Essential Tremor

What is essential tremor?

Tremors are rhythmic shaking movements of the hands, lower arms, or head. Essential tremor is not a signal or warning of any serious disease. It is very different from the tremors caused by Parkinson’s disease. Sometimes it is called benign essential tremor. If you have a family history of tremor it may be called familial tremor.

If you have a tremor from some medical problem, like a stroke, the tremor is called a secondary tremor or a post-stroke tremor. It is not an essential tremor.

How does it occur?

Tremors result from muscle contractions you cannot control. The cause of essential tremor is not known.

Anxiety may make the tremor worse.

What are the symptoms?

Essential tremor usually involves 2 or 3 of the following symptoms:

• shaking of the head
• an unsteady quality of the voice
• shaking of the lower or upper arms.

Unless an essential tremor is very severe, your hand or arm does not shake when it is resting. However, your hand or arm does shake when you move it to do something. This is called an intention type of tremor. It is the opposite of a Parkinsonian tremor. A Parkinsonian tremor is called a resting tremor because the shaking occurs mostly when the hand or arm is at rest.

How is it diagnosed?

There is no special test for diagnosing essential tremor. Your healthcare provider will base the diagnosis on your symptoms, medical history, and a physical exam.

Your provider will want to know if you have ever had a stroke because some types of stroke can cause tremor. A few drugs, such as amiodarone, and toxic metals can also cause tremor. Your provider will ask about all of the medicines you are taking and any exposures you may have had to toxic heavy metals.

How is it treated?

Most people who have essential tremor do not need treatment. If the tremor is interfering with your life or becoming socially upsetting to you, your healthcare provider may prescribe a medicine that slows the tremor.

Two of the more useful medicines for reducing tremor are:

• propranolol, which is a type of medicine called a beta blocker and is also used for high blood pressure
• primidone, which is an anti-seizure medicine that also works to reduce tremor

Sometimes the 2 medicines are combined for treatment.

Other medicines that help somewhat less are gabapentin, topiramate, and drugs like Valium or Xanax (benzodiazepines).

None of the medicines available will make the tremor go away completely. For some people they do not help at all. The medicines can cause serious side effects and must be used with caution. Discuss any medicine (prescription, nonprescription, supplements, or natural remedies) with your healthcare provider.

If an intention tremor is very disabling, your healthcare provider may suggest that you see a neurologist or rehab medicine specialist.

Shots of botulinum toxin (Botox) have been tried as a treatment for essential tremor. Botox does slow the tremor. However, it has not yet been shown to be more helpful than the medicines that have been used to treat tremor.

A possible treatment for severe essential tremor is deep-brain stimulation (DBS). DBS uses a surgically implanted, battery-operated medical device called a neurostimulator. The device is similar to a heart pacemaker. It uses thin wires (electrodes) to deliver electrical impulses to targeted areas in the brain that control movement. The electrical impulses can block the abnormal nerve signals that cause tremors. This treatment may help if a tremor is severe and disabling. DBS is done only in specialized centers because it is very complex treatment.

How long do the effects last?

Because no cure has been found yet, you are likely to keep having the tremor.

What can I do to take care of myself?

• Try to learn more about the responses of your body. For example, are there times of day or situations when your tremors are worse? Do they seem to be affected by any medicines you are taking? Share this information at your next office visit.
• Be aware of safety issues if your tremor is not well-controlled. Examples include cigarette hazards and spilling hot liquids on yourself.
• Avoid caffeine because it could make the tremor worse.
• Many people with essential tremor have found that alcohol helps decrease the tremor. However, alcohol should not be used to help control your tremor. You would have to use too much, too often.