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Essential Tremor — SCE Neurology MCQ

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EasyMovement DisordersEssential TremorSCE Neurology

A 45-year-old woman presents with a 3-year history of bilateral resting and action tremor affecting the hands, without bradykinesia, rigidity, or postural instability. Her handwriting is tremulous but not micrographic. The tremor improves with small amounts of alcohol. Family history reveals her mother and grandfather had similar tremor. What is the most likely diagnosis?

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Correct answer: D — Essential tremor

Essential tremor is the most common movement disorder, characterised by bilateral action tremor (postural and kinetic) predominantly affecting the upper limbs, often with a family history (autosomal dominant with variable penetrance). Improvement with alcohol is a characteristic feature. The absence of bradykinesia, rigidity, and rest tremor (though rest tremor can occur in severe ET) distinguishes it from Parkinson's disease. A: PD has asymmetric rest tremor with bradykinesia. C: Dystonic tremor is associated with abnormal posturing. D: Physiological tremor is fine and not impairing. E: No drug history to suggest this.

Reference: NICE NG71; MDS Tremor Classification (2018)