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Essential tremor is a nervous system condition, also known as a neurological condition, that causes involuntary and rhythmic shaking. It can affect almost any part of the body, but the trembling occurs most often in the hands, especially when doing simple tasks, such as drinking from a glass or tying shoelaces.
Essential tremor is usually not a dangerous condition, but it typically worsens over time and can be severe in some people. Other conditions don't cause essential tremor, although essential tremor is 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 symptoms:
Many people associate tremors with Parkinson's disease, but the two conditions differ in key ways:
About half the people with essential tremor appear to have an altered gene. This form is referred to as familial tremor. It isn't clear what causes essential tremor in people who don't have familial tremor.
Known risk factors for essential tremor include:
Altered gene. The inherited variety of essential tremor, known as familial tremor, is an autosomal dominant disorder. An altered gene from just one parent is needed to pass on the condition.
Anyone who has a parent with an altered gene for essential tremor has a 50% chance of developing the condition.
Essential tremor isn't life-threatening, but symptoms often worsen over time. If the tremors become severe, it might be difficult to:
Diagnosing essential tremor involves a review of your medical history, family history and symptoms and 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 symptoms. To do this, your health care provider may suggest the following tests.
In a neurological examination, your health care provider tests your nervous system functioning, including checking your:
Blood and urine may be tested for several factors, including:
To evaluate the tremor itself, your health care provider may ask you to:
A health care provider who still is not sure if a tremor is essential tremor or Parkinson's disease might order a dopamine transporter scan. This scan can help the provider 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 health care provider.
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 the fingers. If Botox is used to treat voice tremors, it can cause a hoarse voice and difficulty swallowing.
Health care providers 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:
A wearable electronic peripheral nerve stimulation device (Cala Trio) is a newer treatment option for people with essential tremor. The device, which can be worn as a wristband for 40 minutes twice a day, works by stimulating peripheral nerves and muscles to create a muscle response that reduces tremors. Studies have found that the device can bring some improvement for tremors.
Surgery might be an option if your tremors are severely disabling, and you don't respond to medicines.
Deep brain stimulation. This is the most common type of surgery for essential tremor. It's generally the preferred procedure in medical centers with significant experience in performing this surgery. It involves putting a long, thin electrical probe into the portion of the brain that causes the tremors, known as the thalamus. A wire from the probe runs under the skin to a pacemaker-like device called a neurostimulator that's implanted in the chest. This device transmits painless electrical pulses to interrupt signals from the thalamus that may be causing the tremors.
Side effects of deep brain stimulation 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.
Focused ultrasound thalamotomy. This noninvasive surgery involves using focused sound waves that travel through the skin and skull. The waves generate heat to destroy brain tissue in a specific area of the thalamus to stop a tremor. A surgeon uses magnetic resonance imaging to target the correct area of the brain and to be sure the sound waves are generating the exact amount of heat needed for the procedure.
Focused ultrasound thalamotomy is done on one side of the brain. The surgery affects the other side of the body from the one where it's done.
Focused ultrasound thalamotomy creates a sore that can result in permanent changes to brain function. Some people have experienced altered sensation, trouble with walking or difficulty with movement. However, most complications go away on their own or are mild enough that they don't interfere with quality of life.
To reduce or relieve tremors:
Make lifestyle changes. Use the hand less affected by tremor more often. Find ways to avoid writing with the hand affected by tremor, such as using online banking and debit cards instead of writing checks.
Try voice-activated commands on your smartphone and speech-recognition software on your computer.
For many people, essential tremor can have serious social and psychological consequences. If the effects of essential tremor make it difficult to live your life as fully as you once did, consider joining a support group.
Support groups aren't for everyone, but you might find it helpful to have the encouragement of people who understand what you're going through. Or see a counselor or social worker who can help you meet the challenges of living with essential tremor.
You'll likely start by seeing your primary care provider. Or you might be referred immediately to a doctor trained in brain and nervous system conditions, called a neurologist.
Here's some information to help you get ready for your appointment.
When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:
Take a family member or friend along, if possible, to help you remember the information you're given.
For essential tremor, some questions to ask your health care provider include:
Don't hesitate to ask other questions.
Your care provider is likely to ask you a number of questions, such as: