Essential tremor diagnosis

Diagnosing essential tremor can be challenging, but an accurate diagnosis that rules out other conditions is critical for the most effective essential tremor treatment.

Neurologists at Penn Medicine’s Movement Disorders Center are experts in the signs and symptoms of essential tremor and related conditions. They use clinical expertise and advanced diagnostic tests to make a diagnosis that guides your care.

How is essential tremor diagnosed?

Essential tremor is diagnosed by a neurologist. During an evaluation, your doctor will talk to you about your symptoms and perform a neurological examination. In rare cases, your doctor may order imaging and blood tests to rule out other causes of tremor.

According to the most recent diagnostic criteria, essential tremor must:

• Occur during active movement
• Affect both upper extremities
• Be present for at least three years
• Occur in the absence of other neurological signs or symptoms

People with essential tremor-plus syndrome may present with additional, very mild neurological signs or symptoms, such as mild balance problems, memory loss, or posturing of arms or legs (involuntary flexion or extension of limbs).

Essential tremor versus Parkinson’s disease

Because essential tremor and Parkinson’s disease both cause tremor, diagnosis can be challenging. There is also some evidence suggesting that people with essential tremor may have an increased risk of developing Parkinson’s, but this link is not fully understood. An accurate diagnosis depends on understanding the many differences in these conditions, including:

• Action tremor vs. resting tremor: Essential tremor occurs during active movement, while Parkinson’s tremor occurs when the limb is at rest.
• Body parts affected by tremor: Essential tremor often causes head or voice tremor, which are not typically seen in Parkinson’s. Parkinson’s can cause resting tremor of one or both legs, which is not seen in essential tremor.
• Neurological symptoms and signs: Parkinson’s disease causes bradykinesia (small and slow movements) and rigidity (stiffness), both of which affect ability to perform daily activities. Parkinson’s also causes changes in cognition, sleep, mood, smell, blood pressure, bowel function, and bladder function. Essential tremor should not cause any of these symptoms or signs, but it can cause mild impairment of coordination and balance.
• Bilateral vs. unilateral symptoms: Essential tremor usually occurs on both sides of the body. Parkinson’s symptoms typically begin on one side of the body.
• Age of onset: Essential tremor most often starts in middle age, but can affect people of all ages, including children. The average age of Parkinson’s symptom onset is 60, and only a small percentage of people show symptoms before age 40.
• Genetic link: More than half of people with essential tremor have a family history of the condition. Inherited Parkinson’s accounts for a much lower number of cases.

Essential tremor and other tremor disorders are often misdiagnosed. Penn Medicine’s comprehensive assessment by a team of providers with decades of experience can provide a precise diagnosis quickly.

People seek us out for essential tremor diagnosis for our:

• Depth of experience: Our team sees hundreds of people with essential tremor each year. We know the signs of essential tremor and how they compare to signs of other conditions, including Parkinson’s disease and dystonia. We detect the subtle differences between these neurological conditions to make an accurate diagnosis.
• Collaborative care: Our model of care is built on collaboration. Movement disorders specialists meet regularly to discuss each case. They use their collective experience and wisdom to make an accurate diagnosis that leads to the most effective essential tremor treatment plan.
• Research-backed care: As part of an academic medical center, our doctors are also researchers. Their work seeks to learn more about what causes essential tremor and other movement disorders to improve diagnosis and treatment.