Essential Tremor

Causes of essential tremor

Although the cause of essential tremor is not known, research indicates the condition can be inherited. The problem stems from a problem deep in the brain in areas that control movements. Essential tremor can be a symptom of a variety of neurological conditions such as:

• Multiple sclerosis
• Stroke
• Traumatic brain injuries
• Parkinson’s disease

Risk factors for essential tremor

There are two known risk factors for essential tremor including:

• Age — essential tremor typically affects people over the age of 40 but can affect people of all ages.
• Genetics — a type of essential tremor called a familial tremor runs in families; if one of your parents suffers from essential tremor, you have a 50 percent chance of also suffering.

Symptoms of essential tremor

Essential tremor typically begins in one side of the body, intensify gradually and worsen with movements. In some patients, they are brought on by changes in your emotional state such as stress, fatigue or extreme temperatures.

• Shaking hands or other body parts such as the arms, head, legs or torso
• Difficulty writing
• Having problems holding small objects such as a pen
• Shaking in the voice

Symptoms are often confused with Parkinson’s disease symptoms. Some differences include the timing of the tumors — essential tumors present during activity, while Parkinson’s tremors occur while at rest. Essential tumors often affect the hands or head, while Parkinson’s tremors start in the hands but evolve to the chin, legs and other body parts.

Diagnosis of essential tremor

Because there is not a diagnostic test that can confirm an essential tremor diagnosis, essential tremors are diagnosed by performing tests that rule out other potential conditions that could be causing your symptoms. During a physical exam, your doctor will evaluate your full medical and family medical history, review your symptoms and perform a neurological exam.

The neurological exam will check your:

• Reflexes
• Tone and strength of your muscles
• Speech
• Posture
• Sensory abilities

Other testing for essential tremor includes:

• Blood tests — can determine if you have other conditions that are causing your condition such as thyroid abnormalities, alcoholism or side effects from medications.
• Imaging tests — imaging tests, such as an MRI or CT scan, can determine if there are other abnormalities in the brain that could be causing your symptoms.
• Electromyogram — test for nerves or muscle problems.
• Functional tests — your doctor may perform tests to see how well you perform a variety of activities including writing, typing, holding a cup and bucking your belt

Treatment of essential tremor

There is not a cure for essential tremor, so the goals of treatment are to relieve symptoms. Some patients may not need treatment at all if symptoms are mild.

If your tremors are caused by an underlying condition, treating the condition will often relieve symptoms of essential tremor.

If the cause or your essential tremor is unknown, treatment can involve:

Medications for essential tremor

• Beta-blockers — some patients experience symptom relief by taking beta-blocker medications.
• Anti-seizure medications — if beta-blockers are not effective, anti-seizure medications may help relieve the symptoms of essential tremor.
• Tranquilizers — patients who have intense tremors that are intensified by emotional stress may find symptom relief with medications such as Xanax.
• Medications used for Parkinson’s disease — if you have tremors from Parkinson’s disease, you may be prescribed medication that is used to treat Parkinson’s.
• Botox medications — Botox can help relieve symptoms of essential tremor in patients who are experiencing symptoms in the head. Botox can help relieve symptoms for up to three months.

Surgery (Deep brain stimulation)

In severe cases where patients do not respond to medications, surgery may be necessary to relieve symptoms. Deep brain stimulation (DBS) is the most commonly used surgery to treat essential tremor. During deep brain stimulation treatment, a neurostimulator (similar to a pacemaker) device is implanted in the chest and a lead is run from the device up to the area of the brain where the tremors are originating. The neurostimulator will send painless electrical signals up the wire to the brain to disable the tremor.