Zittern gehört zu den häufigsten neurologischen Symptomen und beeinträchtigt die Lebensqualität
der Patienten häufig in starkem Maße. Gerade in der Primär-Versorgung älterer Menschen
ist es entscheidend, einen Tremor im Rahmen einer Parkinson-Krankheit von anderen
möglichen Tremores abzugrenzen, um eine gezielte Therapie zu ermöglichen. Dieser Beitrag
bietet einen kompakten Überblick zum Thema und soll bei der Früherkennung des Parkinson-Tremors
unterstützen.
Abstract
Tremor is the most common movement disorder in clinical neurology and it significantly
impacts patients’ quality of life. In primary care, particularly among older adults,
differentiating between tremor types is essential for early diagnosis and appropriate
management, especially when Parkinson’s disease is suspected. This review provides
a concise overview of tremor classification and diagnostic strategies, with a focus
on distinguishing Parkinsonian tremor from other common tremor syndromes such as essential,
dystonic, functional, orthostatic, and secondary tremors.
Key clinical characteristics, including tremor type (rest, postural, kinetic, re-emergent),
frequency, distribution, and associated neurological signs, are discussed in detail.
The hallmark of Parkinsonian tremor, an asymmetric resting tremor with a “pill-rolling”
quality and possible re-emergence after postural, is highlighted as a critical diagnostic
clue, particularly when accompanied by bradykinesia and non-motor prodromal symptoms
such as REM sleep behaviour disorder, constipation, or hyposmia.
The article outlines a pragmatic diagnostic pathway, including clinical examination,
structured anamnesis, medication review, and the use of neuro-imaging or DAT-SPECT
when indicated. Therapeutic options are also discussed, ranging from dopaminergic
medication to advanced interventions like deep brain stimulation or focused ultrasound
for refractory tremor. The review aims to support non-expert clinicians in making
accurate early diagnoses and initiating therapy.
Schlüsselwörter
Tremor - Parkinson-Tremor - Tremorsyndrome - klinische Charakteristika - diagnostischer
Pfad
Keywords
tremor - Parkinsonian tremor - tremor syndromes - clinical characteristics - diagnostic
pathway
