Essential Tremor
Essential tremor is a disorder of the nervous system that causes body parts to shake. The movements and shaking cannot be controlled voluntarily. While essential tremor usually affects arms and hands, it can also affect other parts of the body, including the head.
Advanced essential tremor can disrupt daily life, making it hard to do basic tasks, such as eating or dressing. For many patients, the condition also means struggling with embarrassment or anxiety, especially in social circles. Essential tremor shouldn’t be confused with Parkinson’s disease, which also has similar symptoms.
Symptoms
Hand tremor is the most common symptom of essential tremor, but the condition can also cause voice tremor, head tremor, and affect other body parts. Essential tremor symptoms typically occur during voluntary movements (kinetic tremor) and postural activities, such as eating, writing, or holding objects, and are less likely to occur at rest (rest tremor), which distinguishes it from Parkinson’s disease. Intention tremor, which occurs during targeted movements and is associated with cerebellar disorders, is a different type of tremor.
Symptoms of essential tremor can range from mild essential tremor, where the shaking is subtle and may not require treatment, to more severe tremors that significantly impact daily life. Certain factors, such as stress, fatigue, and environmental changes, can make tremors worse. Essential tremor usually affects one side of the body more than the other, but many patients experience symptoms on both sides.
Essential tremor affects daily activities, including eating, drinking, dressing, and fine-detail work like handwriting or using eating utensils. As tremor affects more body parts or becomes more severe, it can severely disrupt basic tasks and may lead to social isolation and depression due to its psychological impact. Tremor severity can fluctuate, and more severe tremors may require medical attention.
Causes of Essential Tremor
Around half of patients diagnosed with essential tremor have genetic factors, and this inherited form is known as familial essential tremor. Familial essential tremor often appears at a younger age and tends to run in families. The pattern of inheritance is most consistent with autosomal dominant transmission, meaning there is a 50% chance of passing it on to children. Essential tremor can also occur in younger individuals, especially if there is a family history of the disorder.
The cause of essential tremor is unknown, but it is believed to involve a disruption in communication between different parts of the brain, particularly the cerebellum. Some studies suggest that certain factors, such as exposure to toxins and certain chemicals, may contribute to the onset of essential tremor. Additionally, changes in brain tissue, especially in the cerebellum, have been observed in some studies and may play a role in the disease mechanisms.
Other risk factors include age: people over 40 are more at risk. Essential tremor isn’t particularly life-threatening, but the condition can be life-altering. For instance, patients may have difficulty holding a cup of tea or eating without shaking. The condition isn’t contagious, and there is no way to prevent it either.
Diagnosis of Essential Tremor
Essential tremor is diagnosed by observing the typical pattern of tremor and excluding other movement disorders, such as Parkinson’s disease. Diagnosis involves a thorough neurological exam by a healthcare professional, who will assess your symptoms and may use imaging tests to rule out other neurological disorders.
Essential tremor is sometimes misdiagnosed as Parkinson’s disease due to overlapping symptoms; however, rest tremor is more characteristic of Parkinson’s disease, while essential tremor usually occurs during action or postural activities. The diagnostic process focuses on identifying the specific type of tremor and excluding known causes.
Your Diagnostic Options
No single test can confirm whether a patient has essential tremor diagnosed.
Your doctor may try to rule out other conditions, for which blood and imaging tests may be necessary. These include:
Computerized Tomography (CT Scan)
Blood Tests
Rule out other conditions, such as toxin exposure, thyroid concerns, and Wilson’s disease.
Magnetic Resonance Imaging (MRI)
Genetic Testing
Positron Emission Tomography (PET Scan)
If you experience shaking, you should see a doctor, especially if the pattern is repetitive.
Impact of Essential Tremor
The impact of essential tremor can be far-reaching, affecting not only physical abilities but also emotional and social well-being. People with essential tremor often experience severe tremors that interfere with daily tasks, making it challenging to work, enjoy hobbies, or participate in social activities. These symptoms can lead to embarrassment, anxiety, and even social withdrawal, as individuals may feel self-conscious about their tremors.
In more severe cases, essential tremor can increase the risk of falls and injuries, particularly in older adults. Because tremors can worsen over time, it’s important for people with essential tremor to seek medical advice if symptoms persist or become more severe. Early diagnosis and treatment can help manage symptoms and improve overall quality of life.
Management and Treatment
Unfortunately, there is no cure for essential tremor. However, your doctor may help you manage symptoms to improve your quality of life.
Some medications can help control symptoms with other treatments. The list includes:
Medication
Your doctor may recommend propranolol and primidone, which are two of the most commonly prescribed medicines to treat essential tremor. Propranolol is effective in 40% to 50% of patients, while primidone is recommended for its action on neurotransmitters. If propranolol or primidone are not effective alone, a combination of both may provide relief. Other medications, such as atenolol, sotalol, nadolol, and topiramate, may also be considered if first-line treatments are unsuitable.
Deep Brain Stimulation
A surgical procedure in which a device is implanted to deliver electrical pulses to a specific part of the brain. In this procedure, the electrode is implanted in the ventral intermediate nucleus (Vim) of the thalamus, which helps interrupt signals that cause shaking and muscle movements. DBS can significantly reduce tremors.
Focused Ultrasound
MRI-guided high-intensity focused ultrasound is a nonsurgical treatment option for people with essential tremor who are medication refractory. This technique uses ultra-high-frequency sound waves to target the area of the brain that causes tremor and can help reduce the severity of shaking.
Adaptive Devices
There are devices designed to control shaking, such as tremor-canceling devices, vibration devices, and weighted items.
Botulinum Toxin
Injecting Botulinum toxin into the affected muscles can reduce the severity of shaking.
Healthcare providers often also suggest physical therapy, which can help improve overall muscle strength and coordination. Occupational therapists help patients adapt to life with essential tremor. For instance, just using heavier utensils may reduce the extent of shaking. Patients also benefit from wrist weights that counter tremors.
Non-pharmacological strategies to reduce tremors include lifestyle modifications, therapy, and relaxation techniques. Reducing trigger factors and practicing stress management can help manage symptoms. While some people report that drinking alcohol may temporarily reduce tremors, health professionals do not recommend it as a treatment due to potential side effects and interactions with medications.
Treatment options may vary depending on the affected body part and tremor severity, so your healthcare provider will tailor the approach to your specific needs.
Outlook with Essential Tremor
Patients notice a difference after treatment starts, but the time to improvement isn’t the same for everyone. Usually, essential tremor is progressive, meaning the shaking will only get worse over time. Essential tremor is a condition that gets worse slowly, taking years to reach levels where it starts to disrupt a person’s life. As the condition worsens, it can increasingly disrupt daily life and activities, but with timely treatment, it is possible to improve the quality of life.
Essential tremor is a lifelong condition, and while it is not curable, timely care is critical. It doesn’t cause significant problems at first, but you can experience daily disruptions, especially as the disease progresses and the condition worsens.
When to Reach Out
If you or a loved one has experienced unexplained shaking or sudden involuntary hand movements in Westchester or NYC, schedule an evaluation at Chester Neurology. We take time to evaluate potential underlying causes and provide a precise diagnosis, followed by a treatment plan. Essential tremor doesn’t have to affect your life adversely, especially with treatment and care.
Call us today at (914) 816-1941 or email info@chesterneurology.com to schedule an appointment.
We serve families in Westchester, the Bronx, Manhattan, and more, all with compassion, clarity, and commitment.
Take the First Step
Contact Us Today
Early diagnosis and correct identification makes planning, treatment, and care accessible to everyone.