Tremor

Rest Tremor

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Rest Tremor

  • Definition
  1. Patient attempts to maintain body position at rest (despite support against gravity)
  • Symptoms
  1. Tremor characteristics
    1. Low to moderate frequency: 3 to 6 Hz
    2. High amplitude
  2. Patient attempts to maintain body position at rest
    1. Tremor occurs despite rest position
    2. Limb is completely supported against gravity
    3. Example: Hand Tremor while resting on lap
  3. Provocative factors (increases Tremor amplitude)
    1. Mental stress
    2. Distraction (e.g. Serial 7s, counting backwards)
    3. Moving another body part (e.g. walking)
  4. Palliative factors (decreases Tremor amplitude)
    1. Goal-directed movement (e.g. Finger-Nose-Finger)
  • Examination
  1. See Parkinson's Disease
  2. Passively flex and extend arms for cogwheel rigidity
  3. Observe for shuffling gait
  • Causes
  1. Parkinson's Disease (most common)
  2. Multiple-Systems atrophy
  3. Progressive Supranuclear palsy
  4. Drug-Induced Tremor
    1. Neuroleptic medications
    2. Metoclopramide (Reglan)
  5. Rubral Tremor
  6. Psychogenic Tremor
  7. Severe Essential Tremor
  • Management
  1. Levodopa-Carbidopa (Sinemet)
  2. Anticholinergics
  3. Other antiparkinson Meds
  4. Deep Brain Stimulation
  5. Pallidotomy
  6. Thalamotomy