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Essential Tremors & Other Tremor Disorders

Essential tremor is a neurological disorder that leads to rhythmic shaking in the hands, legs, voice, trunk or head. Though it is often confused with Parkinson's disease, essential tremor is not tied to any other condition. It is the most common of all neurologic diseases, except stroke. It's even more common than Parkinson's disease.

The Northwestern Medicine Parkinson’s Disease & Movement Disorders Clinic offers a comprehensive, individualized treatment approach for essential tremors and other tremor disorders.

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Other Tremor Disorders

Enhanced Physiologic Tremor (EPT)

EPT is easily visible and is mainly postural. The diagnosis is not made if there is an underlying neurological pathology. Screening for potential metabolic derangements associated with tremor should be performed. The distinction between EPT and mild forms of essential tremor is ambiguous and somewhat arbitrary and is usually based on the presence and extent of functional disability with the latter.

Primary Orthostatic Tremor

Primary Orthostatic Tremor is a unique syndrome, characterized by the presence of high frequency (13-18Hz) tremor of the trunk and legs that occurs only with stance. In other words, patients are asymptomatic when lying or sitting. Symptoms rarely persist with walking. Yet, subjectively, patients report feeling unsteady when standing up. Constant change of position of the feet relieves the symptoms. Patients quickly learn to march in one spot. The clinical exam is benign but for minimally visible and sometimes only palpable fine amplitude rippling of the leg muscles. The diagnosis can be confirmed by the electromyography of the quadriceps muscles, which records a typical 13-18 Hz tremor pattern. Symptoms respond to low-dose clonazepam.

Task- & Position-Specific Tremor

This is a group of tremor syndromes that shares the common feature of tremor activation when engaged in a specific task. The most common type is primary writing tremor, in which symptoms appear only or predominantly with that particular activity. Use of the limb with other activities (eating, weight-lifting, etc.) does not produce tremor. Other examples include task-specific tremors of musicians and athletes, as well as isolated voice tremor. In some of these cases, patients have involuntary muscle contractions of the limb in conjunction with tremor, or focal dystonia with dystonic tremor.


To meet with one of the Northwestern Medicine clinic's movement disorders specialists, call the clinical affiliate practice phone number at 312-695-7950.

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