Essential Tremor

For most people with essential tremor, symptoms begin gradually. The main symptom is trembling or shaking of the hands and arms when you use them. The shaking is involuntary, meaning you aren’t trying to shake and you can’t stop it. The tremor may worsen with fatigue, stress, caffeine, low blood sugar, nicotine, and temperature extremes. Rest tends to improve the tremor. Usually, essential tremor causes tremor in the hands and arms on both sides. However, it may be more predominant on one side.

Essential tremor can affect other body parts, including the head and jaw. Other essential tremor symptoms include:

• Ataxia, which is uncoordinated movements leading to balance and gait problems

• Head tremor causing nodding or shaking

• Internal tremor, which people describe as a shakiness inside but that others can’t see

• Postural tremor, which occurs when you try to maintain a position against gravity, such as holding your arms outstretched

• Vocal tremor causing quivering, quavering or shaking voice

It’s common for people to mistake essential tremor for Parkinson’s disease. Most people think of Parkinson’s disease first, even though it’s much less common than essential tremor. There are key differences between the two conditions including:

• Body parts: Both conditions usually start in the hands. Essential tremor can also involve the head and voice, while Parkinson’s rarely does. Parkinson’s tremor usually affects the legs and other body parts.

• Other symptoms: Essential tremor can cause minor balance problems. But Parkinson’s disease can cause stiff legs, a shuffling gait, and a stooped posture.

• Mortality: Essential tremor usually gets more pronounced with time, but is not life threatening. Parkinson’s disease itself is not life threatening, but its complications can shorten life expectancy.

• Tremor timing: Essential tremor occurs or worsens with action, while rest reduces it. Parkinson’s tremor happens at rest and tends to improve with action.

Another key difference between the two is the effect of alcohol. Alcohol usually provides temporary relief from essential tremor. However, excessive alcohol consumption can lead to severe rebound tremor when the alcohol wears off. Alcohol has little to no effect on Parkinson’s tremor. This is often a useful observation when diagnosing the cause of tremor.

Experts do not fully understand the exact cause of essential tremor. Research suggests the problem may be with the cerebellum. The cerebellum is an area of the brain that coordinates muscle movements. In essential tremor, it may not communicate the way it should with other areas of the brain. Some studies have even shown some degeneration in the cerebellum in people with essential tremor. Scientists are working to identify which gene mutations are responsible for essential tremor and how they affect the nervous system.

Most cases of essential tremor are due to an inherited gene mutation. Research is exploring the exact genes and the way they are inherited. But most experts believe it is an autosomal dominant disorder. This means you only need one copy of the defective gene to get the condition. You inherit one copy of each gene from each of your parents. So, if one parent has essential tremor, you have a 50% chance of inheriting the gene and developing it yourself.

There may be more than one gene involved in essential tremor, because the inheritance pattern varies. Sometimes, people develop essential tremor with no family history of it. It’s also possible that environmental factors play a role

The risk of developing essential tremor also increases with age. It is possible for children to have essential tremor. But the incidence goes up after age 40.

Deciding whether or not to treat essential tremor depends on the severity of the tremor and whether it affects daily living. People with a mild tremor may not require any kind of treatment. However, they can still benefit from self-care strategies. This mainly involves avoiding things that worsen the tremor and getting adequate rest. Practicing relaxation techniques can also be helpful.

As tremors get more severe, adjustments to daily activities may be necessary. This can include strategies like using a straw to drink and large handled utensils to eat. Occupational therapists can suggest specific tactics for adapting activities. Physical therapy can also be useful to strengthen weak muscles and improve control and coordination.

Other treatment options include:

• Oral medicines, including beta blockers, tranquilizers, and antiseizure drugs. These medicines work by controlling the actions of brain chemicals called neurotransmitters.

• Botulinum toxin injections work by blocking nerve signals to muscles causing muscle relaxation. It is necessary to repeat injections every 3 to 4 months.

• Deep brain stimulation (DBS), which involves implanting a small electrode in the brain. It connects to a pulse generator implanted in the chest. DBS works kind of like a pacemaker for the heart. The pulse generator sends electrical pulses to the electrode. This interrupts the faulty brain signals that cause the tremor.

• Focused ultrasound, which is a noninvasive procedure. It uses sound waves to target and destroy a specific area of the brain and stop the tremors.

Essential tremor does not pose a serious risk to long-term health. However, it can cause complications that interfere with daily living and decrease independence. It can also cause people embarrassment. As symptoms worsen, it can become difficult or impossible to write legibly, feed yourself, and complete self-care activities. People with vocal tremors may eventually struggle to speak. Seeking regular medical care can help manage symptoms, keep you up to date on the latest treatment strategies, and maintain your quality of life.