Systematic clinical approach for diagnosing upper limb tremor
Publication year
2020Source
Journal of Neurology, Neurosurgery, and Psychiatry, 91, 8, (2020), pp. 822-830ISSN
Publication type
Article / Letter to editor

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Organization
Neurology
PI Group Systems Neurology
Journal title
Journal of Neurology, Neurosurgery, and Psychiatry
Volume
vol. 91
Issue
iss. 8
Page start
p. 822
Page end
p. 830
Subject
240 Systems Neurology; Radboudumc 3: Disorders of movement DCMN: Donders Center for Medical NeuroscienceAbstract
Tremor is the most common movement disorder worldwide, but diagnosis is challenging. In 2018, the task force on tremor of the International Parkinson and Movement Disorder Society published a consensus statement that proposes a tremor classification along two independent axes: a clinical tremor syndrome and its underlying aetiology. In line with this statement, we here propose a stepwise diagnostic approach that leads to the correct clinical and aetiological classification of upper limb tremor. We also describe the typical clinical signs of each clinical tremor syndrome. A key feature of our algorithm is the distinction between isolated and combined tremor syndromes, in which tremor is accompanied by bradykinesia, cerebellar signs, dystonia, peripheral neuropathy or brainstem signs. This distinction subsequently informs the selection of appropriate diagnostic tests, such as neurophysiology, laboratory testing, structural and dopaminergic imaging and genetic testing. We highlight treatable metabolic causes of tremor, as well as drugs and toxins that can provoke tremor. The stepwise approach facilitates appropriate diagnostic testing and avoids unnecessary investigations. We expect that the approach offered in this article will reduce diagnostic uncertainty and increase the diagnostic yield in patients with tremor.
This item appears in the following Collection(s)
- Academic publications [227613]
- Donders Centre for Cognitive Neuroimaging [3564]
- Electronic publications [107273]
- Faculty of Medical Sciences [86193]
- Open Access publications [76399]
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