August 3, 2026

@michaelokun

One of the most interesting discussions at the Aspen Movement Course centered on persons with a long-standing unilateral rest tremor, sometimes accompanied by a postural tremor, but without clear bradykinesia. Years ago, Professor David Brooks and colleagues used 18F-dopa PET imaging to show that the vast majority of these individuals already had evidence of nigrostriatal dopaminergic degeneration, supporting a diagnosis of Parkinson's disease rather than essential tremor or a functional movement disorder. Subsequent DaT imaging studies and careful long-term clinical follow-up have repeatedly confirmed these early observations. Another important pearl is that younger-onset Parkinson's disease may present with a fine, rapid tremor that can even appear myoclonic at first glance, creating additional diagnostic challenges. The lesson is simple: not every isolated tremor is essential tremor, and careful longitudinal examination, supported when appropriate by biomarkers, remains one of the most powerful tools in arriving at the correct diagnosis.