Essential tremor is a frequent disease, but rather often under-diagnosed, due to the fact that the patients with mild essential tremor don’t visit the neurologist, or due to some confusion in establishing the diagnosis in advanced stages of the disease. The clinical diagnosis is the most important, and is sustained today by imaging techniques such as Datscan using 123I-Ioflupane, used in the differential diagnosis between essential tremor and Parkinsonian syndromes. The precise and early diagnosis permit the specific, customized symptomatic treatment, taking care of al the particularities of every patient, and in case of no-response to medical treatment, neurosurgical methods are available, some of them very recent, some still in clinical trials, as well as the genetic studies in order to establish the etiology of the most frequent disease in the field of movement disorders.