14/09/2026
*Tremors in Wilson's Disease is typically:*
- *Type:*
Coarse, irregular, high-amplitude. Often described as a "wing-beating" tremor when arms are held abducted and flexed at elbows.
- *Distribution:*
Usually bilateral, proximal > distal, involving upper limbs. Can involve head and trunk in advanced disease.
- *When it occurs:*
Combination of features -
- Rest tremor is less common
- Postural tremor is prominent - appears when arms are held outstretched
- Intention / kinetic tremor - worsens as the hand approaches a target, like finger-to-nose test
- Rubral-like tremor due to involvement of basal ganglia, dentato-rubro-thalamic pathways
- *Character:* Low frequency, slow, not the fine rapid tremor of hyperthyroidism or essential tremor. Irregular and jerky.
- *Associated features often seen:* Dystonia, dysarthria, drooling, parkinsonian rigidity, Kayser-Fleischer rings, ataxia.
This pattern is due to copper deposition in the basal ganglia, thalamus, midbrain and cerebellum.
