Tremors history checklist

 

Tremor Evaluation Checklist for Clinicians

1. Initial History Taking

Onset and Progression

Document: Sudden vs gradual, age at onset, progression pattern

Family History

Particularly essential tremor, parkinsonism, neurological conditions

Medication Review

Include: Beta-agonists, psychiatric meds, anticonvulsants, caffeine intake

2. Characterize the Tremor

Rest Tremor Assessment

Observe with hands relaxed in lap, check for pill-rolling quality

Postural Tremor Assessment

Arms outstretched, wings position, observe for re-emergent tremor

Action/Kinetic Tremor

Finger-nose-finger test, drinking from cup, writing sample

3. Associated Features

Parkinsonian Features

Check: Bradykinesia, rigidity, postural instability

Cerebellar Signs

Assess: Gait ataxia, dysmetria, nystagmus

Systemic Features

Check: Thyroid status, liver disease signs, peripheral neuropathy

4. Red Flags Assessment

Acute/Subacute Onset

May indicate stroke, inflammatory, or drug-induced cause

Young Age of Onset (<40 class="notes" div="" years="">Consider Wilson's disease, MS, genetic conditions

Isolated Unilateral Tremor

Consider structural lesions

5. Initial Workup

Basic Laboratory Tests

TSH, electrolytes, liver function, B12 level

Wilson's Disease Screen (if age <40 class="notes" div="">Ceruloplasmin, 24-hour urine copper, eye exam

Imaging (if indicated)

Based on red flags and neurological findings

6. Functional Impact Assessment

Activities of Daily Living

Eating, drinking, writing, personal hygiene

Occupational Impact

Work performance, specific task difficulties

Social Impact

Social interactions, emotional impact, quality of life