A 35-year-old woman presents to the neurology clinic with concern for tremor. She states she first noticed her right hand would start “shaking” when she was taking exams in college, or when she was particularly nervous, but would go away afterward. Over the next 10 years, the shaking slowly became more evident in her right hand and began involving her left hand, and she began having difficulty writing legibly and buttoning her shirt. Two years ago, she noticed the same “shakiness” in her head. Most recently she has noticed difficulty singing. She reports it is not worse with activity, and improves with rest. She claims she can get it to “calm down” with an evening glass of wine. Her husband says it is not present when she sleeps. She endorses having one alcoholic beverage per day, and states her father was also “shaky.”