The Clinical Evaluation of Parkinson’s Tremor

Heidemarie Zach, Michiel Dirkx, Bas Bloem, Rick C. Helmich

Dear colleagues,

Tremor in Parkinson's disease can come in many different forms, and it has a highly variable appearance. This stimulated us to summarize a few crucial points as well as helpful tips and tricks for a good tremor evaluation. Given the variation of tremors occurring in Parkinson´s disease, the clinician sometimes has to be creative and use special techniques to bring up the true tremor severity. Our article just scratched the surface of the huge variety of tremor evaluation techniques. Many clinicians might have their individual, “special” approaches and tricks. We would like to invite you to share your opinions, suggestions and personal experiences, for example with regard to the following issues.

1. Resting tremor occurs per definition in a state of pure rest. But how do you achieve a fully relaxed state?

2. Postural tremor is common in Parkinson's disease, but is has different possible etiologies. Is there an optimal posture to examine postural tremor? Do you differentiate between different postural tremors (re-emergent, dystonic, "pure" postural tremor)? Do you treat these postural tremors differently in clinical practice?

3. Tremor amplitude is highly variable. Which tasks do you use to for provocation?

4. Motor and cognitive co-activation can lead to dystonic posturing, mirror movements, and motor restlessness, which may impact tremor amplitude. How do you overcome these problems?

We look forward to receive your comments, questions and suggestions.

Heidemarie Zach, Michiel Dirkx, Bas Bloem and Rick Helmich

Read the full article published in the Journal of Parkinson’s Disease here:

The Clinical Evaluation of Parkinson’s Tremor, by Heidemarie Zach, Michiel Dirkx, Bas Bloem and Rick C. Helmich, J Parkinsons Dis, 5:3, 471-474, 2015, DOI 10.3233/JPD-150650