Differential Diagnosis

The impacts of misdiagnosis or late diagnosis can be far-reaching. For example, misdiagnosis may lead to inappropriate treatment. If tremor is improperly assigned to old age or anxiety, the opportunity for early effective treatment may be lost. Tremors—as opposed to essential tremor—may also be associated with the use of certain medications or may be the result of different conditions, such as Parkinson's disease, myoclonus, or Wilson's disease. Other diseases associated with tremor include...

• Pallidonigral degeneration
• Multiple system atrophy
• Olivopontocerebellar atrophy
• Striatonigral degeneration
• Progressive pallidal atrophy
• Huntington's disease
• Benign hereditary chorea
• Fahr's disease
• Paroxysmal dystonic choreoathetosis
• Familial intention tremor and lipofuscinosis
• Ramsay-Hunt syndrome (progressive myoclonic ataxia)
• Ataxia telangiectasia
• Dystonia musculorum deformans
• DOPA-responsive dystonia
• Spasmodic torticollis
• Meige syndrome
• Task-specific tremor (writer's or voice tremor)
• Space occupying lesions of the brain
• Various metabolic disease (e.g., hepatic encephalopathy, etc.)
• Peripheral neuropathies (e.g., Charcot-Marie-Tooth, Guillain-Barré, etc.)

Proper diagnosis is crucial as these conditions may also require medical attention. Some people with ET also have associated dystonia including cervical dystonia, writer's cramp, spasmodic dysphonia, and cranial dystonia. Occasionally, patients report associated parkinsonism. The late diagnosis of ET delay treatment and increases the likelihood of functional disability and related psychosocial problems.

Essential tremor may be incorrectly assigned to other conditions or, in severe cases, be mistaken for Parkinson's disease, despite the many differences between the two diseases. For example, PD is characterized by hypokinetic features and rigidity. Other conditions that may be mistaken for ET include asterixis, epilepsia partialis continua, clonus, and rhythmic myoclonus.

	Diagnosis