Essential tremor Health Article

Signs and tests

Your doctor can make the diagnosis by performing a physical exam and asking questions about your medical and personal history.

A physical exam will show shaking with movement, usually small movements that are faster than 5 times per second. There are usually no problems with coordination or mental function.

Further tests may be needed to rule out other reasons for the tremors. Other causes of tremors may include:

• Alcohol withdrawal
• Cigarette smoking
• Hyperthyroidism
• Pheochromocytoma
• Too much caffeine
• Use of certain medications
• Wilson's disease

Blood tests and imaging studies (such as a CT scan of the head, brain MRI, and x-rays) are usually normal.

Treatment

Treatment may not be necessary unless the tremors interfere with your daily activities or cause embarrassment.

Medicines may help relieve symptoms. How well medicines work depend on the individual patient.

Two medications used to treat tremors include:

• Propranolol, a drug that blocks the action of stimulating substances called neurotransmitters, particularly those related to adrenaline
• Primidone, an antiseizure drug that also controls the function of some neurotransmitters

The drugs can have significant side effects.

Side effects of propranolol include:

• Fatigue
• Nose stuffiness
• Shortness of breath (people with asthma should not use this drug)
• Slow heart beat

Side effects of primidone include:

• Drowsiness
• Difficulty concentrating
• Nausea
• Problems with walking, balance, and coordination

Other medications that may reduce tremors include:

• Antiseizure drugs such as gabapentin and topiramate
• Mild tranquilizers such as alprazolam or clonazepam
• Blood pressure drugs called calcium-channel blockers such as flunarizine and nimodipine

Botox injections, given in the hand, have been used to reduce tremors by weakening local muscles.

In severe cases, surgery to implant a stimulating device in the brain may be an option.

Expectations (prognosis)

An essential tremor is not a dangerous condition, but some patients find the tremors annoying and embarrassing. In some cases, it may be dramatic enough to interfere with work, eating, or drinking.

Complications

Severe essential tremor can interfere with daily activities, especially fine motor skills such as writing. Sometimes the tremors affect the voice box, which occasionally leads to speech problems.