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Essential Tremor Workup
Updated: Oct 22, 2018
Author: Deborah A Burke, MD; Chief Editor: Selim R Benbadis, MD  more...

WORKUP

Approach Considerations
No biologic markers exist for essential tremor. If the family history and examination findings are
indicative of essential tremor, no laboratory or imaging studies are required. However, if the family
history and examination findings are not indicative of essential tremor, laboratory and imaging
studies should be considered.
[41, 42]

Laboratory investigations include the following:

Standard electrolyte panel

Thyroid function tests

Blood urea nitrogen (BUN)

Creatinine

Liver function tests

Serum ceruloplasmin (for Wilson disease)

Procedures
Electromyography or accelerometry can be used to assess tremor frequency, rhythmicity, and
amplitude but is not part of the routine evaluation.

Imaging Studies
Findings on computed tomography (CT) scanning and magnetic resonance imaging (MRI) of the
head are normal in essential tremor. MRI helps to exclude structural and inflammatory lesions
(including multiple sclerosis) and Wilson disease. MRI should be performed if the tremor has acute
onset or stepwise progression.

Although the classic resting tremor of Parkinson disease is different in many aspects from that of
essential tremor, it is often difficult to distinguish variants. Single-photon emission CT (SPECT)
scanning using ioflupain 123 I (DaTSCAN) is now a US Food and Drug Administration (FDA)–
approved procedure that can support a diagnosis of parkinsonism, hence decreasing the
misdiagnosis of essential tremor as Parkinson disease.
[1, 2, 3]

Midbrain ultrasonography has been suggested as a tool to differentiate essential tremor from
Parkinson disease as a result of a study finding that high substantia nigra hyperechogenicity has a
high positive predictive value for Parkinson disease. However, another study found a significant
increase in substantia nigra hyperechogenicity in patients with essential tremor compared with
controls.
[43, 44, 45, 46]

Other Tests
In 2017, researchers presented a new neuropsychological measure that can discriminate
Parkinson's disease tremor and essential tremor with high diagnostic accuracy. The tremor stability
index, derived from kinematic measurements of tremulous activity, was tested in a cohort
comprising 16 rest tremor recordings in tremor-dominant Parkinson's disease and 20 postural
tremor recordings in essential tremor, and validated on a second, independent cohort comprising a
further 55 tremulous Parkinson's disease and essential tremor recordings. The index's maximum
sensitivity, specificity and accuracy were 95%, 95% and 92%, respectively.
[47]

Treatment & Management

 
 

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