Postural tremor

A postural tremor is one that is worsened by a particular posture, for example when the arms are outstretched.

It has a variety of causes, for example:

• it may be an exaggerated physiological tremor due to:
  • anxiety
  • thyrotoxicosis
    
    
• metabolic:
  • hepatic encephalopathy
  • CO2 retention
    
    
• brain damage, e.g.:
  • Wilson's disease
  • syphilis
    
    
• essential tremor
  
  
• drugs, e.g. salbutamol
  
  
• spasmodic torticollis may be exaggerated by certain postures

Notes:

• postural tremor is a position specific tremor occurring when maintaining a specific posture or position (1)
  • is considered an action tremor and can be seen in essential tremor (ET), Parkinson's disease and dystonia
  • the re-emergent tremor which has been considered a postural tremor in the past, has been found to be a continuation of the rest tremor during stable posturing and tends to be dopamine responsive
  • propranolol has been found to be helpful in treating head tremor, by nature considered a postural tremor, in the setting of ET but not dystonia

Reference:

• Frei K, Truong DD. Medications used to treat tremors. J Neurol Sci. 2022 Apr 15;435:120194. doi: 10.1016/j.jns.2022.120194. Epub 2022 Feb 19. PMID: 35279634.