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Background: Essential tremor (ET) is one of the most common movement disorders and remains a clinical diagnosis. Over the past century, evolving knowledge of tremor phenomenology and disease heterogeneity has led to multiple diagnostic and classification frameworks aimed at improving diagnostic consistency and research comparability. Methods: A narrative review of the literature was conducted using PubMed/Medline, Embase, Scopus, and Google Scholar. Publications addressing the development, validation, modification, and clinical application of ET diagnostic criteria and classification systems were reviewed and synthesized chronologically. Results: The concept of ET evolved from early descriptions of hereditary tremor by Burresi and the classical clinical characterization proposed by Critchley to increasingly standardized diagnostic frameworks. Major milestones included the WHIGET criteria, the 1998 Movement Disorder Society (MDS) Consensus Statement, the 2000 MDS diagnostic criteria, and the 2018 International Parkinson and Movement Disorder Society (IPMDS) classification. These frameworks progressively improved diagnostic standardization while reflecting changes in the understanding of ET. Recognition of substantial clinical heterogeneity, including motor and non-motor manifestations, culminated in the 2018 IPMDS two-axis classification system and the introduction of essential tremor plus (ET-plus). Conclusions: The evolution of ET diagnostic criteria reflects a transition from descriptive clinical observations to structured syndrome-based classification systems. Although the 2018 IPMDS framework currently represents the most comprehensive classification approach, important controversies remain regarding ET heterogeneity, the biological validity of ET-plus, and the absence of objective biomarkers. Future diagnostic frameworks will likely integrate clinical phenotyping with neurophysiological, imaging, genetic, and digital biomarkers to enable more precise disease classification.
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