Essential tremor

Essential tremor is a movement disorder characterized by shaking that you can't control. Such a tremor is involuntary, small repetitive, rhythmic shaking or twitching. The condition is sometimes called benign essential tremor.

Essential tremor may start in the hand or fingers. The shaking may increase or spread to other parts of the body over time, such as the head, feet or torso. Essential tremor doesn't cause other health problems, but it can make completing everyday activities more difficult. For instance, your hand or fingers may shake when you lift a cup or point at something. Or your voice may shake when you speak.

If you have questions about your neurological health or need expert care for essential tremor, the Parkview neuroscience team can help. Ask your primary care physician if a referral would be appropriate for you.

For more information, call 260-217-4379.

More on symptoms of essential tremor

The main symptom is small tremors that you can't control. It could be on one side of your body or both. It usually starts in the hands but can be in the arms, legs, head, or torso. It can make your voice shaky and could affect the way you walk.

Over time, some people may also develop feelings of depression or anxiety. Some individuals will also have trouble with memory or with planning and making decisions.

The shaking caused by essential tremor only occurs when a person moves, unlike Parkinson’s disease which causes tremors while individuals are at rest.

How is essential tremor diagnosed?

There is no one test to diagnose essential tremor. Your doctor may ask about your family history and how long you've had the shaking. Your doctor will watch how you move and check your muscle strength and reflexes. You may have lab or imaging tests to see if something else is causing your symptoms.

Treatment options

Some people may not need treatment for essential tremor. If you are self-conscious about your tremors, there are some things you can do to reduce them or make them less noticeable. Talk with your doctor about treatment options and the best treatment plan for you.

Medication

Medications are the most common treatment for movement disorders, like essential tremor.

Medicine is usually started when your symptoms become disabling or disrupt your daily activities. Although medicines often improve symptoms, they also may cause side effects. It may take some time to find the best combination of medicines for you.

Several medicines may be used at different stages of the disease. They include:

Beta-blockers
Primidone
Topamax

Because symptoms change as the disease progresses, your doctor will adjust your medicine to deal with symptoms as they appear.

Focused ultrasound

If you have not responded to medication, focused ultrasound is an incision-free, non-invasive outpatient procedure that may help reduce your symptoms. Using sound waves guided by MRI, a focused ultrasound targets and ablates tissue without incisions or permanent implants. This treatment method presents little to no risk of infection and you will typically go home the same day.

Learn more about focused ultrasound treatment

Physical or occupational therapy

A physical therapist can help you learn exercises and stretches to do at home to improve your posture, strength, flexibility and endurance.

A physical or occupational therapist can also help you to:

Plan more efficient movements for activities you do every day, such as bathing and dressing, so that these activities are easier and less tiring
Improve your balance and walking
Use walking aids (such as canes or walkers) correctly

Less invasive treatments

Several treatments for Essential tremor are considered less invasive than surgery. These include:

MRI ultrasound lesioning
Radiosurgery lesioning

Your neurologist can determine if you are a candidate for these treatment options.

Surgery

Brain surgery to treat essential tremor may be considered when medications:

No longer control symptoms
Cause severe or disabling side effects

Like other treatment options, surgery isn't a cure. Surgery should not be considered a replacement for medications either. Medications are usually still needed after surgery, although you likely would not need as much medicine as before. This means you may have fewer side effects.

The types of surgery include:

Deep brain stimulation, which uses electrical impulses to stimulate a target area in the brain.
Pallidotomy and thalamotomy are procedures that involve precisely altering a very small area in a deep part of the brain that causes symptoms.

Not everyone is a good candidate for surgery. People who have very advanced essential tremor or who have other serious health problems usually aren't good candidates for surgery. Your physician will discuss all treatment options to help you determine the best treatment for you.

Living with essential tremor

Some things can affect how much you shake. For example, drinking or eating something with caffeine may make tremors worse for a while. Some medicines also can increase tremors. These include antidepressants and thyroid replacements. Talk to your doctor if you think one of your medicines makes your tremors worse.

How can you care for benign essential tremor?

Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. Some medicines that help control tremors must be taken every day, even if you are not having tremors. You will get more details on the specific medicines your doctor prescribes.
Get plenty of rest.
Eat a balanced, healthy diet.
Try to reduce stress. Regular exercise and massages may help.
Limit alcohol. Heavy drinking can make your tremors worse.
Avoid drinks or foods with caffeine if they make your tremors worse. These include tea, cola, coffee and chocolate.
Wear a heavy bracelet or watch. This adds a little weight to your hand. The extra weight may reduce tremors.
Drink from cups or glasses that are only half full. You may also want to try drinking with a straw.

When to call about essential tremor

Watch closely for changes in your health, and contact your doctor if:

You notice your tremors are getting worse.
You can’t do your everyday activities because of your tremors.
You are sad or embarrassed about your shaking.