How is head tremor diagnosed?

Head tremor is diagnosed mainly by examination. A neurologist or movement disorder specialist looks at the direction and regularity of the shaking, whether other body parts are involved, and whether there are signs of dystonia or of another neurological condition. Brain MRI and other tests are used when a secondary cause is suspected. A good video of the tremor is often as informative as the examination itself ^[1].

Key facts

Diagnosis is mainly clinical: examination and good video ^[1].
Signs of dystonia — a null point, a sensory trick, neck pulling — change the treatment plan.
MRI is used when a secondary cause is suspected; it is not required for our online review.
Our team reviews tremor videos and reports online free of charge.
Before surgery, every specialist on the team evaluates the patient in Istanbul.

What the specialist looks for

Direction and regularity of the shaking; whether it changes with head position
A null point (a head position where the tremor stops) and a sensory trick (touching the face or chin eases it) — typical of dystonia
Tremor of the hands, voice or legs; slowness and stiffness
Balance, coordination and eye movements
Family history, the age at onset and how the tremor has progressed

Rating scales

Severity is scored with standard tremor rating scales so that results before and after treatment can be compared. In our published series, each patient was scored on a 0–4 tremor rating scale before surgery and again with stimulation on and off at 2 days and 2, 6 and 12 months, by two movement disorder specialists who did not know whether the stimulator was on; patients with dystonia were also scored on a dystonia scale ^[2].

Tests that may be used

Brain MRI — to look for a lesion, multiple sclerosis or a stroke
Blood tests — thyroid, liver and metabolic causes
Electromyography or accelerometry — measures the rhythm of the tremor
Dopamine transporter imaging — only when Parkinson’s disease is suspected

Our online case review

Send us your reports and a short video of the tremor by WhatsApp or info@neuromodulationinturkey.com.
Prof. YILMAZ’s team reviews the material and, if needed, arranges a video consultation.
You receive an assessment of the likely tremor type and whether DBS is likely to help.
If surgery is recommended, a full evaluation by every specialist on the team takes place in Istanbul before any decision is final.

A brain MRI is helpful if you already have one, but it is not required for the online review.

How to record a useful tremor video

Sit upright facing the camera, without a headrest, for 30 seconds.
Turn the head slowly to the right and to the left; then look up and down.
Hold both arms straight out in front for 10 seconds; then touch your nose with each finger.
Write a sentence and draw a spiral on paper, in view of the camera.
Say a long “aaa” and read a sentence aloud.
Film in good light, with the camera steady and the whole head and shoulders in view.

The evaluation in Istanbul

Before surgery, a neurologist, psychologist, cardiologist, anesthesiologist, physiotherapist and nutrition specialist each assess you independently, and Prof. YILMAZ makes the final decision. All laboratory tests, MRI under general anesthesia and CT scans are included in the package. See international patients.

Your surgeon

Prof. Atilla YILMAZ, MD

Every operation is performed personally by Prof. YILMAZ, a stereotactic and functional neurosurgeon who has carried out 1,200+ neuromodulation procedures, including 800+ DBS surgeries, for patients from 60+ countries. He is the first author of the published double-target Vim+PSA series for rare tremor syndromes ^[2].

President, Middle-Eastern Society for Stereotactic and Functional Neurosurgery (MSSFN); Board of Directors, WSSFN and International Neuromodulation Society
Proctor for Medtronic, Abbott and Boston Scientific — the three leading DBS manufacturers appoint him to train other neurosurgeons on their systems
40+ neurosurgeons trained from 30 countries; first-ever DBS surgeries performed in six countries
Trained at the University of Florida (observership with Prof. Okun and Prof. Foote) and Umeå University Hospital, Sweden

Full profile and credentials

Frequently asked questions

Do I need an MRI before my case can be reviewed?

No. An MRI helps if you already have one, and there is no requirement on how recent it is. The online review can go ahead without it.

Which doctor diagnoses head tremor?

A neurologist, ideally one specialized in movement disorders. If surgery is considered, a functional neurosurgeon joins the evaluation.

How long does the online review take?

The team usually replies after reviewing your videos and reports; if more information is needed, they will tell you exactly what to send.

Can head tremor be diagnosed from a video?

A good video is very informative and is often enough for a first assessment. The final decision about surgery is made after an examination in person.

Sources

Bhatia KP, et al. Consensus Statement on the classification of tremors from the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord 2018. utsouthwestern.elsevierpure.com/en/publications/consensus-statement-on-the-classification-of-tremors-from-the-tas
Yilmaz A, Eray HA, Cakir M, Ceylan M, Blomstedt P. Deep Brain Stimulation with Double Targeting of the VIM and PSA for the Treatment of Rare Tremor Syndromes. Stereotact Funct Neurosurg 2024;102:224–239. DOI 10.1159/000539162. pubmed.ncbi.nlm.nih.gov/38934181/