Essential Tremor

Question 1

An essential tremor is a movement disorder involving a tremor (unwanted and uncontrolled shaking). Are essential tremors typically unilateral or bilateral?

Answer 1

• bilaterally
• essentially it is symmetrical throughout the body

Question 2

An essential tremor is a movement disorder involving a tremor (unwanted and uncontrolled shaking). All of the following can be affected, but which is most common?

1 - hands
2 - legs
3 - head
4 - voice
5 - torso

Answer 2

1 - hands

Question 3

Are essential tremors more prominent at rest or during voluntary movement?

Answer 3

• voluntary movement
• a tremor at rest is called a resting tremor

Question 4

In an essential tremor, which occurs when patients perform voluntary movements, does the tremor get worse at the start of the movement or when they are trying to complete movements?

Answer 4

• complete movements

Question 5

The exact cause of an essential tremor is unknown, but which of the following have been linked with causing essential tremors?

1 - family history
2 - ageing
3 - lifestyle (lack of sleep caffeine)
4 - all of the above

Answer 5

4 - all of the above

• typically there is thought to be alterations in the cerebello-thalamo-cortical circuit

Question 6

Does the risk of developing an essential tremor increase or decrease with age?

Answer 6

• increases with age
• equally affects men and women

Question 7

What is the estimated prevalence of an essential tremor?

1 - 0.3 – 0.9% general population
2 - 3 – 9% general population
3 - 30 – 90% general population
4 - none of the above

Answer 7

4 - none of the above

Question 8

In patients with an essential tremor, they can typically present with symptoms in the following:

• hands, legs, head, torso and voice

If patients develop other symptoms such as muscle stiffness and memory issues, is this still classed as an essential tremor?

Answer 8

• no
• if other symptoms are present then it is unlikely to be an essential tremor

Question 9

To be diagnosed with an essential tremor, how long do patients need to have had the symptoms for?

1 - >12 weeks
2 - >1 year
3 - >3 years
4 - >6 years

Answer 9

3 - >3 years

Question 10

Which of the following can improve an essential tremor?

1 - alcohol
2 - caffeine
3 - lack of sleep
4 - medications

Answer 10

1 - alcohol
- 50-75% improve with alcohol
- acts as a suppressant so reduces tremor

Question 11

All of the following can make essential tremors worse, EXCEPT which one?

1 - alcohol
2 - caffeine
3 - lack of sleep
4 - medications

Answer 11

1 - alcohol

Question 12

Do essential tremors and Parkinsons disease always occur in isolation?

Answer 12

• no
• can occur together

Question 13

In addition to an essential tremor, there is essential tremor plus. What is the distinguishing feature between essential tremor vs. essential tremor plus?

1 - duration of tremor
2 - age at onset of tremor
3 - additional neurological symptoms of uncertain significance
4 - all of the above

Answer 13

3 - additional neurological symptoms of uncertain significance

Question 14

Differentiating between essential tremor (ET) and Parkinsonism can be difficult. Does ES or Parkinsonism present with unilateral symptoms?

Answer 14

• Parkinsonism

Question 15

Is hypophonia (soft speech) present in essential tremor or Parkinsonism?

Answer 15

• Parkinsonism
• caused by a poor coordination in the vocal musculature

Question 16

Is a lack of facial expression and a reduced blink rate present in essential tremor or Parkinsonism?

Answer 16

• Parkinsonism

Question 17

Is a vocal tremor present in essential tremor or Parkinsonism?

Answer 17

essential tremor

Question 18

Is a resting tremor present in essential tremor or Parkinsonism?

Answer 18

• Parkinsonism
• may also present with Cogwheel rigidity, reduced arm swing on walking and en bloc turning

Question 19

In a patient with an essential tremor, we would need to perform imaging to help diagnose the patient and try to rule out Parkinsons disease. What imaging should be used to distinguish between Parkinsons disease and an essential tremor?

1 - DAT-SPECT
2 - F-FDG PET/CT
3 - standard MRI
4 - standard CT

Answer 19

1 - DAT-SPECT
- I123-ioflupane

Question 20

Which of the following is NOT a differential for an essential tremor?

1 - Parkinson’s disease
2 - Alzheimer’s
3 - Multiple sclerosis
4 - Huntington’s Chorea
5 - Hyperthyroidism
6 - Fever

Answer 20

2 - Alzheimer’s

Question 21

When treating a patient with an essential tremor, all of the following should be used in conservative management, EXCEPT which one?

1 - reassure the patient
2 - removal of medications
3 - reduction in caffeine
4 - weighted cups / instruments / bracelets
5 - increased alcohol intake

Answer 21

5 - increased alcohol intake
- although it can reduce the tremor, it would not be recommended

Question 22

Which of the following is NOT a medication used to treat patients with an essential tremor?

1 - Propranolol
2 - Primidone
3 - Topiramate
4 - Haloperidol
5 - Botulinum therapy

Answer 22

4 - Haloperidol
- typical anti-psychotic, which would most probably make the patients symptoms worse

Question 23

Which 2 of the following are used to treat patients with an essential tremor?

1 - Deep brain stimulation
2 - Transcranial MRI-guided focused ultrasound thalamotomy
3 - cerebral surgery
4 - lobectomy

Answer 23

1 - Deep brain stimulation
2 - Transcranial MRI-guided focused ultrasound thalamotomy