Essential Tremor

What Is It?

Tremor is the shaky movements of your hands, limbs, head or voice that you can't control. Sometimes tremor is a normal reaction to a situation such as fear, fatigue or anger. It also can be a side effect of too much caffeine, a medication, or withdrawal from a drug or medicine. When tremor occurs during activities and there is no anatomic, emotional or chemical cause, it can be a sign of a neurological disease called essential tremor. 

Essential tremor is different than Parkinson's disease, another neurological illness. Essential tremor is most noticeable when your body is in action, such as when you are writing, typing or pouring a beverage. In contrast, the tremors of Parkinson's are more noticeable at rest. 

In essential tremor, tremors begin when you use your hands. For example, when you are writing, typing or pouring a beverage. Essential tremor often begins in the dominant hand.  

People sometimes worry that essential tremor is the start of Parkinson's disease. The two conditions are very different. The tremors of Parkinson's are more noticeable at rest. People with Parkinson's watch their hands shake when they rest in their lap. But when they reach out to grab or hold something, such as a cup of coffee, the shaking stops.  

As many as one in four people develop essential tremor as they age. You are more likely to develop essential tremor if you have a parent or sibling with the condition.  

Essential tremor is much more common than Parkinson's disease.   

Symptoms

The main symptom is shaking of one or both hands or the head. The shaking is uncontrollable. But it is not always dramatic. Sometimes, speech trembles.  

Stress, caffeine and certain medicines may make the tremor worse. 

Diagnosis

Your doctor will identify essential tremor by its pattern and your history.  

Features that make the diagnosis likely include:

• Shaking that gets worse when you try to maintain one position (such as holding a pen)

• A family history of tremor

Your doctor will review your medications. He or she will identify any that can cause tremor as a side effect.  

Your doctor may want you to have additional tests. These tests can identify other medical conditions that can cause similar symptoms. If any of these conditions are causing your tremor, you do not have essential tremor.  

If you have diabetes, tremor can be a symptom of low blood sugar levels. Tremor can also be caused by an excess of certain metals in your body. For example, excessive copper deposits and exposure to mercury or arsenic can cause tremor. 

Expected Duration

Essential tremor is a permanent condition. The degree of tremor typically worsens as you age. It also can expand from one part of your body to other parts over time. 

Prevention

No one knows what causes essential tremor. Therefore, there is no way to prevent it.  

Stress, inadequate sleep, caffeine and certain medicines may make the tremor worse. If stress makes your tremor worse, you can learn ways to reduce your stress.  

If caffeine worsens your symptoms, try to cut down on caffeinated beverages such as coffee, tea and soft drinks.  

Medicines that can make the tremor more noticeable include: 

• Stimulants such as methylphenidate (Ritalin) 

• Lithium 

• Valproate

• Some antidepressants 

• Thyroid replacement medicine (in excessive doses)

Talk to your doctor if any of these medications could be worsening your tremor.

Treatment

Many people with essential tremor do not require treatment.  However, if the tremor causes significant distress or disability, medications called beta-blockers are the most effective treatments. Examples include atenolol (Tenormin) and propranolol (Inderal). 

Beta-blockers usually improve the tremor so that it does not interfere with normal activities. In some people, the tremor disappears completely. If you stop taking the medication, the tremor will return.  

Other drugs that may help include one or more of the following (which are sometimes used in combination):

• The antiseizure drug primidone (Myidone, Mysoline) 
• Gabapentin (Neurontin), a drug used primarily to treat chronic pain 
• Many people find that drinking small amounts of alcohol temporarily relieves tremor. But alcohol should not be relied upon as treatment.

Physical therapy and occupational therapy may help people with essential tremor find easier way to function throughout the day.

For severe symptoms, your doctor may discuss injections of botulinum toxin (Botox) or very special surgical procedures such as deep brain stimulation (implantation of electrodes into the brain). These are generally reserved for severe tremors that don't respond to other therapies. 

When To Call A Professional

Call your doctor if your tremor starts to interfere with your ability to do your normal, daily activities.

Prognosis

Treatment can minimize the symptoms. But essential tremor slowly worsens over time. Most people experience only mild or moderate symptoms. In other people, essential tremor can cause substantial disability. 

Additional Info

International Tremor Foundation
https://www.essentialtremor.org/

National Institute of Neurological Disorders and Stroke
https://www.ninds.nih.gov/