus - neurophysiology - classification


Publication History

Article published online:
13 March 2023

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