Essential Tremor

Trembling

Step 1: View clinicals

A 65 year old lady presents with fine tremors of both hands for 2 years. The tremors were postural in nature, more pronounced with stress, and absent at rest. Her handwriting has worsened to the point where she is unable to write legibly anymore. Her medical history is unremarkable and she is not on any medications.


Step 2: Order all relevant investigations

TSH + FT4

TSH: 1.0 mIU/L (0.4 – 4.0) FT4: 15 pmol/L (8 - 27)

Liver Function Tests

Total bilirubin, ALT, AST, ALP, GGT, INR, S. Albumin: all within normal parameters.

Renal Functions

Blood urea: 15 mg/dL (3 - 20) S. Creatinine: 0.6 mg/dL (0.5 - 1.2)

Nerve Conduction Studies

Nerve conduction studies of the upper limbs are completely normal.


Step 3: Select appropriate management

Propranolol
Gamma knife radiosurgery
Levodopa
Lithium


Score: ★★☆