Suggested Pre-Referral Evaluation and Management Guidelines
Assess for associated gait disorder, slowness of movement, ataxia, family history or alcohol abuse history. Assess for use of antipsychotics, antiemetics, amiodarone, valproic acid, Lithium, or asthma medications. Also assess for drug withdrawal and symptoms of thyrotoxicosis.
Suggested Additional Test/Management Prior to Specialty Visit
Thyroid function tests if indicated. If the patient is under the age of 50, or has any associated neurologic complaints, consider ordering a ceruloplasmin and 24 hour urine copper to exclude Wilson's. Consider trial of Inderal LA 60-80 mg/d OR primidone up to 100 mg qhs in mild familial case.
Patient Education/Information (includes preps)
Education about medication side effects, withdrawal or familial tremor when appropriate