Benign Essential Tremor

Benign essential tremor is a relatively common condition associated with older age. It is characterised by a fine tremor affecting all the voluntary muscles. It is most notable in the hands but affects many other areas, for example causing a head tremor, jaw tremor and vocal tremor.

 

Features

  • Fine tremor
  • Symmetrical
  • More prominent on voluntary movement
  • Worse when tired, stressed or after caffeine
  • Improved by alcohol
  • Absent during sleep

 

Differential Diagnosis of Tremor

Benign essential tremor is diagnosed clinically based on the presenting features. It is important to look for features to exclude other causes of a tremor.

The key differential diagnoses of a tremor are:

  • Parkinson’s disease
  • Multiple sclerosis
  • Huntington’s Chorea
  • Hyperthyroidism
  • Fever
  • Medications (e.g. antipsychotics)

 

Management

There is no definitive treatment for benign essential tremor. The tremor is not harmful and does not require treatment if not causing functional or psychological problems.

Medications that can be tried to improve symptoms are:

  • Propranolol (a non-selective beta blocker)
  • Primidone (a barbiturate anti-epileptic medication)

 

Last updated April 2019
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