Tremor in adults - NICE guidance - suspected neurological conditions - recognition and referral

Tremor in adults

Summary points from NICE guidance relating to tremor in adults are:

Tremor suggesting Parkinson's disease

• refer adults with suspected parkinsonian tremor, other asymmetric tremor, or tremor associated with stiffness, slowness, balance problems or gait disorders for neurological assessment before treatment

Essential tremor

Suspect essential tremor in an adult with symmetrical postural tremor and no symptoms of parkinsonism.

In adults with suspected essential tremor:

• review regular medication
• check thyroid function
• assess alcohol consumption using a tool such as AUDIT (Alcohol Use Disorders Identification Test) - manage if evidence of alcohol misuse/dependence
  
  

Refer for neurological assessment only if the symptoms are disabling and first-line treatment as specified in the BNF is ineffective or not tolerated.

Consider referring adults with troublesome tremor of the head to a movement disorder clinic

Reference:

• NICE (May 2019). Suspected neurological conditions: recognition and referral