About Essential Tremor

Overview

Essential tremor, also known as tremor or shaking hands, is a neurological condition and movement disorder characterized by involuntary shaking or trembling of a specific part of the body, most commonly the hands. It is the most common movement disorder, affecting approximately 10 million people in the United States. Essential tremor typically occurs on its own without other neurological symptoms, although some individuals may experience mild balance problems. The tremors are usually present during voluntary movements and can be triggered by activities such as eating, drinking, or writing. They are often more pronounced on one side of the body and may worsen during periods of stress or fatigue. Essential tremor does not significantly shorten lifespan but can impact daily activities and quality of life. Diagnosis is made based on medical history, symptoms, and physical examination. Treatment options include lifestyle modifications, such as avoiding caffeine and stress, as well as medications like beta blockers or anti-seizure drugs for more severe symptoms.

Causes and Risk Factors

The causes of essential tremor are still not fully understood. However, faulty signaling between the nerves and muscles is believed to play a role in the development of tremors. Some experts suggest that changes in the brain stem and cerebellum may also contribute to essential tremor.

Non-modifiable risk factors are factors that cannot be changed or controlled. Non-modifiable risk factors for essential tremor include:

• Genetics: Essential tremor can be inherited, with a gene mutation being responsible for the condition. If one of your parents has essential tremor, you have a higher chance of developing it later in life.

Modifiable risk factors are factors that can be influenced or changed. Modifiable risk factors for essential tremor are not well-established. However, some factors that may potentially contribute to the development or worsening of essential tremor include:

• Medications: Certain medications, such as those used to treat seizures or psychiatric disorders, may worsen tremors in some individuals. It is important to discuss any concerns about medication effects with your healthcare professional.
• Toxins: Exposure to certain toxins, such as lead or mercury, may also increase the risk or severity of essential tremor. Avoiding exposure to these substances is important for overall health.

It's important to note that while these factors may be associated with essential tremor, they do not guarantee its development. The exact cause and risk factors for essential tremor are still being studied. If you have concerns about essential tremor or its risk factors, it is recommended to consult with a healthcare professional for personalized advice and guidance.

Symptoms

Early symptoms of essential tremor (tremor or shaking hands) include:

• Trembling, particularly of the hands
• Involuntary shaking that worsens when trying to perform tasks (intention tremor)
• Shaking may also affect the arms, legs, head, face, neck, trunk, voice, and less commonly, the legs and feet

Symptoms at later stages, progression, or higher severity of essential tremor include:

• Tremor becomes more severe over time
• Difficulty with daily activities such as eating, drinking, writing, tying shoelaces
• Changes in the way a person walks
• Changes in thinking
• Depression and anxiety
• Personality changes
• Reduced ability to coordinate voluntary movements
• Loss of hearing and sense of smell in some individuals

It's important to note that essential tremor usually occurs without other neurological symptoms. If these symptoms impair your quality of life, consult with your doctor for appropriate management options.

Diagnosis

To diagnose this condition, the following examinations, tests, and procedures are commonly performed:

• Physical examination: Your healthcare provider will look for physical signs of a medical problem, such as pain, swelling, or the presence of masses within the body.
• Medical history: Your healthcare provider will ask about your personal and family medical histories to understand any potential contributing factors.
• Neurological examination: Your healthcare provider will perform a neurological exam to assess muscle strength, tone, reflexes, balance, coordination, and speech.
• Tremor evaluation: Your healthcare provider may ask you to perform specific tasks like pouring and drinking water, touching your fingers to your nose, holding your hands out in front of you, writing, or drawing a spiral to evaluate the tremor.
• Blood and urine tests: These tests may be done to rule out certain contributing factors or conditions that could be causing the tremor.
• Diagnostic imaging: An MRI or CT scan may be performed to detect any brain damage that could be causing the tremor.

To determine the stage or severity of essential tremor, additional examinations, tests, and procedures may include:

• Clinical procedures: Depending on your symptoms and body system being evaluated, your healthcare provider may recommend additional clinical procedures such as hearing tests or other specialized tests.

These are general descriptions and specific examinations, tests, and procedures may vary depending on individual cases.

Treatment Options

The goals of treatment for this condition are to reduce or control the tremors and improve the individual's quality of life. Here are the different treatment options and how they work:

• Medication types: First-line pharmacological treatments include anticonvulsants and beta blockers. These medications help to reduce tremors by affecting certain chemicals in the brain that are involved in regulating movement.
• Therapies:
  • Occupational therapy can provide skills to make every day functioning easier for individuals with tremors. This may include using electric devices, weighted utensils, or adaptive clothing.
  • Speech therapy may be helpful for individuals with vocal tremors, focusing on relaxation exercises, breathing techniques, and voice training.
  • Psychotherapy, specifically cognitive behavioral therapy, can improve well-being and mental health in tremor patients by addressing any anxiety or social withdrawal caused by the condition.
• Therapeutic procedures: For severe tremors, invasive treatments like deep brain stimulation (DBS) of the thalamic and subthalamic region may be considered. These procedures provide significant improvement in tremors and quality of life.
• Health behavior changes:
  • Some individuals may find that weighing down the affected area with a weighted wristband can help control their tremors.
  • Relaxation techniques can be recommended to manage tremors worsened by anxiety.
  • Avoiding caffeine is also advised as it can increase tremors.

It's important to note that medication dosing and specific treatment plans should be discussed with a healthcare professional. Additionally, each individual's response to treatment may vary, so it's essential to work closely with a healthcare team to find the most effective approach.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.