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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: RE:TremorsForum: Neurology Forum
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Somehow I'm sure I screwed up the proper way to respond to the ccf neuorolgy Doctors response from my 9-11 posting. Sorry but here goes. We live in rural upstate NY 3.5-6 hours from anywhere. Otherwise I wouldn't impose by continuing this. Prior to our post we had found the Merck manual on line. Section 11. NEUROLOGICAL DISORDERS 128.Disorders of movement: Extrapyramidal and Cerbellar disorders Hyperkinetic movement disorders. TREMOR Etiology. It identifies PHYSIOLOGIC tremor = Enhanced tremor,essential tremor,senile tremor,and resting tremor. Tremor of CEREBELLAR DISEASE:= Intention tremor, SUSTENTION tremor,and tibulation. We don't really quite understand the terminology eg:"rotary tremor of the proximal musculature" I really didn't want to ask for an opinion but I guess I'm going to. Basically, my legs tremble if I stand in the same spot for any amount of time (eg singing a hymm at church) my legs stat to tremble the longer I stand the worse it gets. It does stop when I sit or lay down. My hand will tremble when I go to set down a cup,pause while raising a cup to my mouth, or reaching to put away or retirieve a half gallon of oj from the refrigerator. If I lean and put weight on my arm or elbow It will tremble. The only time I get a tremble without weight is if I'm reaching for something and tense my arm(eg if someone were to pass a plate, or if my arm is extended sideways(as if to shake a hand)and I turn my palms down. I do not get the tremor if I hold my arms at my side or when touching my nose ( part of the reason the two local Docs disagree). The main question, in laymans terms, what is the distintions between the Merck definitions,and which is a "best" fit with my my symptoms? Thanks so much for your time.
Dear Mark: I do not think the Merck Manual classification of tremors is a universally accepted one. The tremor that you have has features of an action tremor that becomes prominent with only some degree of loading or damping. You also describe what has been called an orthostatic tremor (a "standing" tremor). These forms of tremor are commonly seen in patients who have a disorder called "essential tremor". This disorder often runs in families from generation to generation with a variable severity of expression. The term "essential" in the name implies that tremor is an isolated finding, and is not related to an underlying disorder such as cerebellar disease or Parkinson's disease. I hope this helps. You would benefit from seeing a movement disoders expert in an academic institution, as I mentioned earlier. Good luck!
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