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Unusual tremor syndromes: know in order to recognise
  1. Robert J Ure1,
  2. Sanveer Dhanju2,
  3. Anthony E Lang3,
  4. Alfonso Fasano3
  1. 1Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, South Yorkshire, UK
  2. 2Faculty of Science, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
  3. 3Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Alfonso Fasano, Division of Neurology, University of Toronto, Movement Disorders Centre—Toronto Western Hospital, 399 Bathurst St, 7 Mc412, Toronto, Ontario, Canada M5T 2S8; alfonso.fasano{at}


Tremor is a common neurological condition in clinical practice; yet, few syndromes are widely recognised and discussed in the literature. As a result, there is an overdiagnosis of well-known causes, such as essential tremor. Many important unusual syndromes should be considered in the differential diagnosis of patients with tremor. The objective of this review is to provide broad clinical information to aid in the recognition and treatment of various unusual tremor syndromes in the adult and paediatric populations. The review comprised of a comprehensive online search using PubMed, Ovid database and Google Scholar to identify the available literature for each unusual tremor syndrome. The review includes fragile X-associated tremor/ataxia syndrome, spinocerebellar ataxia type 12, tremors caused by autosomal recessive cerebellar ataxias, myorhythmia, isolated tongue tremor, Wilson's disease, slow orthostatic tremor, peripheral trauma-induced tremor, tardive tremor and rabbit syndrome, paroxysmal tremors (hereditary chin tremor, bilateral high-frequency synchronous discharges, head tremor, limb-shaking transient ischaemic attack), bobble-head doll syndrome, spasmus nutans and shuddering attacks. Rare tremors generally present with an action tremor and a variable combination of postural and kinetic components with resting tremors less frequently seen. The phenomenology of myorhythmia is still vague and a clinical definition is proposed. The recognition of these entities should facilitate the correct diagnosis and guide the physician to a prompt intervention.


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  • Contributors RJU was involved in research project organization and execution, manuscript preparation and writing of the first draft. SD was involved in research project execution and manuscript preparation and review and critique. AEL was involved in research project conception and manuscript preparation and review and critique. AF was involved in research project conception and organization, and manuscript preparation and review and critique.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.