Essential tremor

What is essential tremor?

An essential tremor (ET), sometimes referred to as familial tremor, hereditary tremor, or benign tremor, is a nerve disorder that makes your hands, arms, eyelids or another part of your body shake. Though an estimated 10 million Americans have ET. It has some overlapping features with other diseases; in particular Parkinson's disease or dystonia and experts are often required to make the diagnosis. Essential tremor is not life threatening, but it can make eating, drinking, writing and even talking difficult.

What are the symptoms of essential tremor?

Essential tremor is most likely to start when you’re 65 or older and can often get worse as you age. Common signs include:

• A rhythmic tremor in the hands, arms, head or voice (it can also be felt as an “internal tremor”)
• Tremor occurs primarily when using the hands
• Tremor is not accompanied by other neurologic signs or symptoms

By contrast, tremors associated with Parkinson’s disease most often affect the hands and are most prominent when your hands are resting. Parkinson’s disease is also typically accompanied by other neurological signs and symptoms, such as stooped posture or changes in walking.

What causes essential tremor?

About half of essential tremor cases, known as familial tremor or hereditary tremor, are caused by being passed down through families and are thought to be a result of a combination of genetic changes. The precise genetic changes involved are not known.

Doctors aren’t sure what causes people without a family history to develop essential tremor, but it's known that the tremor arises from changes to the activity in certain brain circuits that control movement.

How is essential tremor diagnosed?

ET is diagnosed by your physician based on a physical exam and observation of typical symptoms. Sometimes lab or imaging studies are done to rule out other causes, but there is no test to confirm an ET diagnosis.

What are some treatment options for essential tremor?

Lifestyle changes

If your symptoms are mild, simple lifestyle changes may help.

• Following a healthy sleep schedule to avoid tremors caused by sleep disruptions.
• Using relaxation techniques for tremors brought on by stress or heightened emotions.
• Avoiding aggravating medications (antidepressants, antiepileptics or inhalers) or foods (caffeine, energy drinks). Ask your doctor if any of your medications or your diet may contribute to your tremors.

Treatment options

Depending on the severity and location of your tremor, there are several treatment options to help you manage your symptoms and reduce their effect on your everyday life:

• Occupational therapy can teach patients how to adapt their activities and use tools to lessen the impact of their symptoms.
• Using eating utensils with larger handles.
• Wearing wrist weights to stabilize the hand.
• Selecting clothes that are easy on and off – avoid buttons.
• Medications like propranolol and primidone can be helpful in reducing tremor by as much as 50%.
• Botox^® injections can be used to make wrist tremors less severe if medications are not effective.
• Deep Brain Stimulation (DBS) surgery is a minimally invasive surgery that can significantly reduce or even eliminate tremor. If you have moderate to severe ET and have not responded well to medication, you may be a good candidate for DBS surgery.
• Focused X-rays or ultrasound. During stereotactic radiosurgery, the surgeon directs X-rays or ultrasound at the specific part of the brain that’s the source of the tremors.