The manifestation of resting tremors characteristic of Parkinson’s disease in which the fingers (usually forefinger and thumb) rub together as though rolling a pill between them, with an accompanying slight wrist flexion and extension (up and down movement). Often this is one of the earliest symptoms of Parkinson’s and the person is unaware that it is present. The movements (at least in the early stages) often stop when the person notices them or takes another action such as reaching for an object. When measured with an electromyogram (EMG) or an accelerometer (a device that measures the changes in speed and direction of movement), the tremor has a slow cycle of four to six hertz. This helps to differentiate it from essential tremor, which is more rapid and usually does not involve the pill-rolling movements so much as rhythmic trembling sorts of movement, although at this stage differential diagnosis can be difficult. Pill-rolling movements can be the only symptom of Parkinson’s disease for quite some time, up to years. When this is the case, the person usually does not need anti-parkinson’s medications or can control the tremor, if desired, with drugs such as anti-CHOLINERGIC MEDICATIONS.