Foot tremor and essential tremor

I have had undiagnosed essential tremor for about twenty years unilaterally in my hand, and six years bilaterally in both hands. I have also had diagnosed TN.  Recently I had a major change in symptoms, with tremor (postoral, intention, and resting) in chin, neck arms, and foot, as well as jerky movements, such as trying to move a computer mouse and my hand jerks in that direction by about six inches too far.  Or, my leg will jump for no reason. TN has returned after three year absence I also began having some mild cognitive impairments (dyslexic symptoms and stammering) which were not present before. A neurologist seen recently felt that all of the symptoms were an exascerbation of the essential tremor, due to a great deal of stress I am under currently.  He tested my reflexes and checked my balance.  He prescribed medication, which does seem to be lessening symptoms, though they are still present. My reseach suggests that the leg tremors and the cognitive changes are rare possibilities with ET. Would you suggest a second opinion and/or MRI? Do the symptoms sound suspicous of MS or PD?

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
   It is hard to attribute all of the symptoms that you describe to an essential tremor(ET).  It is true that ET will get worse with stress and sleep deprivation.  The jerky hand movements and the leg jerks sound more like myoclonus to me, but I am unable to examine you.  Myoclonus can be found in many disorders, but the most common cause would be due to a metabolic derrangement.  Cognitive changes such as worsening dyslexia and stammering can also be brought out by stress, anxiety and/or depression.  A dementia is rarely present when the patient is aware of the symptoms.  Dementia usually presents with losing things, forgeting people, places, familiar objects and is reported by a family member (the patient generally reports they are fine). I would suggest a metabolic workup (CBC, CMP, Magnesium, Phosphorus, urine tox screen) and Neuroimaging (MRI of the brain with GAD contrast) to evaluate for any structural cuase of cognitive change.  I do not think that the symptoms you describe sound like parkinsons or mulitple sclerosis.  Medications such a propanolol or mysoline will likely be useful.  
I hope this has been helpful.

[Tootoo]

I also wanted to add that I am age 44.  The medication I have been given is Topamax.  My legs are very shaky when I stand, although walking does not really seem to be a problem.