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
Investigations
Management