Essential Tremor

Medically reviewed by Seunggu Han, MD on November 29, 2017Written by Rose Kivi

What is essential tremor?

Essential tremor, also known as benign essential tremor, is a brain disorder that causes a part of your body to shake uncontrollably. The unintentional shaking motion is called a tremor. The hands and forearms are the most commonly affected areas. However, the following parts of your body can also be affected:

  • head
  • face
  • tongue
  • neck
  • torso

In rare cases, tremors can occur in the legs and feet.

Other medical conditions, such as Parkinson’s disease, can cause tremors. With essential tremor, however, there’s no known underlying condition that triggers the tremors. The tremors can begin at any age, but they most commonly affect older people.

Essential tremor is a fairly common disorder, affecting approximately 7 million people in the Unites States according to the journal Tremor and Other Hyperkinetic Movements. It isn’t life-threatening and doesn’t cause any serious health problems, although the shaking may make daily activities, such as eating and drinking, difficult.

What are the symptoms of essential tremor?

The tremors associated with essential tremor are small, rapid movements. You may experience tremors constantly, frequently, or occasionally. Both sides of your body may or may not be equally affected. Most people experience tremors when they’re trying to do something, such as tying their shoelaces. These tremors are known as action tremors. Other people may experience tremors when they’re not doing anything. These are called tremors at rest.

Tremors can range from minor to severe. Your tremors may be so minor that they don’t affect your everyday life, or they may be severe enough to interfere with your normal activities.

The following are symptoms of essential tremor in different parts of the body:

  • You may experience noticeable shakiness in the hands or arms when trying to do activities with your hands.
  • Tremors in the head and neck can make your head shake in an up-and-down or side-to-side motion.
  • Parts of your face may appear to twitch, such as your eyelids.
  • Tremors in the tongue or voice box can make your voice sound shaky when you’re speaking.
  • Tremors in your core, legs, and feet can cause problems with balance. They can also make your gait, or the way you walk, appear abnormal.

Certain factors may make your tremors temporarily worse, including:

What causes essential tremor?

Tremors can be caused by alcohol abuse, an overactive thyroid, a stroke, and a variety of neurological conditions. However, these tremors aren’t characterized as essential tremors.

The exact cause of essential tremor is unknown. Scientists haven’t found any absolute genetic or environmental causes, and no cellular defect has been linked to the condition. However, recent research suggests that essential tremor may be triggered by changes in certain areas of the brain, according to the National Institute of Neurological Disorders and Stroke (NINDS). As with most medical conditions, research is ongoing.

What are the risk factors for essential tremor?

People are at a higher risk of developing essential tremor if they’re over the age of 40.

Genetics can also affect risk. Essential tremor may be inherited, but it can also occur in people who don’t have a family history of the condition. When there’s a family history of essential tremor, it’s called familial tremor. With familial tremor, your child has a 50 percent chance of developing essential tremor if you have the disorder.

How is essential tremor diagnosed?

Doctors diagnose essential tremor by observing the tremors and by ruling out other causes. Your doctor may perform a physical exam to evaluate the severity of your tremors. They might also perform certain imaging tests to determine whether you have an underlying condition that’s causing your tremors, such as Parkinson’s disease. These tests can include CT and MRI scans.

Is essential tremor treatable?

There’s no cure for essential tremor, but the progression of symptoms is gradual and slow. There are also treatments that may help relieve your symptoms. You may not need treatment if your symptoms are minor. Your doctor will advise treatment if your symptoms are severe and interfering with your normal activities. Treatment options include:

Medications

Medications for essential tremor include the following:

Therapies

You can go to physical therapy to improve coordination and muscle control. Botox injections can also be done in your hands to weaken the muscles and minimize or stop shaking.

Surgery

Surgery is performed when other treatments fail to provide relief. It’s a last resort. Surgical options include deep brain stimulation and stereotactic radiosurgery.

  • Deep brain stimulation. In this procedure, small electrodes are placed in the area of your brain that controls movement. These electrodes block the nerve signals that cause tremors.
  • Stereotactic radiosurgery. In this procedure, high-powered X-rays are pinpointed on a small area of the brain to correct tremors.

What’s the outlook for people with essential tremor?

Many people with essential tremor live normal lives. The famous actress Katharine Hepburn led a successful career despite essential tremor that affected her head and voice.

The severity of your tremors may stay relatively the same or may get worse over time. The tremors might also spread to other areas of your body.

You may have to make some adjustments if your tremors are severe. These changes may include:

  • wearing slip-on shoes
  • using a buttonhook to fasten buttons
  • using straws to drink out of cups
  • using an electric razor instead of a manual razor

Some research suggests that people with essential tremor have a higher risk of developing Parkinson’s disease or sensory problems, such as a loss of smell or hearing. However, these associations are still being investigated.

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