Tremor
Tremor is one of the most common disorders of movement. It can affect the head, mouth, hands or legs. It can be caused by drugs (such as caffeine), anxiety, Parkinson’s disease, or other medical and neurological conditions. Other brain disorders can lead to stiffness, unsteadiness, involuntary postures (such as writer’s cramp), twitches and jerking.
What it is
Essential tremor is action and postural, often bilateral and symmetrical, frequently familial, often improved by alcohol. Parkinson's rest tremor is unilateral or asymmetric, present at rest and re-emerging with sustained posture. Cerebellar tremor is irregular and worse at the end of movement. Dystonic tremor has a directional preference. Drug-induced tremor commonly follows salbutamol, lithium, valproate or SSRIs.
Symptoms and signs
- Tremor of the outstretched hands, worse with action — holding a cup, writing, using cutlery (essential tremor).
- Tremor at rest, often pill-rolling, with reduced arm swing and slowness (suggests Parkinsonism).
- Head, voice or jaw tremor — common in essential tremor and dystonic tremor.
- Sudden onset, unilateral, asymmetric or task-specific tremor — needs structural-disease workup.
- Functional tremor — distractibility, entrainment and abrupt onset are key features and the diagnosis matters because it is treatable.
How we investigate
Detailed neurological examination including writing and pouring tasks, video review where helpful. Thyroid function, copper studies in young patients (Wilson's disease), B12, electrolytes. MRI brain where structural cause is suspected. DAT scan via partner imaging to distinguish essential tremor from Parkinsonian tremor where clinically uncertain.
Treatment options at The Vesey
- Essential tremor first-line — propranolol or primidone, titrated to symptom control.
- Essential tremor second-line — topiramate, gabapentin, clonazepam.
- Parkinson's tremor — levodopa-based therapy, dopamine agonists.
- Drug-induced tremor — medication review and rationalisation.
- Refractory tremor pathway — referral for focused ultrasound thalamotomy or deep brain stimulation.
What is the difference between essential tremor and Parkinson's disease? +
Essential tremor is predominantly an action and postural tremor — worst when the hands are outstretched or performing a task such as writing or holding a cup. Parkinson's tremor is a rest tremor — most obvious when the hands are relaxed in the lap — and is typically accompanied by slowness of movement (bradykinesia) and rigidity. A neurological examination, and in uncertain cases a DAT scan, can reliably distinguish the two.
Is tremor hereditary? +
Essential tremor has a strong hereditary component — approximately half of cases follow an autosomal dominant pattern, meaning a child of an affected parent has roughly a 50% chance of inheriting it. Parkinson's disease is predominantly sporadic but about 10–15% of cases have a genetic contribution, most commonly mutations in LRRK2, PINK1 or GBA.
What medications are used to treat tremor? +
For essential tremor, first-line medications are propranolol (a beta-blocker) and primidone (an anticonvulsant); both reduce tremor amplitude in around half of patients. Second-line options include topiramate, gabapentin and clonazepam. For Parkinson's tremor, levodopa-based combinations or dopamine agonists are standard. Drug-induced tremor often improves with dose reduction or switching the causative agent.
Does tremor affect my ability to drive? +
The DVLA requires you to notify them if tremor affects your ability to control a vehicle safely. Mild essential tremor that does not interfere with vehicle control does not need to be reported, but moderate-to-severe tremor — particularly if it affects arm or leg control — does. For Parkinson's disease, the DVLA must be informed. We will document our assessment of driving fitness in your consultation letter.
Pricing at a glance
Initial neurology consultation £260 (60 minutes). MRI brain from £450. DAT scan via partner from £950. Follow-up reviews £190. Insurance accepted: BUPA, Vitality, AXA, WPA, Cigna, Aviva, Healix.
Book an appointment
When to see a specialist
Book if your tremor is interfering with daily tasks, is progressive, is associated with other neurological symptoms, or if you are unsure of the diagnosis and want a structured assessment.
Cost and pathway
Initial neurology consultation £260 (60 minutes). MRI brain from £450. DAT scan via partner from £950. Follow-up reviews £190.
- Open 7 days including Sundays — 8am to 8pm, no weekend surcharge
- No GP referral required — book directly with our consultant neurology team
- Sutton Coldfield location — serving Birmingham, Walsall, Tamworth, Lichfield and the West Midlands
- CQC-regulated — rated 4.88/5 on Doctify from 700+ verified reviews
Sutton Coldfield · Birmingham · Walsall · Tamworth · Lichfield · West Midlands · Open 7 days 8am–8pm
Open 7 days · 8am–8pm · 0121 387 3727