[Diagnosis and treatment of tremor in Parkinson's disease and essential tremor]

Abstract

For patients presenting predominantly or purely with tremor, the correct diagnosis of tremor-dominant Parkinson's disease (PD) versus essential tremor (ET) is very important for prognosis and effective therapy. ET tremor is usually characterized by symmetric bilateral postural and kinetic tremor, which may respond to low alcohol consumption. Many patients have a family history of ET tremors. Medical treatment with primidone or beta-blockers effectively controls ET tremor, but in many cases no treatment is needed at all. The typical tremor form of PD is an asymmetric rest tremor, which is treated with dopaminergic agents such as levodopa. Differential diagnosis of ET and PD may be difficult in a subset of PD patients who present with additional postural and kinetic tremor and in a minority of ET patients who show a clear asymmetry of their postural and kinetic tremor. In some patients with ET, the tremor can later become severe and even require treatment with deep brain stimulation.