Postural Tremor

Aka: Postural Tremor

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II. Description: Subtype of Action Tremor

  1. Patient attempts to maintain Posture against gravity
  2. Example: Tremor holding arms out in front of body
  3. Moderate to high frequency: 5-9 Hz
  4. Low amplitude

III. Causes

  1. Physiologic Tremor
  2. Essential Tremor
  3. Alcohol Withdrawal
  4. Drug Withdrawal
  5. Metabolic Causes of Tremor (e.g. Thyrotoxicosis)
  6. Drug Induced Tremor
  7. Psychogenic Tremor
  8. Cerebellar Tremor

IV. Labs

  1. Thyroid Stimulating Hormone (TSH)
  2. Consider Head imaging

V. Management

  1. See Essential Tremor
  2. Beta Blockers (e.g. Propranolol)
  3. Primidone (Mysoline)
  4. Acetazolamide (Diamox)
  5. Clonazepam (Klonopin)
  6. Botulinum Toxin
  7. Gabapentin (Neurontin)
  8. Deep stimulation
  9. Thalamotomy

VI. References

  1. Hopfner (2020) Neurotherapeutics 17(4):1603-21 +PMID: 32915385 [PubMed]

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