The central clinical feature of essential tremor is kinetic tremor. This is generally observed during numerous activities of daily living, ranging from eating to writing, and may be elicited on neurologic examination during a variety of manoeuvres (eg, finger-nose-finger maneuver, spiral drawing, pouring water between two cups)

The tremor is usually slightly asymmetric, markedly so in 5% of patients.

Half of patients with ET have intention tremor.

Postural tremor is often present

The postural tremor of essential tremor is generally of greatest amplitude at the wrist joint and generally involves wrist flexion-extension rather than rotation-supination; rest tremor is a late feature, and is not seen in the leg

Over time, patients develop cranial tremors involving the neck (most common), voice, or jaw, especially in women. Jaw tremor present with mouse open; mouth closed more typical of PD

Table distinguishing PD from ET


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