- By sahlhealth
- May 18, 2021
- 65 views
Essential tremor is a nervous system (neurological) disorder that causes involuntary and rhythmic shaking. It can affect almost any part of your body, but the trembling occurs most often in your hands — especially when you do simple tasks, such as drinking from a glass or tying shoelaces.
It's usually not a dangerous condition, but essential tremor typically worsens over time and can be severe in some people. Other conditions don't cause essential tremor, although it's sometimes confused with Parkinson's disease.
Essential tremor can occur at any age but is most common in people age 40 and older.
Essential tremor signs and symptoms:
Begin gradually, usually on one side of the body
Worsen with movement
Usually occur in the hands first, affecting one hand or both hands
Can include a "yes-yes" or "no-no" motion of the head
May be aggravated by emotional stress, fatigue, caffeine or temperature extremes
Essential tremor vs. Parkinson's disease
Many people associate tremors with Parkinson's disease, but the two conditions differ in key ways:
Timing of tremors. Essential tremor of the hands usually occurs when you use your hands. Tremors from Parkinson's disease are most prominent when your hands are at your sides or resting in your lap.
Associated conditions. Essential tremor doesn't cause other health problems, but Parkinson's disease is associated with stooped posture, slow movement and shuffling gait. However, people with essential tremor sometimes develop other neurological signs and symptoms, such as an unsteady gait (ataxia).
Parts of body affected. Essential tremor mainly involves your hands, head and voice. Parkinson's disease tremors usually start in your hands, and can affect your legs, chin and other parts of your body.
Diagnosing essential tremor involves reviewing your medical history, family history and symptoms and conducting a physical examination.
There are no medical tests to diagnose essential tremor. Diagnosing it is often a matter of ruling out other conditions that could be causing your symptoms. To do this, your doctor may suggest the following tests:
In a neurological examination, your doctor surveys your nervous system functioning, including checking your:
Muscle strength and tone
Ability to feel certain sensations
Posture and coordination
Your blood and urine may be tested for several factors, including:
Drug side effects
Levels of chemicals that may cause tremor
To evaluate the tremor itself, your doctor may ask you to:
Drink from a glass
Hold your arms outstretched
Draw a spiral
If your doctor is still unsure if your tremor is essential tremor or Parkinson's disease, he or she might order a dopamine transporter scan. This can tell the difference between the two types of tremor.
Some people with essential tremor don't require treatment if their symptoms are mild. But if your essential tremor is making it difficult to work or perform daily activities, discuss treatment options with your doctor.
Beta blockers. Normally used to treat high blood pressure, beta blockers such as propranolol (Inderal) help relieve tremors in some people. Beta blockers may not be an option if you have asthma or certain heart problems. Side effects may include fatigue, lightheadedness or heart problems.
Anti-seizure medications. Epilepsy drugs, such as primidone (Mysoline), may be effective in people who don't respond to beta blockers. Other medications that might be prescribed include gabapentin (Gralise, Neurontin) and topiramate (Topamax, Qudexy XR). Side effects include drowsiness and nausea, which usually disappear within a short time.
Tranquilizers. Doctors may use drugs such as alprazolam (Xanax) and clonazepam (Klonopin) to treat people for whom tension or anxiety worsens tremors. Side effects can include fatigue or mild sedation. These medications should be used with caution because they can be habit-forming.
OnabotulinumtoxinA (Botox) injections. Botox injections might be useful in treating some types of tremors, especially head and voice tremors. Botox injections can improve tremors for up to three months at a time.
However, if Botox is used to treat hand tremors, it can cause weakness in your fingers. If it's used to treat voice tremors, it can cause a hoarse voice and difficulty swallowing.
Doctors might suggest physical or occupational therapy. Physical therapists can teach you exercises to improve your muscle strength, control and coordination.
Occupational therapists can help you adapt to living with essential tremor. Therapists might suggest adaptive devices to reduce the effect of tremors on your daily activities, including:
Heavier glasses and utensils
Wider, heavier writing tools, such as wide-grip pens
Deep brain stimulation might be an option if your tremors are severely disabling and you don't respond to medications.
In deep brain stimulation, doctors insert a long, thin electrical probe into the portion of your brain that causes your tremors (thalamus). A wire from the probe runs under your skin to a pacemaker-like device (neurostimulator) implanted in your chest. This device transmits painless electrical pulses to interrupt signals from your thalamus that may be causing your tremors.
Side effects of surgery can include equipment malfunction; problems with motor control, speech or balance; headaches; and weakness. Side effects often go away after some time or adjustment of the device.
About half of essential tremor cases appear to result from a genetic mutation, although a specific gene hasn't been identified. This form is referred to as familial tremor. It isn't clear what causes essential tremor in people without a known genetic mutation.
Known risk factors for essential tremor include:
Genetic mutation. The inherited variety of essential tremor (familial tremor) is an autosomal dominant disorder. A defective gene from just one parent is needed to pass on the condition.
If you have a parent with a genetic mutation for essential tremor, you have a 50 percent chance of developing the disorder yourself.
Age. Essential tremor is more common in people age 40 and older.
Essential tremor isn't life-threatening, but symptoms often worsen over time. If the tremors become severe, you might find it difficult to:
Hold a cup or glass without spilling
Put on makeup or shave
Talk, if your voice box or tongue is affected