Tremor is a rhythmic involuntary movement normally affecting the limbs. Diagnosis depends on examination of the character of the tremor as well as the presence of other specific features.


- the amplitude (fine or coarse)

- the distribution: head, trunk or limbs (distal or proximal)

- associated features e.g disorder of gait or balance Most tremors disappear during sleep.

Physiological tremor is evident on maintaining a fixed posture, fast in rate (8-12 Hz), fine in character, distal in distribution and non-disabling. It is enhanced by fatigue, anxiety and drugs e.g. caffeine, steroids.

Pathological tremor occurs at rest or with movement, slow in rate, coarse in character, proximal or distal and often asymmetrical in distribution. This tremor is socially and physically disabling.

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