What You Can Do About Essential Tremor

Chances are you’ve seen someone with a rhythmic shaking of the hands, arms or head. Sometimes the shaking even affects a person’s voice. This neurological disorder is called essential tremor. It’s the most common type of movement disorder, affecting an estimated 10 million Americans. It can be barely noticeable or become disruptive to daily activities and social interactions.

The tremor shows up when you’re doing activities liking holding up a newspaper to read, eating, drinking or writing. It tends to get worse if you are stressed or fatigued. It’s thought to be caused by abnormal signals being sent from various parts of your brain to your muscles.

Essential tremor is some sort of neurochemical disturbance, but doctors don’t know exactly what causes it.

Essential tremor can develop in anyone, but in many cases, the disorder runs in families. If one of your parents has it, you have a 50 percent chance of inheriting it. Essential tremor most commonly affects people age 40 and above.

Essential tremor often can be confused with other conditions, so getting the right diagnosis is important.

Diagnosing Essential Tremor

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Essential tremor often can be confused with other conditions, so getting the right diagnosis is important.

Doctors diagnose essential tremor by doing a complete neurological and physical exam. They may order a brain MRI and blood tests for further information.

If you develop a tremor,  seek medical advice to rule out other causes of tremor such as thyroid abnormalities and electrolyte abnormalities. Your doctor can make sure that other medications are not causing the tremor. In addition, your doctor can rule out Parkinson's disease, as well as dystonia (a movement disorder with involuntary muscle contractions). 

Significant differences between Parkinson’s disease and essential tremor include:

  • Essential tremor most commonly affects people when they’re performing different actions or holding particular postures, whereas Parkinson’s movements generally occur while your hands are at rest.
  • People with essential tremor perform tasks at a normal rate and people with Parkinson’s usually move slowly.
  • Those with essential tremor generally don’t have stiffness, trouble walking or trouble with balance, as people with Parkinson’s do.

Treatment Options

There isn’t a single, definitive treatment for essential tremor, which can be mild or severe. The tremor tends to worsen over time. Doctors aim for the least invasive treatment that offers the best result for relieving embarrassment and self-consciousness and allows you to function most normally in your daily life.

Non-medical approaches to treating essential tremor include weighting the arms with wrist weights, and using weighted utensils or a weighted pen to reduce the tremor and improve function. Relaxation techniques and biofeedback can help those whose tremor is worsened by anxiety. Avoiding certain medicines and caffeine also may help.

Essential tremor is primarily treated with propranolol and primidone, which are the most recommended medications by the American Academy of Neurology for treatment of essential tremor. Primidone is an old seizure medication, and propranolol is a beta blocker, so they work fairly well, but not 100 percent for essential tremor.

There are other helpful medications, such as antiseizure medicines and tranquilizers, plus botulinum toxin (Botox) injections. Botox can be used to calm down the muscles to reduce hand or head shaking.

For more severe cases of tremor, surgery is an option that has proven effective in reducing tremor. Between 80 and 90 percent of people who undergo surgery to halt a source of abnormal brain activity find improved function by reducing the tremor.

Another treatment option is deep brain stimulation, which has been FDA-approved for over 20 years. Deep brain stimulation involves putting a lead, which is a small electrode, into the thalamus in the brain, which helps basically normalize the electrical activity.

A wire is implanted under the skin, and then behind the ear. This connects to a pacemaker, which goes under the skin in the patient's chest area. The pacemaker helps deliver electrical impulses to that lead in the patient's brain to help cancel out the tremor. An individual typically comes back several times in the first few months to get the stimulator programmed optimally.

Deep brain stimulation can be highly effective in helping someone with tremor. It is basically for someone who has a refractory tremor that does not respond well to medications. Some patients have 100 percent tremor control, and other patients have somewhere in the 90th percentile tremor control.

One of the latest surgical approaches for essential tremor can be accomplished without incisions. High-frequency ultrasound treatment, recently approved, uses precisely targeted heat from ultrasound waves to destroy cells in the thalamus that are causing tremors. Researchers are still collecting data on its long-term success.