Previously described in terms of activation condition (rest vs. movement), brain region affected (rubral), presence or absence of medical condition(hypothyroid), existence of neurological conditions (dystonia), topography (limb, head, voice), frequency.....
Complicated and contradictory
Generally not necessary to diagnose and properly treat
Phenomenology and a syndromic classification of tremor consensus statement Movement Disorder Society (MDS) 
Treat the correct cause
3 golden rules in tremor assessment
Enhanced physiological tremor
Drug-Induced action tremor
Midbrain or rubral
Tremor causing Rx?
Diarrhea, weight loss, heat intolerenace?
Temporal course? Static or progressive?
What body regions?
Postural / sustension:
Thumb posturing? Other abnormal postures?
Distractibility, entrainment, suggestibility?
Pouring, drinking, using a spoon, FNF, Archimedes spiral test
Intentional component (worsen as draw near target)
Dystonic postures accompanying? (thumb)
Most common adult-onset movement disorder
5% general population
Genetics: AD, variable penetrance, no gene found (polygenic)
Central generator: thought to represent cerebellar-thalamo-cortical outflow pathology
Kinetic and postural, mainly arms; 4-12Hz
Armshead (“yes-yes” vs. “no-no”)
Voice / vocal cord, chin, tongue
Rare in LE’s
No parkinsonian or dystonic features.
Interferes with ADL’s
Spoon, drinking from a cup
Interferes w/ occupational motor tasks
Bilateral action tremor of the hand and forearms
Absence of other neurologic signs
May have isolated head tremor with no signs of dystonia
Secondary / Supportive
Long duration (3 yrs)
+ family Hx
Beneficial response to ETOH
50-90% of cases, but careful for rebound phenomenon