Louis Elan D
Continuum (Minneap Minn). 2016 Aug;22(4 Movement Disorders):1143-58. doi: 10.1212/CON.0000000000000346.
Tremor, which is a rhythmic oscillation of a body part, is among the most common involuntary movements. Rhythmic oscillations may manifest in a variety of ways; as a result, a rich clinical phenomenology surrounds tremor. For this reason, diagnosing tremor disorders can be particularly challenging. The aim of this article is to provide the reader with a straightforward approach to the diagnosis and management of patients with tremor.
Scientific understanding of the pathophysiologic basis of tremor disorders has grown considerably in recent years with the use of a broad range of neuroimaging approaches and rigorous, controlled postmortem studies. The basal ganglia and cerebellum are structures that seem to play a prominent role.
The diagnosis of tremor disorders is challenging. The approach to tremor involves a history and a neurologic examination that is focused on the nuances of tremor phenomenology, of which there are many. The evaluation should begin with a tremor history and a focused neurologic examination. The examination should attend to the many subtleties of tremor phenomenology. Among other things, the history and examination are used to establish whether the main type of tremor is an action tremor (ie, postural, kinetic, or intention tremor) or a resting tremor. The clinician should then formulate two sets of differential diagnoses: disorders in which action tremor is the predominant tremor versus those in which resting tremor is the main tremor. Among the most common of the former type are essential tremor, enhanced physiologic tremor, drug-induced tremor, dystonic tremor, orthostatic tremor, and cerebellar tremor. Parkinson disease is the most common form of resting tremor, along with drug-induced resting tremor. This article details the clinical features of each of these as well as other tremor disorders.
震颤是身体部位的节律性摆动，是最常见的不自主运动之一。节律性摆动可通过多种方式表现出来；因此，围绕震颤存在丰富的临床现象学。正因如此，诊断震颤障碍可能极具挑战性。本文旨在为读者提供一种诊断和管理震颤患者的直接方法。
近年来，随着广泛使用各种神经影像学方法以及严谨、对照的尸检研究，对震颤障碍病理生理基础的科学认识有了显著增长。基底神经节和小脑似乎起着突出作用。
震颤障碍的诊断具有挑战性。震颤的诊断方法包括病史采集和专注于震颤现象学细微差别的神经系统检查，其中细微差别众多。评估应从震颤病史和专注的神经系统检查开始。检查应关注震颤现象学的诸多微妙之处。除其他外，病史和检查用于确定震颤的主要类型是动作性震颤（即姿势性、运动性或意向性震颤）还是静止性震颤。然后临床医生应制定两组鉴别诊断：以动作性震颤为主的疾病与以静止性震颤为主的疾病。在前一种类型中最常见的是特发性震颤、生理性震颤增强、药物性震颤、肌张力障碍性震颤、直立性震颤和小脑性震颤。帕金森病是静止性震颤最常见的形式，还有药物性静止性震颤。本文详细介绍了上述每种震颤以及其他震颤障碍的临床特征。
