Essential Tremor

Overview

Essential tremor is a common neurological condition which causes mild or moderate involuntary, rhythmic shaking of various parts of the body.  Though it primarily affects the hands, making simple tasks like tying a bow difficult, it can also affect the arms, feet, legs, the trunk of your body and your vocal cords. Approximately 10 million Americans live with essential tremor, which is frequently mistaken for Parkinson’s disease. Essential tremor initially appears on only one side of the body and then ultimately spreads to affect both sides of the body.

Unfortunately, due to lack of awareness, embarrassment or perceived stigma associated with the disorder, many people do not seek medical care for essential tremor. Although it is typically not considered to be a dangerous disease, essential tremor generally worsens as time goes by and can cause severe problems for some. 

Risks

Approximately 50% of essential tremor cases can be traced to a genetic cause. For the other half of all cases of essential tremor (approximately 5 million Americans), the cause is unknown.

Symptoms

Essential tremor symptoms may include:

  • Shaking, which will be noticed first in one, then in both hands
  • A slow, gradual increase in shaking over time
  • Tremors on one side of the body, then the other
  • An up-and-down "yes, yes" motion or a left-to-right, “no, no” shaking of the head
  • Increased shaking when under emotional stress or feeling fatigued
  • Affected by caffeine or environmental factors, such as extreme temperatures

Parkinson’s disease and essential tremor are two different disorders that share tremor as a major feature. The exact nature of the tremor, however, is very different and can usually be distinguished by a movement disorder specialist.

Knowing the type of tremor is important because treatments are different. A small percentage of people with essential tremor do develop some symptoms of Parkinson’s disease after many years. Most patients with essential tremor, however, do not develop Parkinson’s.

Diagnosis and testing

The process of diagnosing essential tremor begins with a comprehensive evaluation. Diagnosis of movement disorders is based on a clinical exam, a thorough assessment of your personal medical history and a detailed review of your family history. We also use a variety of screening procedures to determine your condition, although there is no single medical test to diagnose essential tremor. Your doctor will recommend a neurological examination to assess your nervous system and its ability to function properly. You may also undergo laboratory testing to establish if you are being affected by any medications and their side effects, metabolic problems, alcohol in your blood stream and levels of certain chemicals in your blood which may be causing tremors.

Other tests, such as brain scans, may be ordered by your doctor. Brain scans are imaging techniques used to diagnose a wide range of conditions affecting the brain. Types of brain scans include computed tomography (CT scan), magnetic resonance imaging (MRI scan), and positron emission tomography (PET scan).

Treatment

If you are experiencing only mild symptoms of essential tremor, you may not require treatment.  If your shaking has increased and you are experiencing difficulty in everyday tasks, your doctor will discuss treatment options with you which may include medications, therapy or surgery.

Medications for essential tremor may include:

  • Anti-seizure medications
  • Beta blockers
  • Tranquilizers
  • Botulinum toxin

Physical therapy may be recommended to sharpen your coordination, increase your muscle strength and improve your overall ability to control your movements. An occupational therapist may offer solutions to adjust to living with essential tremors.

If your tremors are severe and extremely disabling, your doctor may discuss with you the option of deep brain stimulation surgery. In this procedure, your surgeon will insert a thin electrical probe into the area of your brain which is causing the tremors. This wire is connected to a device which is similar to a pacemaker.

About two weeks after the brain surgery, the pacemakers will be turned on and programming will begin. Many patients experience very rapid improvement in many of their symptoms. Other symptoms can take a few months to improve. The programming of the pacemaker is a very individually tailored experience, so predictions of improvement vary based on the type and severity of symptoms being treated. In general, most patients experience significant improvement by six months from the date of the surgery.

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