Essential tremor , familial tremor (autosomal dominant), occurs at both rest and with intention

Caffeine makes it worse. Alcohol may improve.

Propranolol is the best therapy.

Alternatives = primidone, alprazolam, and clozapine

If medical therapy failed, then thalamotomy is indicated.

Parkinsonism

loss of cells in the substantia nigra resulting in a decrease in dopamine

Tremor + (cogwheel) Rigidity + Bradykinesia + gait disturbance

Other features:

• Limited facial expression (hypomimia)
• small writing (micrographia)
• Postural instability / orthostatic hypotension

Progressive Supranuclear palsy   = Parkinsonism + vertical gaze palsy

Olivopontocerebellar atrophy = Parkinsonism + prominent ataxia

Lewy body dementia = parkinsonism with dementia - visual hallucinations +deteriorated by antipsychotic