Essential Tremor: Essential Facts for Patients

What Is It?

Essential tremor (ET) is the most common movement disorder. It is also known as benign essential tremor, familial tremor, or hereditary tremor.  Patients with ET may experience uncontrollable shaking (tremor) in the hands, head, voice, or other body parts. The condi­tion usually begins as an adult and may gradually become worse with age. Tremor is typically most noticeable when holding the hands outstretched or making fine hand movements, such as holding a cup, using a spoon, or writing. The tremor usually stops if the hands/arms are completely relaxed, such as when resting in the lap. Stress often makes the tremor temporarily worse.
 

What Is the Cause?

The cause of ET is unknown, but more than half of patients have another family member with tremor. Researchers have not found the gene(s) that cause ET. For patients with a family history of ET, symptoms tend to begin at an earlier age. Researchers think ET develops in the brain, but patients’ brain scans appear normal.

There is no diagnostic test for ET. However, your doctor may test your blood for other conditions such as thyroid disease that could worsen the tremor. Some medications may also worsen tremor.
 

Is There a Treatment?

There is effective treatment to lessen the tremor, but there is no cure. Using weighted cups, uten­sils, and even wearing small wrist weights can help some patients. Some patients may benefit from medications. Medications are usually given on a trial-and-error basis. Some work better than others depending on the individual patient. Medications that may help include:

• Beta-blockers, such as propranolol
• Anti-seizure medications, such as primidone, gabapentin, topiramate, and clonazepam

Your doctor may suggest cutting back on caffeine, other stimulants, and some tremor-producing medications. Patients with certain types of tremor may benefit from botulinum toxin injections.  Botulinum toxin is injected into the muscles that cause the tremor, temporarily weakening the muscle to reduce the tremor. These injections must be repeated two to four times per year and are most effective for patients with head or voice tremor.

Although medical treatment may help some patients with tremor, and should be tried first, those with severe tremor may consider a surgical procedure.  Your neu­rologist can advise you on the most appropriate treatment options for your condition. There is more than one type of surgery for ET, they are:

• Thalamotomy: a type of brain surgery where one part of the brain, the thalamus, is destroyed
• Deep Brain Stimulation (DBS): another type of thalamus surgery where a thin wire (also called an electrode) is placed into the thalamus and connected to a pacemaker-like device under the skin in the chest
• Other surgical procedures
   

Is Essential Tremor a Form of Parkinson’s Disease?

No. ET is about 10 times more common than Parkin­son’s disease (PD). Unlike ET, the hand tremor of PD is most obvious when a patient’s hands are relaxed and not when they are being used for activities. Other signs of PD, but not ET, include slowness of move­ment, walking difficulties, and other exam findings.
 

What Can I Expect as I Live with ET?

ET does not shorten your life expectancy. Tremor may increase over time, but the change is usually slow, typically over many years. Eventually some patients may experience a degree of disability, such as difficulty writing, eating, and drinking or even embarrassment. Mild tremor does not typically require treatment, and early treatment does not stop or slow the symptoms’ natural changes. Only consider starting medication treatment when the tremor affects your daily activities or causes problems for you.

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