Find out more about this disorder that causes uncontrollable shaking and learn how it differs from Parkinson's disease.
Essential tremor is a nervous system (neurological) disorder that causes involuntary and rhythmic shaking. It can affect almost any part of your body, but the trembling occurs most often in your hands — especially when you do simple tasks, such as drinking from a glass or tying shoelaces.
Essential tremor is usually not a dangerous condition, but it typically worsens over time and can be severe in some people. Other conditions don't cause essential tremor, although essential tremor is sometimes confused with Parkinson's disease.
Essential tremor can occur at any age but is most common in people age 40 and older.
Essential tremor signs and symptoms:
Many people associate tremors with Parkinson's disease, but the two conditions differ in key ways:
About half of essential tremor cases appear to result from a genetic mutation. This form is referred to as familial tremor. It isn't clear what causes essential tremor in people without a known genetic mutation.
Known risk factors for essential tremor include:
Genetic mutation. The inherited variety of essential tremor (familial tremor) is an autosomal dominant disorder. A defective gene from just one parent is needed to pass on the condition.
If you have a parent with a genetic mutation for essential tremor, you have a 50 percent chance of developing the disorder yourself.
Essential tremor isn't life-threatening, but symptoms often worsen over time. If the tremors become severe, you might find it difficult to:
Diagnosing essential tremor involves reviewing your medical history, family history and symptoms and conducting a physical examination.
There are no medical tests to diagnose essential tremor. Diagnosing it is often a matter of ruling out other conditions that could be causing your symptoms. To do this, your doctor may suggest the following tests:
In a neurological examination, your doctor tests your nervous system functioning, including checking your:
Your blood and urine may be tested for several factors, including:
To evaluate the tremor itself, your doctor may ask you to:
If your doctor is still unsure if your tremor is essential tremor or Parkinson's disease, he or she might order a dopamine transporter scan. This scan can help your doctor tell the difference between the two types of tremor.
Some people with essential tremor don't require treatment if their symptoms are mild. But if your essential tremor is making it difficult to work or perform daily activities, discuss treatment options with your doctor.
OnabotulinumtoxinA (Botox) injections. Botox injections might be useful in treating some types of tremors, especially head and voice tremors. Botox injections can improve tremors for up to three months at a time.
However, if Botox is used to treat hand tremors, it can cause weakness in your fingers. If Botox is used to treat voice tremors, it can cause a hoarse voice and difficulty swallowing.
Doctors might suggest physical or occupational therapy. Physical therapists can teach you exercises to improve your muscle strength, control and coordination.
Occupational therapists can help you adapt to living with essential tremor. Therapists might suggest adaptive devices to reduce the effect of tremors on your daily activities, including:
Surgery might be an option if your tremors are severely disabling and you don't respond to medications.
Deep brain stimulation. This is the most common type of surgery for essential tremor. It's generally the preferred procedure in medical centers with significant experience in performing this surgery. Doctors insert a long, thin electrical probe into the portion of your brain that causes your tremors (thalamus). A wire from the probe runs under your skin to a pacemaker-like device (neurostimulator) implanted in your chest. This device transmits painless electrical pulses to interrupt signals from your thalamus that may be causing your tremors.
Side effects of deep brain stimulation can include equipment malfunction; problems with motor control, speech or balance; headaches; and weakness. Side effects often go away after some time or adjustment of the device.
Focused ultrasound thalamotomy. This noninvasive surgery involves using focused sound waves that travel through the skin and skull. The waves generate heat to destroy brain tissue in a specific area of the thalamus to stop a tremor. A surgeon uses magnetic resonance imaging to target the correct area of the brain and to be sure the sound waves are generating the exact amount of heat needed for the procedure.
Focused ultrasound thalamotomy creates a lesion that can result in permanent changes to brain function. Some people have experienced altered sensation, trouble with walking or difficulty with movement. However, most complications go away on their own or are mild enough that they don't interfere with quality of life.
To reduce or relieve tremors:
Make lifestyle changes. Use the hand less affected by tremor more often. Find ways to avoid writing with the hand affected by tremor, such as using online banking and debit cards instead of writing checks.
Try voice-activated commands on your smartphone and speech-recognition software on your computer.
For many people, essential tremor can have serious social and psychological consequences. If the effects of essential tremor make it difficult to live your life as fully as you once did, consider joining a support group.
Support groups aren't for everyone, but you might find it helpful to have the encouragement of people who understand what you're going through. Or see a counselor or social worker who can help you meet the challenges of living with essential tremor.
You'll likely start by seeing your primary care provider. Or you might be referred immediately to a doctor trained in brain and nervous system conditions (neurologist).
Here's some information to help you get ready for your appointment.
When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:
Take a family member or friend along, if possible, to help you remember the information you're given.
For essential tremor, some questions to ask your doctor include:
Don't hesitate to ask other questions.
Your doctor is likely to ask you a number of questions, such as:
October 29th, 2021