What Is Essential Tremor?
Essential tremor (ET) is one of the most common movement disorders. Also known as benign essential tremor, familial tremor, or hereditary tremor, essential tremor is just one of over 20 different types of tremor identified in humans.
ET is characterized by uncontrollable shaking, most commonly occurring in the hands, head, and voice, though it can also affect the torso or other parts of the body. ET is an “action-related” movement disorder — the symptoms tend to occur when the patient’s body is in motion, and the symptoms tend to disappear when the patient is relaxed. It usually affects the hands first, affecting one or both hands.
ET is caused by brain abnormalities in the area that controls movement and is not caused by an underlying disease (such as Parkinson’s). However, some medical experts consider essential tremor to be a neurodegenerative disorder.
Essential tremor is progressive, which means the symptoms may increase over time, though the disease’s progression is typically slow compared to other movement disorders.
Essential Tremor by the Numbers
- ET is the most common form of action tremor, with an estimated worldwide prevalence of 1% overall and approximately 5% in adults 60+ years of age.
- In the US, the prevalence is approximately 2.2% of the overall population, or about 2x that of ET worldwide.
- ET is found most commonly in adults over the age of 65.
- The prevalence of ET is roughly 10x the prevalence of Parkinson’s disease.
- ET generally affects men and women equally.
- More than 50% of ET cases are believed to be caused by a genetic risk factor, meaning there is a family history of ET. These cases are also known as familial tremor.
What Are the Signs and Symptoms of Essential Tremor?
- Rhythmic, uncontrollable shaking in the hands, arms, legs, torso, head, or voice
- Usually begins in the hands and worsens with movement
- While the key feature of ET is a tremor in both hands and arms, it can also include a ‘yes-yes’ nodding or ‘no-no’ shaking movement of the head
- ET symptoms typically begin gradually and are often more prominent on one side of the body
The rhythmic shaking is most noticeable when making fine hand movements, holding out one’s arms, or just making basic movements. ET symptoms tend to disappear when the hands or arms are completely relaxed. This trait is almost the exact opposite of Parkinson’s disease which tends to be most obvious when the patient’s hands are relaxed.
ET is most common among middle-aged or older adults (age 40 and above, and most commonly found in adults over 65) and affects men and women equally.
Additionally, stress, heightened emotions, exhaustion, and other situational factors may trigger ET or even make it temporarily worse.
You Are More Than Your Symptoms
Movement disorders are incredibly complex diseases affecting multiple systems in the body. At Neurology Solutions, we believe that these challenging diseases require a comprehensive approach that treats the whole patient— not a list of symptoms.
How Is Essential Tremor Diagnosed?
Even though ET is a disease of the brain, ET patients’ brain scans appear normal. To date, medical researchers have not found a gene or genes that cause Essential Tremor. However, some ET patients will nevertheless have a family history of ET, and in these cases, the ET symptoms usually start at an earlier age.
There is no diagnostic test for ET. But a blood test may uncover an underlying condition such as thyroid disease which could make the ET symptoms worse.
Are there Other Types of Tremor Besides Essential Tremor?
While ET is the most common form of tremor, there are more than 20 different types of tremor. Some of these include:
- Dystonic Tremor
This type of tremor occurs in people affected by dystonia.
- Parkinsonian Tremor
A tremor is a common symptom of Parkinson’s disease.
- Cerebellar Tremor
Cerebellar tremor is typically caused by damage to the cerebellum region of the brain caused by a disease such as multiple sclerosis, a stroke, a tumor, or a traumatic brain injury. Chronic alcoholism can also cause cerebellar tremor.
What It’s Like to Live With Essential Tremor
ET is not life-threatening — it does not shorten your lifespan.
However, people with ET can have difficulty with any activity that requires fine hand movements, such as writing, drawing, eating, or typing on a computer.
ET symptoms can be embarrassing for the patient, and eventually, even disabling as the disease symptoms can make it difficult or even impossible for those with ET to perform work and daily life tasks.
Our Approach to Treating Essential Tremor
While there is no cure for ET, several different treatments can help ease the tremor. Some essential tremor patients benefit from using weighted utensils and cups or wearing small weights attached to their wrists. Some patients benefit from medications such as beta-blockers (propranolol) or anti-seizure drugs (primidone, gabapentin, topiramate, and clonazepam). Sometimes, an ET patient can benefit from cutting back on caffeine or other stimulants or discontinuing the use of tremor-producing medications.
Botulinum toxin can be an effective treatment for Essential Tremor, especially for patients with head or voice tremor. The botulinum toxin is injected into the muscles that cause the tremor which weakens the muscles, thus reducing the severity of the tremor. These injections can last for several months and must be repeated two to four times a year.
ET patients with severe tremor may consider surgical procedures to treat their disease. There are several different types of surgical procedures used for ET cases, including:
- Deep Brain Stimulation (DBS)
- Thalamotomy via Focused Ultrasound
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