Essential tremor: is it a neurodegenerative disease? No

In the past decade, many advances have been made regarding clinical characteristics, neurophysiology, imaging, pathology and genetics of essential tremor, the most common of movement disorders. The first part of this article summarizes available data in these fields, with emphasis on recent reports. In the discussion, the reported data supporting the view that essential tremor is a neurodegenerative disease is critically reviewed and this hypothesis is challenged. Finally, an alternative pathophysiological explanation based on the generation of central oscillating pacemakers is put forth. This hypothesis allows for different causes of essential tremor and therefore explains the existing heterogeneity of clinical manifestations and therapeutic response.