Postural Tremor

The patient in this video has no hand tremor during rest. However, when the patient is asked to maintain her arms in an outstretched position, a right hand tremor can be seen (postural tremor). The patient also had an action tremor (not shown in this video) and was subsequently diagnosed to have essential tremor – the most common of all movement disorders. The cause is currently unknown, however a positive family history is often noted and genetic linkage has been established in several chromosomal regions. Essential tremor is a postural and action tremor and tends to affect the hands, head and voice. If the head is affected, the movement can be anterior-posterior (affirmative, yes-yes tremor) or lateral (negative, no-no tremor). Patients with mild non-disabling symptoms do not require treatment. Those with moderate-severe, disabling symptoms can be treated medically and beta-blockers (e.g. propranolol) are used as first line medications. Use of deep-brain stimulation and high intensity focused ultrasound are emerging therapies that are used in specialized centres for severe cases of essential tremor that are not responsive to medications.