Learn about essential tremor, including symptoms, causes, and effective treatment.
Essential Tremor: Overview
Essential tremor (ET) is the most common movement disorder in the United States, characterized by involuntary and rhythmic shaking. While not life-threatening, this condition can have a significant impact on an individual’s quality of life. The symptoms, causes and treatment options for essential tremor are summarized below.
Symptoms of Essential Tremor
Essential tremor is characterized by involuntary shaking. While essential tremor can affect almost any part of the body, trembling is most often present in the hands. Learn more about the full range of symptoms of essential tremor.
The most commonly observed symptom of essential tremor is a rhythmic, involuntary shaking. The symptoms of essential tremor generally appear gradually, and in some individuals, may be more prominent on one side of the body. Many who are diagnosed with essential tremor notice symptoms in the hands first, but a slight shaking motion of the head may be noticed as well. Ultimately, this shaking may affect an individual’s hands, arms, legs, torso, or head.
Difficulty with Daily Tasks
The involuntary shaking associated with essential tremor can make it difficult for individuals to complete daily tasks, such as eating with utensils or drinking from a cup. Writing, drawing, and computer work can also be difficult. In addition, those with essential tremor may experience a shaky voice, as this condition can affect the voice box.
Comparing Symptoms: Essential Tremor Vs. Parkinson’s Disease
Essential tremor is often confused with Parkinson’s disease, but essential tremor is actually eight times more common than Parkinson’s Disease, affecting an estimated 7 million people in the U.S. While both essential tremor and Parkinson’s disease are movement disorders, meaning both interfere with an individual’s movement, there are key differences:
Essential tremor is characterized by a rhythmic, involuntary shaking, which affect the hands, head, torso and legs. Essential Tremor can also be known as postural or action tremor, which refers to tremor that occurs when someone holds up a part of the body against the force of gravity, for example, holding an arm out in front of the body. Most types of tremor are considered action tremor.
Unlike essential tremor, Parkinson's disease is also associated with numerous problems such as poor balance, difficulty swallowing, and stooped posture. Those with Parkinson's disease may experience resting tremor or action tremor. Resting tremor refers to a tremor that occurs when the body part is at rest. For example, resting tremor can be seen in a hand while someone is seated and the hand is resting on the thigh. Patients with both Essential Tremor and Parkinson’s disease often present with tremors during muscle contractions, including during intentional activities such as outstretched hands (postural tremors) and when hands are in motion during tasks (kinetic tremors).
Causes of Essential Tremor
The cause of essential tremor is not known, and this neurological disorder is not associated with any particular disease. However, some medical experts speculate that the following factors may contribute to this condition:
Essential tremor can be passed through generations in families, which is why essential tremor is sometimes called familial tremor. While the inheritance pattern for essential tremor can vary, if you have a parent with a genetic mutation for essential tremor, you have a 50% chance of developing the disorder yourself.
Essential tremor is not limited to those with family history, however. Some individuals who begin to show symptoms of this neurological disorder have no known previous family history of the disorder. In these instances, essential tremor appears to occur spontaneously for unknown reasons.
Essential tremor is more common in people aged 40 and older, but essential tremor may affect anyone of any age, including children. Also, if the essential tremor is inherited, its effects may appear earlier in life. Age is also related to the progression of this disorder. In general, as an individual ages, tremor frequency (the speed of the tremor shakes) may be reduced; however, the severity of the tremor will actually increase.
There are many lifestyle factors that health experts have found can worsen essential tremors. These factors include:
- Physical and mental stress
- Extreme temperatures
- Caffeinated drinks
- Excessive alcohol intake
- Cigarettes and tobacco
Health experts say that taking actions to avoid these behaviors or conditions may help improve the severity of your essential tremor symptoms. Stress reduction has also been observed to notably reduce the symptoms of essential tremor.
If you believe you have essential tremor, or you’re dealing with new unexplained, involuntary shaking, please consult your doctor for an essential tremor evaluation. Your primary care provider will likely refer you to a neurologist with specialized training in brain and nervous system conditions for a complete diagnosis. There are no definitive tests to diagnose essential tremor. However, your doctor or neurologist may begin your diagnosis by running tests to rule out other conditions that may be causing your symptoms. Potential tests may include neurological, lab, and performance-based options.
Your health care professional may perform a series of neurological tests in order to rule out other disorders. During your neurological examination, your doctor may test your:
- Ability to feel certain sensations
- Tendon reflexes
- Muscle strength and tone
These tests may help rule out other movement conditions such as Parkinson’s Disease, and help your doctor understand the extent of your symptoms.
To rule out other possible ailments, your doctor may run laboratory tests on both blood and urine for the following conditions:
- Thyroid disease
- Metabolic problems
- Drug reactions
- Chemical imbalances
To analyze the presence and severity of the tremor, your doctor may ask you to perform the following tasks:
- Drink from a glass
- Hold your arms outstretched
- Draw a spiral
These tasks will allow your health care provider to examine the extent and severity of your symptoms, and may help them further rule out underlying causes.
Treatment & Therapy for Essential Tremor
While particularly mild cases of essential tremor may not require treatment, severe cases can affect a person’s ability to eat, drink, speak, draw, or write. Individuals who find their tremor impacts daily life can benefit significantly from treatment and therapy.
Groundbreaking new technologies have given those with essential tremor new treatment options. Cala Trio offers personalized therapy for hand tremor by delivering electrical stimulation to nerves in the wrist. These nerves project from the wrist to central brain networks that are responsible for generating hand tremor in essential tremor.
