Essential Tremor (ET)

Essential tremor (ET) is a neurological disorder. It causes your hands, head, trunk, or voice to shake rhythmically. It is often confused with Parkinson disease.

ET is the most common tremor disorder. It causes tremor when using the arms and hands, and can affect your ability to write, eat, or hold objects. ET is most common among people older than age 65. But it can affect people at any age.

The cause of ET isn’t known. In many people the condition runs in the family, although the genes responsible may be different for different families. One theory suggests that a tremor results when your cerebellum and other parts of your brain are not communicating the right way. The cerebellum is a part of the brain that controls muscle coordination.

Sometimes, a tremor is a symptom of another neurological disorder, such as Parkinson's disease or dystonia. Sometimes, ET is mistaken for these other diseases when they are not present. A healthcare provider’s careful diagnosis is extremely important.

If you have ET, you will have shaking and trembling at different times and in different situations. But some characteristics are common to all. Here is what you might typically experience:

• Tremors occur when you move and are less noticeable when you rest.
• Certain medicines, caffeine, or stress can make your tremors worse.
• Tremor may improve with ingestion of a small amount of alcohol (such as wine).
• Tremors get worse as you age.
• Tremors don’t always affect both sides of your body in the same way.

Here are different signs of ET:

• Tremors that are most obvious in your hands.
• A hard time doing tasks with your hands, such as writing or using tools.
• Shaking or quivering sound in your voice.
• Uncontrollable head-nodding.
• In rare instances, tremors in your legs or feet.

Your rapid, uncontrollable trembling, as well as questions about your medical and family history, can help your healthcare provider determine if you have ET. He or she will probably need to rule out other conditions that could cause shaking or trembling. For example, tremors could be symptoms of diseases, such as hyperthyroidism. Your healthcare provider might test you for those, as well.

In some cases, the tremors might be related to other factors. To find out for certain, your healthcare provider may have you try to:

• Abstain from heavy alcohol use (if you’re an alcoholic, trembling is a common symptom).
• Cut out cigarette smoking.
• Stay away from caffeine.
• Not take certain medicines.

Propranolol and primidone are 2 medicines often prescribed to treat ET. Propranolol blocks the stimulating action of neurotransmitters to calm your trembling. Primidone is a common anti-seizure medicine that also controls the actions of neurotransmitters.

Gabapentin and topiramate are 2 other anti-seizure medicines that are prescribed. In some cases, tranquilizers like alprazolam or clonazepam might be suggested.

For severe tremors or for tremors that are not helped by medication, a stimulating device (deep brain stimulator) surgically put in your brain may help.

The specific cause of ET is not known, so scientists are not sure how the condition can be prevented.

ET is usually not dangerous. But it can certainly be frustrating if you have to deal with it. Certain factors can make tremors worse. The following steps may help to decrease tremors:

• Don't smoke.
• Stay away from caffeine.
• Limit alcohol. Small amounts of alcohol may improve the symptoms of ET, but the risk for alcoholism is a concern when people rely on it.
• Stay away from stressful situations as much as possible.
• Use relaxation techniques, such as yoga, deep-breathing exercises, or biofeedback.
• Check with your healthcare provider to see if any medicines you’re taking could be making your tremors worse.

Talk with your healthcare provider about other options, such as surgery, if ET starts to affect your quality of life.

If you have been diagnosed with ET, talk with your healthcare provider about when you might need to call. He or she will likely advise you to call if your tremors become worse, or if you develop new neurologic symptoms, such as numbness or weakness.