Pediatric Movement Disorders - Tremor

Workup

The workup of tremor depends upon the specific type of tremor and its possible cause. Any medications that may worsen tremor should be avoided, if possible. If the tremor had sudden onset, an MRI of the head may be able to show a stroke, multiple sclerosis, or other lesion. Electroencephalogram (EEG), which measures electrical activity in the brain, is important if there is a suspicion that the tremor is due to focal seizures. If there has been gradual onset, it is important to check electrolytes, including glucose, calcium and magnesium, thyroid function, copper in the urine (for Wilson's disease), and possibly the amount of adrenaline metabolites (for pheochromocytoma). If parkinsonian features are present, a trial of L-DOPA may be helpful. Rarely, an EMG may help to determine if the tremor is more likely to be due to dystonia or myoclonus. Tests for myoclonus, including EEG with back-averaging and SEP (somatosensory evoked potentials), may help to confirm the presence of dystonia or myoclonus. If there is a family history of tremor, it may be helpful to try the use of alcohol. This is often tried with an adult family member, rather than the child. If the tremor improves with alcohol, this suggests that it will also improve with other medications such as primidone.