NE & Clinical Evaluation
- NE 必做
- Resting vs. Action (KPI): K = Kinetic, P = Postural, I = Isometric
- Wing beating (Wilson)
- 手腕翹起來，看是否有 Asterixis
- Frequency 分類
- < 4 Hz: Cerebellar (Palatal tremor 1 – 4 Hz)
- 4 – 8 Hz: Pathological (Parkinsonism)
- 8 – 12 Hz: Physiological (Essential 4 -12 Hz)
- >= 13 Hz: Orthostatic
- 病史必問
- Alcohol responsive? Family history
- 老男人必說：FXTAS
- 必說 Wilson disease…
DDx by Tremor Syndrome & Characteristics
- ET (Essential Tremor): Bilateral ULs tremor, Action, Spiral 會有 60° Axis, AD，通常躺下來會緩解
- PD (Parkinson’s Disease): Disappear with action
- Cerebellar: Slow, Proximal limbs (3 Hz)
- Drug induced: Li, Amiodarone, VPA, Beta-agonist, Cyclosporine, Theophylline, Dopamine blocker (Neuroleptics, can induce parkinsonism or tremor)
- Dystonic tremor: Null point presented
- Holmes: Rest + Action tremor, slow, 2 – 3 Hz
- Metabolic: Thyroid function
Phenotypic DDx Subgroups
1. Resting Tremor
- iPD, PSP, MSA, CBD (Asymmetrical)
- Wilson disease
- FXTAS
- SCA-3
- Vascular parkinsonism
- Drug induced parkinsonism
- Normal pressure hydrocephalus
- Toxin: MPTP, Manganese, Cyanide
- Midbrain rubral tremor
2. ET Phenocopies
- SCA12
- FXTAS
- Familial cortical tremor syndrome (FCTME)
3. Postural Tremor
- Physiological tremor
- Exaggerated physiological tremor:
- Stress, Fatigue, Alcohol, Anxiety
- Endocrine, Hypoglycemia, Thyrotoxicosis, Drug
- Essential tremor, Orthostatic tremor
- Peripheral neuropathy (Roussy-Lévy syndrome in CMT cases)
