![]() ![]() This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. In addition, tremor can be a prominent feature in patients with other movement disorders such as fragile X-associated tremor/ataxia syndrome, and Wilson's disease in which parkinsonian features may be present. ![]() Key points Two subtypes of essential tremor pathology have been identified: a primarily cerebellar variant with Bergmann gliosis and Purkinje cell torpedoes, and a Lewy body variant. The tremor is often not very responsive to levodopa therapy. Clinical diagnosis of tremor disorders and treatment strategies for essential tremor are described in detail. Besides Parkinson's disease, tremor can be an important feature of other parkinsonian disorders, such as atypical parkinsonism and drug-induced parkinsonism. Benign tremulous parkinsonism may be a distinct clinical entity characterized by tremor predominance plus minimal progression of other aspects of parkinsonism. Essential tremor may be associated not only with parkinsonism but other neurological disorders, suggesting the possibility of essential tremor subtypes. Benign tremulous parkinsonism is classically considered a disease of the elderly, characterized clinically by dominance of tremor over other motor features (often for many years) and exhibiting slower clinical and neuropathological disease progression 1. When associated with Parkinson's disease, tremor may be present at rest or as an action tremor overlapping in phenomenology with essential tremor. Tremor, the most common movement disorder, may occur in isolation or may co-exist with a variety of other neurologic and movement disorders including parkinsonism, dystonia, and ataxia. Sometimes called benign essential tremor, essential tremor often causes social embarrassment, and up to 25 of those affected retire early or modify their career path. ![]()
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