Metabolic Causes of Tremor

Metabolic causes of tremor include systemic metabolic, neurometabolic, and endocrine abnormalities. These can be diagnosed by identification of specific biochemical abnormalities detected by laboratory assays from serum or cerebrospinal fluid. The recognition of diagnostic biochemical or endocrinological abnormalities causing tremor is important because many conditions have specific treatments available that can correct or mitigate tremor. In this chapter we review most common causes of tremor that can be evaluated by laboratory-based investigation, including recommended biochemical tests, phenomenology of tremor and other neurologic abnormalities, and available therapies beyond symptomatic therapy. We emphasize the treatable causes because the delayed diagnosis may have very negative impact on the prognosis and therapeutic outcomes. We did not include drug and external toxin-induced causes of tremor in this chapter.