An update on tremors
This review describes the most recent advances in epidemiology, classification, genetics, pathology and treatment of essential tremor. In addition, recent advances in more rare forms of tremor are summarized. Clinical, biochemical, pathological and imaging studies suggest an abnormal functioning of the cerebellum in essential tremor. Minor changes of cognition and personality may be due to secondary effects. Dementia and possible shortened life span seem to be limited to late-onset essential tremor. Many of these issues are not yet finally settled and need confirmation in further studies. The current essential tremor classification seems not to reflect the variety of phenotypic expressions. Regarding treatment, there is now a level B evidence for topiramate. Levetiracetam may induce a positive response in Holmes tremor, but is ineffective in orthostatic tremor. These findings have extended our knowledge about essential tremor. It appears that a new, more distinct classification system is required. Recent treatments have remained unchanged.