Stimulation of the nerves in the wrist is thought to disrupt the network activity causing hand tremor. This disruption can provide temporary and meaningful tremor reduction in the hand that undergoes treatment. The wristband is calibrated to your unique tremor pattern. Learn more about Cala Trio by reading this essential tremor therapy information for healthcare patients.
Essential tremor affects every person differently. Our individualized approach to treatment and therapy can help you address the source of your tremor. If you’re interested in incorporating Cala Trio™ therapy into your essential tremor treatment plan, get started with essential tremor therapy. Our wristband is available by prescription only, so reach out to your doctor today.
If you are in the medical field and interested in offering Cala Trio* to your patients, check out this essential tremor therapy information for healthcare professionals.
Certain lifestyle factors have been observed to increase the severity of tremors. Taking steps to form healthy habits and avoid negative lifestyle factors can help decrease the symptoms of tremors.
What to avoid:
- Avoid caffeine, tobacco, and excessive alcohol intake: These substances have been observed to increase the severity of essential tremor symptoms.
- Avoid stressful situations: Stress has also been observed to have a significant impact on the severity of essential tremor. In order to mitigate your symptoms, avoid placing yourself in stressful situations.
What to adopt:
Practice relaxation techniques: Techniques such as deep breathing can help control the effects of stress, which may in turn mitigate the severity of your essential tremor symptoms.
Consider timing: If you find your tremors are worse at particular parts of the day, try to finish necessary tasks during other windows of time.
Assistive devices: Therapists may suggest that those with essential tremor use assistive devices such as heavy glasses and utensils, wrist weights, and heavy pens to reduce the effect of tremors on daily activities.
When essential tremor significantly interferes with an individual’s daily activities, doctors may prescribe drug treatment. The drugs most commonly prescribed for essential tremor include:
This is the most commonly prescribed type of medication for essential tremor. Generally used to treat high blood pressure, beta-blockers such as propranolol have been shown to relieve tremors in some individuals; however, they are not a good option for those with heart problems or asthma, and can come with significant side effects.
These drugs are designed to treat epilepsy, and have been prescribed to individuals with essential tremor who don’t experience relief from beta-blockers. As with any medication, these can come with significant side effects.
Individuals who experience worsened tremors as a result of tension or anxiety may be prescribed benzodiazepine drugs. These medications are habit-forming and can cause side effects including sedation and fatigue.
Those who suffer from severe head and voice tremors may be prescribed onabotulinumtoxinA (Botox), as it may improve tremors for a few months at a time. However, depending on injection placement, use of Botox for tremors has been observed to cause weakness in the fingers and may affect your voice.
Medication is not always the optimal solution, and its efficacy varies by individual. These drugs work systemically, not tailored to essential tremor. Beyond their inherent side effects, these drugs can interact with existing medications.
Some health care professionals may suggest physical therapy to help individuals improve their coordination, build muscle strength, and enhance control. Generally, physical therapy for essential tremor is focused on resistance training. This resistance training is typically performed on the upper extremity in order to build strength and coordination.
If your tremor proves to be significantly disabling, and your symptoms are unresponsive to other treatment types, you may qualify for surgery. However, surgical procedures come with heightened risk and are typically only recommended in the most severe instances of essential tremor.
Currently, there are two main types of surgical procedures used to treat essential tremor:
Deep Brain Stimulation (DBS):
This minimally invasive surgical procedure uses a neurostimulation device to deliver electrical pulses to specific locations in the brain that are thought to be the cause of the tremor. These electrical pulses block abnormal activity in the brain, allowing the brain to function more normally. The device is placed under the collarbone, and connected to a wire implanted under the skin that runs up into the scalp — it is then guided to the brain through a small hole made in the skull. It is the tip of this wire that sends the electrical impulses.
This procedure is completed in two phases:
- First stage: the electrode is placed into the brain while the patient is awake or asleep. Correct placement of the electrode is ensured by monitoring brain activity or by using a portable computed tomography machine.
- Second stage: the patient is put under anesthesia, and the neurotransmitters are placed under the collarbone.
This surgery does come with risks, which include:
- Brain hemorrhage, including stroke
- Device malfunction
- Lack of benefit for essential tremor symptoms
- Worsening mental or emotional status
Introduced in 2016, this focused ultrasound procedure uses magnetic resonance imaging (MRI) to designate the exact location in the brain where tremors originate. Doctors then use MRI guidance to focus ultrasound waves on that location. The patient is kept awake throughout the procedure and fitted with a helmet that passes ultrasound waves into the brain. The device measures temperature throughout the brain, ensuring that only the perfect amount of energy hits the target in the brain, eliminating or reducing the tremor.
Because this procedure uses ultrasound energy, there aren’t radiation-related risks. However, this procedure creates a lesion that can result in permanent changes to brain function, which may result in:
- Muscle weakness
- Sensory loss
- Numbness or tingling in extremities
Surgery is only advised for patients that meet specific criteria, and non-invasive therapies are typically preferred before pursuing these treatment options.
Support Groups for Essential Tremor
Essential tremor can make daily life challenging, and it’s important to feel supported when dealing with this sometimes debilitating condition. As with any neurological condition, essential tremor can have a significant social and psychological impact on individuals. However, you’re not alone — and it’s important to seek out support when needed. There are essential tremor support groups in communities across the country that can help those with ET deal with the stress and daily toll of this neurological condition.
Frequently Asked Questions
Read answers to some of the most frequently asked questions about essential tremor below.
For more readings and research on essential tremor and its effects, visit:
We want to make sure that all people living with essential tremor can understand the research we fund and conduct. Our goal is to give you the information needed to help you understand and manage your tremors. To learn more visit Clinical Research Summary.