[Trembling hands and more: when to suspect Parkinson's disease].
[Trembling hands and more: when to suspect Parkinson's disease].
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Original abstract
Tremor is the most common movement disorder in clinical neurology and it significantly impacts patients' quality of life. In primary care, particularly among older adults, differentiating between tremor types is essential for early diagnosis and appropriate management, especially when Parkinson's disease is suspected. This review provides a concise overview of tremor classification and diagnostic strategies, with a focus on distinguishing Parkinsonian tremor from other common tremor syndromes such as essential, dystonic, functional, orthostatic, and secondary tremors.Key clinical characteristics, including tremor type (rest, postural, kinetic, re-emergent), frequency, distribution, and associated neurological signs, are discussed in detail. The hallmark of Parkinsonian tremor, an asymmetric resting tremor with a "pill-rolling" quality and possible re-emergence after postural, is highlighted as a critical diagnostic clue, particularly when accompanied by bradykinesia and non-motor prodromal symptoms such as REM sleep behaviour disorder, constipation, or hyposmia.The article outlines a pragmatic diagnostic pathway, including clinical examination, structured anamnesis, medication review, and the use of neuro-imaging or DAT-SPECT when indicated. Therapeutic options are also discussed, ranging from dopaminergic medication to advanced interventions like deep brain stimulation or focused ultrasound for refractory tremor. The review aims to support non-expert clinicians in making accurate early diagnoses and initiating therapy.