Mike O'Callaghan Military Medical Center, Nellis Family Medicine Residency, Nellis Air Force Base, NV, USA.
Am Fam Physician. 2018 Feb 1;97(3):180-186.
Tremor is an involuntary, rhythmic, oscillatory movement of a body part. It is the most common movement disorder encountered in primary care. The diagnosis of tremor is based on clinical information obtained from the history and physical examination. The most common tremors in patients presenting to primary care physicians are enhanced physiologic tremor, essential tremor, and parkinsonian tremor. All persons have low-amplitude, high-frequency physiologic tremors at rest and during action that are not reported as symptomatic, but can be enhanced by anxiety, medication use, caffeine intake, or fatigue. Features consistent with psychogenic tremor are abrupt onset, spontaneous remission, changing tremor characteristics, and extinction with distraction. Other types of tremor include cerebellar, dystonic, and drug- or metabolic-induced. The first step in evaluating a patient with tremor is to categorize the tremor based on its activation condition, topographic distribution, and frequency. Resting tremors occur in a body part that is relaxed and completely supported against gravity. Action tremors occur with voluntary contraction of a muscle and can be further subdivided into postural, isometric, and kinetic tremors. The most common pathologic tremor is essential tremor, which affects 0.4% to 6% of the population. In one-half of cases, it is transmitted in an autosomal-dominant fashion. More than 70% of patients with Parkinson disease have tremor as the presenting feature. This tremor is typically unilateral, occurs at rest, and becomes less prominent with voluntary movement. If there is diagnostic uncertainty, single-photon emission computed tomography can be used to visualize the integrity of the dopaminergic pathways in the brain, and transcranial ultrasonography may be useful to diagnose Parkinson disease.
震颤是身体某一部位的不自主、有节奏、振荡性运动。它是初级保健中最常见的运动障碍。震颤的诊断基于从病史和体格检查中获得的临床信息。在向初级保健医生就诊的患者中，最常见的震颤是增强生理性震颤、特发性震颤和帕金森震颤。所有人均有低幅度、高频生理性震颤，在休息和活动时不会被报告为症状性震颤，但可因焦虑、药物使用、咖啡因摄入或疲劳而增强。符合心因性震颤特征的是突然发作、自发性缓解、震颤特征改变以及分心时消失。其他类型的震颤包括小脑性震颤、肌张力障碍性震颤和药物或代谢性震颤。评估震颤患者的第一步是根据其激活条件、拓扑分布和频率对震颤进行分类。静止性震颤发生在放松且完全被重力支撑的身体部位。动作性震颤发生在肌肉自愿收缩时，可以进一步细分为姿势性震颤、等长性震颤和动力性震颤。最常见的病理性震颤是特发性震颤，影响 0.4%至 6%的人群。在一半的病例中，它以常染色体显性方式遗传。超过 70%的帕金森病患者以震颤为首发症状。这种震颤通常是单侧的，发生在休息时，随着自愿运动而减少。如果存在诊断不确定性，可以使用单光子发射计算机断层扫描来观察大脑中多巴胺能通路的完整性，经颅超声可能有助于诊断帕金森病。
