CHARACTERISTICS OF PATHOLOGICAL TREMOR Tremor at rest
'Pill-rolling' tremor, decreasing with movement. Rate: 3-7 per second. Amplitude: coarse. Distribution: distal limbs. Usually associated with bradykinesia and rigidity.
PARKINSON'S DISEASE OR DRUG INDUCED PARKINSONISM
Tremor on maintaining posture and throughout range of movement
Tremor absent at rest, when the limb is relaxed, but present on maintaining a fixed posture and during movement. Rate: 6-12 Hz amplitude: fine Slow insidious onset Distribution:
Upper limbs involved, lower limbs rarely. Titubation (tremor of the head on the trunk) often present.
Specific types of postural tremor are recognised
FAMILIAL TREMOR - often Mendelian dominant. ESSENTIAL TREMOR - no family history. SENILE TREMOR - develops in old age.
The tremor may progress until handwriting becomes impossible and feeding difficult. Alcohol may temporarily abort the tremor; beta blockers may produce an improvement.
Tremor absent at rest; present during movement and maximal on approaching target, e.g. finger-nose test. Rate: 4-6 per second. Amplitude: coarse. Distribution: Proximal and distal.
Titubation may occur. Usually associated with other cerebellar signs
CEREBELLAR TREMOR ('intention tremor')
Extremely severe tremor - sufficient to interrupt movement and throw patient off balance.
MIDBRAIN TREMOR due to disease involving the cerebellar/ red nucleus connections, e.g. multiple sclerosis.
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