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, tying shoelaces, writing or applying pressure to the arm of a chair to get up.

Essential tremor is usually not a dangerous condition, but it typically worsens over time and can be severe in some people.  Essential tremor is sometimes confused with Parkinson’s disease.

Essential tremor can occur at any age but is most common in people over 40.

Symptoms of Characteristics of Essential Tremor

• Begin gradually, usually more prominently on one side of the body
• Worsen with movement
• Usually occur in the hands first, affecting one hand or both hands
• Can include a “yes-yes” or “no-no” motion of the head
• May be aggravated by emotional stress, fatigue, caffeine or temperature extremes

Essential tremor vs. Parkinson’s disease

Many people associate tremors with Parkinson’s disease, but the two conditions differ in key ways:

• Timing of tremors.Essential tremor of the hands usually occurs when you use your hands. Tremors from Parkinson’s disease are most prominent when your hands are at your sides or resting in your lap.
• Associated conditions.Essential tremor doesn’t cause other health problems, but Parkinson’s disease is associated with stooped posture, slow movement and shuffling gait. However, people with essential tremor sometimes develop other neurological signs and symptoms, such as an unsteady gait (ataxia).
• Parts of body affected.Essential tremor mainly involves your hands, head and voice. Parkinson’s disease tremors usually start in your hands, and can affect your legs, chin and other parts of your body.

Causes of Essential Tremor

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.

Complications of Essential Tremor

Essential tremor isn’t life-threatening, but symptoms often worsen over time. If the tremors become severe, you might find it difficult to:

• Hold a cup or glass without spilling
• Eat normally
• Put on makeup or shave
• Talk, if your voice box or tongue is affected
• Write legibly

Diagnosis of Essential Tremor

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. If you have developed a new tremor or have a tremor not yet diagnosed, please call our office to schedule a visit with me for further evaluation.

Treatment of Essential Tremor

Most people with essential tremor don’t require treatment as long as their symptoms are mild. But if your essential tremor is making it difficult to work or perform daily activities, discuss treatment options with Dr. Guy.

Medications available to treat Essential Tremors

• Beta blockers. Normally used to treat high blood pressure, beta blockers such as propranolol (Inderal) help relieve tremors in some people. Beta blockers may not be an option if you have asthma or certain heart problems (i.e.e – a slow heart rate). Side effects may include fatigue, lightheadedness or heart problems.
• Anti-seizure medications. Epilepsy drugs, such as primidone (Mysoline), may be effective in people who don’t respond to beta blockers. Other medications that might be prescribed include gabapentin (Gralise, Neurontin) and topiramate (Topamax, Qudexy XR). Side effects include drowsiness and nausea, which usually disappear within a short time.
• Doctors may use benzodiazepine drugs such as clonazepam (Klonopin) to treat people for whom tension or anxiety worsens tremors. Side effects can include fatigue or mild sedation. These medications should be used with caution because they can be habit-forming.
• 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.

Therapy classes for Essential Tremor

Dr. Guy and neurologists 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:

• Heavier glasses and utensils
• Wrist weights
• Wider, heavier writing tools, such as wide-grip pens

Surgery for Essential Tremor

In rare instances, surgery may be an option — only 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.

If you have any questions or concerns regarding tremors, please reach out to Dr. Guy.

This information was made available to Mayo Clinic.