Thread by @hyderabaddoctor

Shaking of hands: Essential tremor (ET) or Parkinson's disease (PD)

1. Shaking of hands (tremors) are common. The usual question among patients (and doctors) is what is the root cause- ET or PD?
Here I would highlight the clinical differences between the two.
#MedTwitter

2. ET affects both hands, whereas PD affects one hand (asymmetric ET- one hand more affected than other & unilateral ET- affecting only one hand can rarely occur).
If tremors remain confined to one hand for >3 years, one should look for structural brain disease (unusual for PD).

3. Tremor in ET is brought on by doing an activity (holding a cup of coffee or writing), whereas people with PD have resting tremors.
Tremors in ET can be better seen with outstretched arms and hands.
Tremors in PD can be better seen by distracting the patient (and observing).

4. ET tremors are suppressed by alcohol intake (I wouldn't recommend this for those who don't drink).
ET tremors are made worse with anxiety or when in presence of strangers or when someone is watching the patient.

5. Over a period of time, the severity of tremors in ET remains same or there is only mild worsening. However, tremors in PD get worse over time.
Additional symptoms such as slowness of movements, postural imbalance, or stiffness of arms, when present, are suggestive of PD.

6. In ET, tremors can involve head & neck, voice and jaw. Leg tremors are rare in ET.
Resting tremors in legs favor a diagnosis of PD.
#neurotwitter #Parkinsons #tremor

7. ET is more of a social problem (embarrassment for the patient), and sometime causes fear whether it is PD or not.
ET is rarely disabling.
On the other hand, PD causes motor disability in most people, especially after 5 years of symptom onset.

8. Tremors of ET as well as PD disappear during sleep.
Positive family history is present in 50% of ET patients, as compared to only 15% in PD patients.

9. Drugs helpful in treating ET tremor: propranolol and primidone.
Drugs helpful in treating PD tremor: Levodopa, dopamine agonists, anticholinergics.
Deep brain stimulation (DBS) works in both.

10. Finally: 6-19% of patients with ET can progress to develop PD after a mean duration of 22 years. Fortunately, ET history in patients with PD is associated with a benign prognosis with slower motor and non-motor progression.
nature.com/articles/s4159…