Date:
Patient:
MRN:
Clinician: (Neurologist, Movement Disorders Specialist)
Reason for Visit:
Follow-up for essential tremor
Assessment of tremor severity and impact on daily activities
Medication adjustment
Botulinum toxin injection (if applicable)
History of Present Illness:
Briefly describe the patient’s essential tremor:
Age of onset
Body parts affected (hands, head, voice, etc.)
Progression of symptoms (worsening, stable)
Impact on daily activities (eating, writing, dressing)
Mention any associated symptoms (anxiety, fatigue)
Past Medical History:
Include any relevant past medical conditions, such as:
Hyperthyroidism (can exacerbate tremor)
Parkinson’s disease (differential diagnosis)
Stroke (may cause tremor)
Medications that can worsen tremor (beta-blockers, some antidepressants)
Family History:
History of essential tremor in first-degree relatives
Social History:
Occupation (impact of tremor on work)
Caffeine and alcohol intake (can affect tremor)
Physical Exam:
General: Neurological examination focusing on:
Tremor characteristics (amplitude, frequency, postural vs. kinetic)
Coordination
Gait
Balance
Mental status
Labs:
List any recent laboratory tests performed to rule out other diagnoses, such as thyroid function tests.
Imaging:
Mention any recent brain imaging studies (MRI) if performed to rule out other causes of tremor.
Assessment:
Confirm the diagnosis of essential tremor based on clinical features.
Describe the severity of the tremor using a standardized scale (e.g., Essential Tremor Rating Scale [ETRS]).
Assess the impact of tremor on the patient’s quality of life.
Plan:
Outline the treatment plan based on severity and impact:
Medications: Consider adjusting current medications or initiating new medications (beta-blockers, primidone, propranolol).
Botulinum toxin injections: Discuss the possibility and risks/benefits of injections for specific tremor types (e.g., hand tremor).
Physical therapy: Consider occupational therapy to learn tremor management techniques and strategies for daily activities.
Deep brain stimulation (DBS): Briefly mention DBS as a potential option for severe, medication-resistant tremor (consult with a specialist if applicable).
Prognosis:
Briefly discuss the long-term course of essential tremor. Essential tremor is typically progressive, but the rate of progression varies.
Education:
Document any education provided to the patient regarding:
Essential tremor and its management options
Importance of medication adherence (if applicable)
Strategies to manage tremor in daily activities
Notes:
Include any additional relevant information not covered above, such as patient’s emotional well-being and support system.
Disclaimer: This is a template and should be adapted to the specific needs of each patient.