How mismatch of signature in bank cheque led to the diagnosis of a neurological condition

A recent tweet from Hyderabad-based, Dr. Sudhir Kumar is a clear example of how even the most subtle symptom can be a big indicator of an underlying health condition. In the tweet made on X (formerly Twitter), Dr. Kumar highlights how a minor change ended up in the diagnosis of a neurological condition called essential tremors.
The patient, 30 year old, visited the doctor after undergoing several incidents which included the inability to hold a cup of tea properly and most shockingly, getting a cheque canceled due to signature mismatch.
Dr. Kumar writes: 30-year old Mr Jasprit (name changed) presented to OPD with shaking of both hands for the past six months. He had difficulty in holding a cup of tea while drinking.
He pressed the panic button, when a cheque issued by him was not honored at the bank due to a “signature mismatch”.
Mr Jasprit googled about his symptoms and his panic multiplied manifold. He made a diagnosis of Parkinson’s disease (PD) based on “extensive research” of his symptoms on Google.
Mr Jasprit requested me to give the best medical treatment for his PD. I requested him to remain calm while I took a detailed history and clinically examined him.

As per Dr. Kumar’s observation, the patient had the following signs:
1. He had shaking (tremors) of hands only when he performed an action, such as while holding an object or while trying to write. There were no tremors at rest.
2. He walked normally and there was no slowness of movements.
3. There was no stiffness or rigidity of limbs while trying to move them.
4. There were no balance issues while walking or while turning.
These clinical features were hallmarks of another disease and not PD.
My final diagnosis was: Essential tremors (ET),” writes Dr. Kumar.
Read the tweet here:

What are essential tremors?

Essential Tremor (ET) is a neurological disorder characterized by rhythmic and involuntary shaking, typically affecting the hands, though it can extend to other parts of the body. Unlike Parkinson’s disease, essential tremors occur during voluntary movements and are often more pronounced with action, such as holding objects or reaching for items.
ET is a progressive condition that can worsen over time, impacting daily activities and quality of life. While the tremors are generally not life-threatening, they can become severe enough to interfere with tasks requiring fine motor skills, such as writing or drinking from a cup. Essential Tremor can affect individuals of any age, but it is more commonly observed in older adults. Treatment options may include medications, lifestyle modifications, and, in some cases, surgical interventions to manage symptoms. Though essential tremors can be challenging, early diagnosis and appropriate management strategies can help individuals lead fulfilling lives despite the condition.

ET is misconstrued as Parkinson’s disease

Dr. Kumar highlights the key differences between ET and Parkinson’s disease:
1. In ET, tremors occur while doing an activity, whereas in PD, tremors occur while at rest,
2. People with PD have associated other symptoms such as slowness of movements, rigidity of limbs and loss of balance. These symptoms are absent in ET,
3. ET generally affects both hands from the beginning, whereas PD starts in one hand, and after a long gap, the other side may also get affected,
4. The deterioration in symptoms is more rapid in PD than in ET.
I counselled Mr Jasprit about the diagnosis and the likely long-term outcome.
I also discussed the treatment options, however, he decided to wait and watch for any progression of symptoms, before starting medicines,” writes Dr. Kumar.