When Parkinson is Not Parkinson – Diagnostic and Management Challenges of Essential Tremor: Case Series from the Movement Disorders Center.

Abstract

Introduction: Tremor (Tr), a rhythmic and involuntary movement characteristic of disorders such as essential tremor (ET) and Parkinson’s disease (PD), can be a source of confusion for general neurologists.
The aim of this study was to identify the difficulties associated with the diagnosis and management of ET in the Republic of Moldova, based on the experience of the Movement Disorders Center.
Materials and Methods: A retrospective analysis of 14 clinical cases with ET/ET-plus evaluated at the Movement Disorders Center of the “D. Gherman” Institute of Neurology and Neurosurgery (2024–2025) was conducted. Demographic, clinical, and therapeutic data were collected, and descriptive statistical analysis was performed using SPSS v.23.
Results: Among 87 patients suspected of PD, 14 were confirmed with ET (simple ET 3 [21.4%], ET-plus 9 [64.3%], PD + ET 2 [14.3%]), with a median age at presentation of 73 years and tremor onset at 66 years. All patients exhibited kinetic and postural tremor of the upper limbs, with involvement of the head (57.1%), chin (7.1%), and voice (7.1%). Associated motor symptoms included ataxia (42.9%) and parkinsonism (21.4%). Most patients (57.1%) had prior treatments with partial or no effect; propranolol 60 mg/day was initiated in 78.6% of cases.
Conclusions: Diagnosis and management of tremor remain challenging due to the overlap of ET and PD symptoms, limited access to functional investigations, essential medications, and the lack of surgical options. The results highlight the need for standardized protocols and continuous training of neurologists to optimize long-term management.