<em>Decision-IQ:</em> Don’t Let Shaking Rattle You: Understanding Tremor in the Clinic

Decision-IQ: Don’t Let Shaking Rattle You: Understanding Tremor in the Clinic

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Developed in collaboration
Med-IQ      Duke Medicine

Online Course | Specialties: Family Medicine, Geriatrics, Neurology, Primary Care, Psychiatry
Released: 2/8/2022
Expires: 2/7/2023
Max Credits: 0.25
Continue to Course Read Abstract

Kathryn P. L. Moore, MD, MSc
Assistant Professor
Department of Neurology
Duke University School of Medicine
Durham, NC
Activity Planners
Genevieve Olucha, PhD
Clinical Content Manager
Baltimore, MD

Kerry Kennedy, ELS
Editorial Manager
Baltimore, MD

Laura Rafferty, ELS
Senior Editorial Manager
Baltimore, MD

Samantha Gordon, MS
Accreditation Manager
Baltimore, MD

Amy Sison
Director of CME
Baltimore, MD
Learning Objective
Upon completion, participants should be able to:

  • Differentiate between common types of tremor and take appropriate steps for evaluation and care

Target Audience
This activity is intended for neurologists, physiatrists, psychiatrists, and primary care providers.
Statement of Need
The accurate diagnosis of tremor disorders is complicated by the overlapping clinical presentation of various types of tremor. This overlap commonly leads to misdiagnosis, which can result in ineffective and/or inappropriate treatment. Clinicians can benefit from education on distinguishing between common types of tremor, including essential, dystonic, enhanced physiologic, drug-induced, functional, and parkinsonian tremor. Additionally, physicians must continually remain up-to-date on standards of care, as treatment guidelines for specific tremor types are updated frequently. For instance, in 2019, the Movement Disorder Society conducted an evidence-based review of treatment for essential tremor and subsequently published treatment recommendations. Similarly, in 2021, the American Academy of Neurology published guidelines for treating motor symptoms in patients with early Parkinson disease. Physicians must be familiar with these guidelines to make appropriate evidence-based treatment decisions within their clinical practices.

Collaboration Statement
This activity was developed by Med-IQ in collaboration with Duke Health.

Accreditation/Designation Statements
Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Med-IQ designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Medium/Method of Participation
This CME/CE activity consists of a 0.25-credit online publication. To receive credit, read the introductory CME/CE material, read the publication, and complete the post-survey, evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly.

Initial Release Date: February 8, 2022
Expiration Date: February 7, 2023
Estimated Time to Complete This Activity: 15 minutes

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Med-IQ requires any person in a position to control the content of an educational activity to disclose all financial relationships with any ineligible company over the past 24 months. The ACCME deems financial relationships as relevant if the educational content an individual can control is related to the business lines or products of the ineligible company. Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and mitigate COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

Drug/Product Usage by Faculty
Off-label/unapproved drug uses or products are mentioned within this activity.

Disclosure Statement
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been mitigated through an established COI mitigation process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation.

Kathryn P. L. Moore, MD, MSc, has indicated no real or apparent conflicts.

The peer reviewers and activity planners have no financial relationships to disclose. 
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Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, Med-IQ has a policy to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.
Med-IQ is not liable for any decision made or action taken in reliance upon the information provided through this activity.
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For questions or comments about this activity, please contact Med-IQ. Call (toll-free) 866 858 7434 or email

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Complimentary CME
This activity is available free of charge to participants.

© 2022 Duke University Health System


Here are the key takeaways from this activity. Deeper insights and evidence, plus an opportunity to receive credit, is available at the "Continue" button below.

  • When making a differential diagnosis for tremor, numerous types of tremor must be considered, such as essential, dystonic, enhanced physiologic, drug-induced, functional, and parkinsonian tremor
  • A complete evaluation should include detailed tremor history, physical examination, medication review, focused neurologic examination (ie, spiral drawing and finger/toe tapping), and imaging as needed (ie, DaT)
  • Functional DaT neuroimaging can be used to distinguish drug-induced parkinsonism from Parkinson disease
  • The Movement Disorder Society Evidence-Based Review of Treatments for Essential Tremor recommends propranolol and primidone for essential tremor, which have numerous Level 1 studies to support their use and can be used together
  • The American Academy of Neurology recommends carbidopa-levodopa as first-line treatment for motor symptoms in early Parkinson disease

View reference list.

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The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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