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Essential Tremor

History Taking

Chief Complaint:

  • Intermittent shaking or tremors in hands and/or arms

  • Difficulty in performing routine tasks requiring fine motor skills

  • Involuntary rhythmic movements

History of Presenting Complaint:

  • Onset, duration, and progression of the tremors

  • Tremor worsens with voluntary movements or when reaching towards an object (action or intention tremor)

  • Tremors may reduce or disappear during rest or sleep

  • Possible presence of 'yes-yes' or 'no-no' head tremors (titubation)

  • Difficulty with writing, eating, drinking or dressing due to tremors

  • Presence of tremors in other body parts such as the legs, head, or voice (if voice is involved, patient might complain of changes in the quality of their voice or speech)

  • No associated symptoms suggestive of Parkinson's disease like bradykinesia, rigidity, or postural instability

System Review:

  • Neurological review should focus on excluding other potential causes of tremors (e.g., hyperthyroidism symptoms, alcohol withdrawal symptoms, use of certain medications)

Past Medical History:

  • Any history of neurological conditions

  • Other systemic illnesses like thyroid disease

  • Previous diagnoses of tremors and their management

Drug History:

  • Use of drugs known to cause tremors (such as amphetamines, corticosteroids, SSRIs, lithium)

  • Regular alcohol use and potential withdrawal symptoms

  • Response to any previously prescribed tremor medications

Family History:

  • Essential tremor is often familial with autosomal dominant inheritance, so positive family history of tremors is relevant

Personal History:

  • Smoking and alcohol consumption, as these can affect the nervous system and alcohol may temporarily relieve symptoms of essential tremor

  • Exposure to toxins or occupational hazards known to affect the nervous system

Social History:

  • Impact of the tremor on their occupation (if the job involves fine motor skills)

  • Impact on their quality of life and activities of daily living

  • Emotional distress, anxiety, or depression related to the condition

Physical Examination




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