Essential Tremor: Symptoms, Causes and Treatment Options

Essential tremor often causes shaking in the hands. Photo Courtesy: AsiaVision/iStock

Essential tremor (ET) is a nervous system condition that affects more than six million adults in the United States. It makes parts of your body shake in a rhythmic way that you can’t control. ET usually affects the hands, but it can also affect the head or voice. 

We don’t know the specific cause of ET, but it’s often passed down from parent to child. It’s easy to confuse ET with other neurological conditions, so it’s important to get the right diagnosis. ET tends to get worse over time. But the good news is that it’s not dangerous and there are treatments that can help.

What Are the Symptoms of Essential Tremor?

 Symptoms of ET usually start in older adults — it’s most common in people over age 65. Your symptoms will depend on which body part is involved:

  • Hand symptoms: When ET affects the hands, it makes your hands shake only when you try to do something, like pick up a glass or use a pencil. Your hands don’t shake when they’re at rest. And it often affects one hand more than the other.
  • Head symptoms: When ET affects your head, you make rhythmic head movements like you’re nodding your head “yes” or shaking your head “no.” 
  • Voice symptoms: When ET affects the voice, it makes your voice quiver or sound hoarse. These symptoms may make it hard for you to speak. 

ET symptoms usually get worse over time. Symptoms may also get worse at certain times, like when you:

  • Are feeling tired or stressed
  • Are in extremely hot or cold temperatures
  • Drink caffeine
  • Take certain medicines

You may find that hand shaking from ET actually decreases temporarily when you drink a small amount of alcohol.

What Causes Essential Tremor?

Most cases of ET are inherited — meaning that it’s passed down from parents to children through a gene mutation. If you have one parent with this inherited type of ET, you have a 50% chance of developing it yourself.

We don’t know the cause for non-inherited ET. And for both types of ET, experts aren’t sure exactly what makes the symptoms start. But researchers think it’s related to problems in the brain areas responsible for muscle movement.

How Do Doctors Diagnose Essential Tremor?

Your primary care doctor may diagnose you themselves, or they may send you to a neurologist (brain and nerve specialist). 

It’s easy to confuse the symptoms of ET with more serious neurological conditions, like Parkinson’s disease. But there are key differences to help tell them apart. For example, Parkinson’s affects both sides of the body equally and causes tremors when your hands are at rest. It also causes a stooped posture, slow movements and shuffling when you walk. 

Your doctor will do several tests and ask several questions to rule out Parkinson’s and other diseases and figure out if you have ET. First, they’ll ask questions about your history and symptoms. Questions may include:

  • Does anyone in your family have ET?
  • Do you drink alcohol or use other drugs or medicines that might cause shaking?
  • What parts of your body do your symptoms affect?
  • Do you shake when you’re sitting quietly, or only when you’re trying to use your hands to do something?

They’ll also ask if anything makes your symptoms worse — like caffeine, alcohol, medicines or stress. 

Then your doctor will do a physical exam, including:

  • Checking your reflexes
  • Looking at how you walk (called a gait test)
  • Checking your muscle strength, posture and coordination
  • Doing a pinprick test and other tests to check your sensation
  • Asking you to do a task, like drawing a spiral, to show your tremor movements

Your doctor may also do blood tests or other tests to check for other conditions that may cause shaking, like thyroid problems or drug side effects.

What Are the Treatments for Essential Tremor?

Essential tremors treatments include:

  • Medicines
  • Focused ultrasound therapy
  • Deep brain stimulation therapy

Learn more about each treatment option. Then talk with your doctor to decide which treatment is right for you.

Best Medicines for Essential Tremor

Your doctor can help you find the best medicine to treat your tremors. Sometimes they’ll recommend using two drugs together to get better results. Medicines to treat ET include:

  • Beta blockers like propranolol — These drugs are usually used to treat high blood pressure. They can also help with tremors, because they block certain body chemicals that contribute to shaking. These work best for ET of the hands. 
  • Epilepsy drugs like primidone — These drugs reduce symptoms by controlling the action of chemicals naturally produced by your brain.
  • Tranquilizers like Klonopin — These can ease symptoms for people whose shaking gets worse with anxiety or stress.
  • Botox — This is typically used for cosmetic treatments that reduce facial wrinkles. But it’s also useful for ET that affects the head, because it can stop overactive muscle action. 

All medicines come with risks and side effects. For example, beta blockers can cause changes in blood pressure, depression, or trouble with physical activity or sexual function. Talk with your doctor about the benefits and risks before you start taking any new medicine.

Ultrasound Treatment for Essential Tremor

Ultrasound for essential tremor is a noninvasive surgery that sends ultrasound waves through the skin and bone to targeted areas of the brain. Doctors use MRI (magnetic resonance imaging) methods to focus these waves to destroy the specific brain tissue that’s causing ET symptoms.

Because this treatment causes changes to your brain, some people have complications, like changes in your movements or sensation. But most complications are mild and they often improve with time. Discuss the risks and benefits of ultrasound treatment with your doctor, to decide if it’s right for you.

Deep Brain Stimulation for Essential Tremor

Deep brain stimulation is a surgical procedure. In this treatment, your doctor will implant a probe in the area of your brain that’s causing your ET symptoms. Then they’ll implant a device similar to a pacemaker in your chest. This device will send electronic signals to the probe in your brain to interrupt the brain signals that cause your symptoms.

Side effects of deep brain stimulation include changes in your movements, speech or balance. It can also cause headaches and weakness. If you have side effects after deep brain stimulation therapy, your doctor may be able to adjust the device to help with these problems. Side effects may also decrease on their own with time.

Talk to your doctor about the risks and benefits of deep brain stimulation.

Your Next Steps for Living with Essential Tremor

Yoga and mediation may help with essential tremor symptoms. Photo Courtesy: alvarez/iStock

If you’ve been diagnosed with ET, work with your doctor to make a treatment plan. You can also take steps at home to reduce shaking from ET. Try these tips:

  • Drink less alcohol and caffeine
  • Manage your stress with relaxation techniques like yoga or mindfulness meditation
  • Try alternative treatments like deep breathing and biofeedback

Even if your tremors get worse over time, you can find ways to manage your symptoms. Joining an ET support group can also help you learn to cope with ET.

Resource Links: