Essential tremor

Essential tremor is a non-dangerous neurological disorder that causes a rhythmic shaking in almost any part of your body, but it occurs mostly in your hands, especially when you do such simple tasks as holding a glass, tying shoelaces, shaving or writing. It may also affect your head, voice, legs and arms. It is not caused by other diseases (although it may be mistaken for Parkinson’s disease) and it can emerge at any age but is most common in people age 40 and older. Essential tremor does worsen over time.

Essential tremor begins gradually, usually in one or both hands. If it is affecting your head, it may seem like you are shaking it up and down in a “yes” motion or side to side in a “no” motion. Voluntary movement can trigger essential tremor or make it more exaggerated. Emotional stress, fatigue, caffeine and extremes of temperature can aggravate your condition. Essential tremor has a characteristic frequency of 4‒7 cycles per second, higher than that you see in Parkinson’s disease.

Essential tremor is different from Parkinson's disease is three distinct ways:

• Essential tremor of the hands usually occurs when you use your hands; with Parkinson’s disease, hand tremors occur when your hands are at rest.
• Essential tremor does not cause other health conditions or problems; Parkinson’s disease may cause stooped posture, shuffling gait and unsteady, slow movement.
• Essential tremor typically involves your hands, head and voice; Parkinson’s disease tremors may affect other parts of the body.

About half of essential tremor cases are called familial tremors and they appear to result from a genetic mutation. It is an autosomal dominant disorder that takes only a single defective gene from just one parent to pass on the condition; if you have the genetic mutation and your spouse does not, the chance that your child will inherit the condition is 50 percent. We do not know what causes essential tremor in people without a known genetic mutation .

Diagnosis  of Essential Tremor 
To diagnose essential tremor, our team will review your medical and family history and symptoms and conduct a physical examination. Since there are no specific tests to diagnose this condition, we will rule out other conditions that may be causing these symptoms by asking you to take a neurological exam and some performance tests. The neurological exam will check your nervous system functions including tendon reflexes, muscle tone and strength, ability to feel certain sensations, posture, coordination and gait. The performance tests will determine how well you can drink from a glass, hold your arms outstretched, write and draw a spiral.

We will test your blood and urine for thyroid disease, metabolic conditions, and drug, chemical and alcohol levels.

Treatment Options  for Essential Tremor
If your symptoms are mild, you may not require treatment. If you do require help with work or home activities, there are several options we can offer, including medications, therapy, surgery and lifestyle changes. 

The medications available to help you cope with essential tremor include beta blockers, antiseizure and epilepsy drugs, tranquilizers and botulinum toxin (Botox®) injections.

We may recommend you participate in physical or occupational therapy.

Surgical options include deep brain stimulation. A thin probe is inserted into your thalamus and a wire runs from the probe to a neurostimulator device implanted in your chest. The device sends electrical impulses to interrupt the signals that may be causing your tremors.

We may suggest such lifestyle changes as restricting or eliminating caffeine and alcohol, using heavier drinking glasses and utensils, wearing wrist weights, using wider writing pens and learning and practicing stress and anxiety reducing techniques.