Overview

Essential tremor is a relatively common movement disorder. It affects about 5% of American adults over age 60, and 1% of the total population worldwide. Essential tremor is characterized by involuntary and rhythmic shaking, most often occurring in the hands. This tremor often occurs when a patient tries to use their hands for daily tasks such as eating, drinking, shaving, writing or doing hobbies. In addition, it also can affect the head, voice, and, rarely, the torso and other body parts. 

It is a slowly progressive condition, meaning it tends to worsen over time. Severity, age at onset and pattern of progression can vary from individual to individual. However, most patients describe to their doctors that they’ve had the tremor for years or decades, and initially it was not severe or bothersome, but it became worse over the years.

There is no cure for this movement disorder, but essential tremor does not shorten the lifespan of patients with the condition.

Why is it called “essential” tremor? This means it exists alone, and is not caused by illness or injury or medication side effect.

How it differs from Parkinson’s disease: Essential tremor is sometimes confused with Parkinson’s disease, because both cause tremors. In general terms, essential tremor is an action tremor, mostly occurring when muscles are being used and activated to perform a task. The tremor associated with Parkinson’s is a resting tremor, occurring when the body is relaxed and not moving much. Parkinson’s disease also is associated with other motor issues, such as slow movements (bradykinesia) and stiff muscles (rigidity), which are not present in essential tremor. Essential tremor is far more common than Parkinson’s disease.

Diagnosis and Treatment

There is no specific diagnostic test for essential tremor. It is diagnosed clinically, through a thorough history and physical exam.  Tests may include:

• Physical and/or neurologic exam, including testing your reflexes, sensations and coordination, as well as your motor exam
• Checks of your ability to do certain tasks, such as drinking from a glass or drawing a spiral shape on a piece of paper
• Review of your family and medical history, and medications
• Blood tests for potential metabolic causes of tremor that could mimic essential tremor (like an overactive thyroid gland)

Treatments

While there is no cure for essential tremor, there are ways to manage symptoms and preserve quality of life, or you may have a combination of treatments. You may not need medical or surgical treatment if your tremor isn’t impacting your daily life, or you may have a combination of treatments. Your health care provider will create a customized treatment plan based on your unique symptoms, starting with the least-invasive and lowest-risk options first. You may benefit from a combination of treatment options customized to your personal needs.

Essential tremor treatment options include:

Medication

There are a number of medications that can be used to treat essential tremor. The choice of medication, dosage, and possible changes or combinations will be recommended by your care team. 

• Beta blockers typically are used to treat high blood pressure and include drugs such as propranolol (Inderal LA, InnoPran XL). They may help relieve tremors in some people.
• Antiseizure medicines such as primidone (Mysoline) may be effective in people who don’t respond to beta blockers. Other medicines that might be prescribed include gabapentin (Neurontin,) and topiramate (Topamax).
• Tranquilizers can be helpful in patients who experience worsened tremors with tension or anxiety. These drugs include benzodiazepines, such as clonazepam (Klonopin).
• OnabotulinumtoxinA (Botox) injections can be helpful in treating some types of tremors, especially head and voice tremors. Botox injections can improve tremors for up to three months at a time.

Occupational Therapy

Occupational therapies can help. Your therapist may teach you ways to help improve your ability to carry out tasks, even with the tremor.

Surgical Treatment Options for Essential Tremor

If you don’t respond well to medication and lifestyle interventions, your health care provider may talk to you about surgical options for essential tremor treatment. The goal of surgery is to affect the disordered brain circuitry causing the tremors, reduce severe tremor and improve quality of life. The two most common surgical options worldwide are high-intensity focused ultrasound (also abbreviated as MRgFUS, or HiFU) and deep brain stimulation (DBS).  

To perform the DBS technique, a surgeon puts a long, thin electrical probe into the thalamus, which is the part of the brain causing the tremors. The probe connects to a small device implanted in the chest that sends electrical pulses to the thalamus, which interrupts the signals from the brain that cause tremors. 

Focused ultrasound thalamotomy is an incisionless procedure that uses sound waves to destroy the tissue in the thalamus that causes the tremors. 

The differences between HiFu and DBS include:

Causes and Risk Factors

Essential tremor is a neurologic disorder, which means it is caused by a miscommunication between nerve cells in the brain. Although the exact cause is unknown, there is probably a genetic component. Between 30% and 70% of patients have a family history of benign essential tremor, referred to as familial tremor.

Support

Norton Neuroscience Institute is committed to being there for you, from neurologic disorder diagnosis through treatment and beyond. Our patient resource centers provide education, health information, referrals, classes and more at no cost for Norton Neuroscience Institute patients.

Reviewed by Abigail J. Rao, M.D., brain and tumor neurosurgeon and  functional neurosurgeon, Norton Neuroscience Institute  

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