1. www.wemove.org Essential Tremor Slide Library Version 1.0 - All Contents Copyright © WE MOVE 2001 Essential Tremor: Diagnosis/Differential Diagnosis Part 4 of 7

2. Diagnosis of ET Clinical history/family history Physical examination (including QOL/disability, etc.) Absence of abnormal laboratory findings (normal TFT, serum ceruloplasm, etc.) Current medications Effect of ETOH Archimedes spiral; handwriting test; water test; peg board; CT scan (when warranted) www.wemove.org

3. Methods of Measuring Tremor Physiologic techniques (e.g., accelerometry, EMG, digitizing tablets, or gyroscopic techniques) Subjective clinical measures (e.g., rating scales, spiral drawings, or handwriting) Objective functional performance tests (e.g., water spilled from cup, nine-hole pegboard test, maze tests) Impact of tremor on patients’ lives (e.g., disability, handicap, quality of life, or burden of illness) www.wemove.org

4. Functional Disability Associated with ET May Affect... Handwriting Ability to drink liquids from a cup or glass Precise, fine manipulations of the hands Capability to feed oneself Ability to dress Speech (i.e., dysarthria as in voice tremor) Social interactions leading to embarrassment www.wemove.org

5. Accelerometry for ET Autospectra obtained by accelerometry from a patient with ET (frequency plotted against root- mean-square [rms] acceleration [g x 10- 3 ]) www.wemove.org

6. Clinical Characteristics of ET Lou JS, Jankovic J. Essential tremor: clinical correlates in 350 patients. Neurology. 1991;41(Pt 1):234-238. www.wemove.org

7. Differential Diagnosis Parkinson’s disease (PD) Pallidonigral degeneration Multiple system atrophy (MSA) Olivopontocerebellar atrophy (OPCA) Striatonigral degeneration Progressive pallidal atrophy Huntington’s disease (HD) Benign hereditary chorea www.wemove.org

8. Differential Diagnosis (cont.) Fahr’s disease Paroxysmal dystonic choreoathetosis (PDC) Ataxia-telangiectasia (AT) Familial intention tremor and lipofuscinosis Ramsay-Hunt syndrome (progressive myoclonic ataxia) Dystonia musculorum deformans DOPA-responsive dystonia www.wemove.org

9. Differential Diagnosis (cont.) Cervical dystonia (spasmodic torticollis) Meige syndrome Task-specific tremors (writer’s or voice tremor) Space-occupying lesions of the brain Various metabolic diseases (e.g., hepatic encephalopathy, etc.) Peripheral neuropathies (e.g., Charcot-Marie-Tooth, Guillain-Barré, etc.) www.wemove.org