Dilip Kumar Jha, Anupam Kumar Singh

of goal-directed activity (finger-nose test, heel-shin test). Following tremor syndromes are predominantly part of this group. Physiologic Tremor It is low amplitude, high frequency tremor of 10–12 Hz, seen in normal people, not visible in normal circumstances. It is accentuated by increased sympathetic activity due to drugs or diseases. Common drugs that increase adrenergic activity include beta-adrenergic agonists, such as salbutamol, terbutaline, amphetamines, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), levodopa, nicotine and xanthines. Anxiety, excitement, muscle fatigue, hypoglycemia, alcohol and opioid withdrawal, thyrotoxicosis, fever and pheochromocytoma also increase sympathetic drive. Enhancement of physiologic tremor is the most common cause of postural-action tremor. Thus, a medical rather than primar