• van de Wardt Jaron J Department of Neurology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands., van der Stouwe A M Madelein AMM 0000-0001-9497-2019 Department of Neurology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands a., Michiel Dirkx, Elting Jan Willem J JWJ Department of Neurology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands. , Bart Post, Marina Aj Tijssen, and Rick C Helmich.
• Department of Neurology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.
• J. Neurol. Neurosurg. Psychiatr. 2020 Aug 1; 91 (8): 822-830.

AbstractTremor is the most common movement disorder worldwide, but diagnosis is challenging. In 2018, the task force on tremor of the International Parkinson and Movement Disorder Society published a consensus statement that proposes a tremor classification along two independent axes: a clinical tremor syndrome and its underlying aetiology. In line with this statement, we here propose a stepwise diagnostic approach that leads to the correct clinical and aetiological classification of upper limb tremor. We also describe the typical clinical signs of each clinical tremor syndrome. A key feature of our algorithm is the distinction between isolated and combined tremor syndromes, in which tremor is accompanied by bradykinesia, cerebellar signs, dystonia, peripheral neuropathy or brainstem signs. This distinction subsequently informs the selection of appropriate diagnostic tests, such as neurophysiology, laboratory testing, structural and dopaminergic imaging and genetic testing. We highlight treatable metabolic causes of tremor, as well as drugs and toxins that can provoke tremor. The stepwise approach facilitates appropriate diagnostic testing and avoids unnecessary investigations. We expect that the approach offered in this article will reduce diagnostic uncertainty and increase the diagnostic yield in patients with tremor.© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

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