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Table 1 Key clinical features and pathophysiological basis of tremor in Parkinson’s disease, essential tremor and dystonia

From: Rest tremor revisited: Parkinson’s disease and other disorders

  Parkinsonian tremor Essential tremor Dystonic tremor
Key clinical features
 Topography Hand > others Hands > head > voice > others head > Hands > others
 Activation condition Rest > postural/kinetic Postural > kinetic > rest Postural > kinetic > rest
 Symmetry Asymmetrical Symmetrical Asymmetrical
 Suppression of tremor during movement onset in most cases not found rare
 Frequency 4-6Hz 4-8 Hz 7 Hz
 Amplitude Regular Regular Irregular
 Potential accompanying signs Bradykinesia, rigidity, etc Impaired tandem gait Dystonic posture
Possible pathophysiological basis
 Triggering factor Dopaminergic dysfunction in nigrostriatal system Reduced inhibition in cerebellum and brainstem Reduced inhibitory reflex at multiple levels (spinal, brainstem, and cortical, etc.)
 Activated circuit Cerebello-thalamo-cortical circuit