{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:00:19Z","timestamp":1791234019783,"version":"4.1.0"},"reference-count":76,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2020,5,26]],"date-time":"2020-05-26T00:00:00Z","timestamp":1590451200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Junior Scientific Masterclass Groningen","award":["Mandema Stipendium 2018"],"award-info":[{"award-number":["Mandema Stipendium 2018"]}]},{"name":"Dutch Brain Foundation","award":["F2013[1]-15"],"award-info":[{"award-number":["F2013[1]-15"]}]},{"name":"Dutch Organization for Scientific Research","award":["VENI grant, #91617077"],"award-info":[{"award-number":["VENI grant, #91617077"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"accepted":{"date-parts":[[2020,3,22]]},"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:p>Tremor is the most common movement disorder worldwide, but diagnosis is challenging. In 2018, the task force on tremor of the International Parkinson and Movement Disorder Society published a consensus statement that proposes a tremor classification along two independent axes: a clinical tremor syndrome and its underlying aetiology. In line with this statement, we here propose a stepwise diagnostic approach that leads to the correct clinical and aetiological classification of upper limb tremor. We also describe the typical clinical signs of each clinical tremor syndrome. A key feature of our algorithm is the distinction between isolated and combined tremor syndromes, in which tremor is accompanied by bradykinesia, cerebellar signs, dystonia, peripheral neuropathy or brainstem signs. This distinction subsequently informs the selection of appropriate diagnostic tests, such as neurophysiology, laboratory testing, structural and dopaminergic imaging and genetic testing. We highlight treatable metabolic causes of tremor, as well as drugs and toxins that can provoke tremor. The stepwise approach facilitates appropriate diagnostic testing and avoids unnecessary investigations. We expect that the approach offered in this article will reduce diagnostic uncertainty and increase the diagnostic yield in patients with tremor.<\/jats:p>","DOI":"10.1136\/jnnp-2019-322676","type":"journal-article","created":{"date-parts":[[2020,5,26]],"date-time":"2020-05-26T21:16:48Z","timestamp":1590527808000},"page":"822-830","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":72,"title":["Systematic clinical approach for diagnosing upper limb tremor"],"prefix":"10.1136","volume":"91","author":[{"given":"Jaron van de","family":"Wardt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9497-2019","authenticated-orcid":false,"given":"A M Madelein","family":"van der Stouwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiel","family":"Dirkx","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Willem J","family":"Elting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"Post","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5783-571X","authenticated-orcid":false,"given":"Marina AJ","family":"Tijssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4035-6573","authenticated-orcid":false,"given":"Rick C","family":"Helmich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,5,26]]},"reference":[{"key":"2024120318500639000_91.8.822.1","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1002\/mds.22838","article-title":"How common is the most common adult movement disorder? update on the worldwide prevalence of essential tremor","volume":"25","author":"Louis","year":"2010","journal-title":"Mov Disord"},{"key":"2024120318500639000_91.8.822.2","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1002\/mds.27121","article-title":"Consensus statement on the classification of tremors. from the task force on tremor of the International Parkinson and movement disorder Society","volume":"33","author":"Bhatia","year":"2018","journal-title":"Mov Disord"},{"key":"2024120318500639000_91.8.822.3","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1097\/WCO.0000000000000582","article-title":"The patchy tremor landscape: recent advances in pathophysiology","volume":"31","author":"Nieuwhof","year":"2018","journal-title":"Curr Opin Neurol"},{"key":"2024120318500639000_91.8.822.4","first-page":"2","article-title":"Consensus statement of the movement disorder Society on tremor. 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