Essential Tremor Disorder

If you or a loved one has been experiencing shaking or tremors, it might be due to essential tremor, a neurological movement disorder. Essential tremor is often mistaken for Parkinson’s disease but is about eight times more common. 

Essential tremor can be challenging but there are treatments that can help. Read on to learn more about its causes, signs and treatment options.

What is essential tremor?

Essential tremor is a movement disorder that causes uncontrollable shaking or trembling. These shakes usually happen in the hands but can also impact the head, voice, trunk or legs. Unlike tremors caused by temporary factors like stress or being cold, essential tremor doesn’t go away and can get worse over time.

This condition isn’t life-threatening, but it can make daily tasks harder. Activities such as writing, eating, drinking from a cup or tying your shoes may become difficult. Some people may also feel embarrassed or anxious about their tremors.

If you notice shaking that affects your daily life, talk to your health care provider or a Banner Health specialist.   

Who gets essential tremor?

Essential tremor can affect anyone, but it is more common in adults between ages 40 and 60. Younger people can also develop it, though it’s less common. 

If someone in your family has essential tremor, you may be more likely to develop it too. It often runs in families.   

What causes essential tremor?

The exact cause of essential tremor isn’t fully understood, but it may be linked to a problem in the cerebellum, the part of the brain that controls movement and coordination. In people with essential tremor, the brain sends irregular signals to muscles, causing them to shake.

In some cases, essential tremor runs in families, suggesting that genetics (the information passed down from your parents) may play a role. However, not everyone with essential tremor has a family history of it. 

How does essential tremor differ from Parkinson’s disease?

Essential tremor and Parkinson’s disease both cause shaking but differ in a few ways:

• Parkinson’s tremors happen when you are at rest, while essential tremor usually occurs when you use your hands. 
• Parkinson’s can cause stiffness, slow movements and balance problems.
• Essential tremor can affect your head and neck, while Parkinson’s rarely affects your head and neck. 

Symptoms of essential tremor

The main symptom of essential tremor is shaking, usually in the hands. Tremors may happen when doing activities like eating or drinking (action tremor). It can also occur while holding fixed positions or poses (postural tremor). They usually don’t happen when resting (resting tremor).

Here is what you might experience:

• Shaking hands: Tremors that are most noticeable in your hands. They might improve with rest. 
• Shaking head or voice: Your head may move in a yes or no motion. Your voice may shake or quiver when speaking.
• Difficulty with fine motor skills: Writing, using a fork or buttoning a shirt may become harder.

Essential tremor can affect both sides of the body, but one side may be worse. Symptoms often start mild and worsen over time. Certain factors can make shaking worse, such as:

• Stress and anxiety
• Exercise, fatigue or lack of sleep
• Caffeine or nicotine
• Some medications
• Hot weather or overheating

How is essential tremor diagnosed?

There is no single test to diagnose essential tremor. To confirm the diagnosis, your health care provider will review your medical and family history and do a physical exam. They may ask you to perform certain tasks to check how the tremors affect your movements. 

In some cases, your provider might order tests, such as blood tests and imaging scans, to rule out other conditions that could cause tremors, like Parkinson’s or thyroid problems.

Treatment options for essential tremor

There is no cure for essential tremor, but several treatments can help manage the symptoms and improve quality of life. The treatment plan will depend on the severity of the tremors and how much they affect daily life.

Medications

Your provider may prescribe medications to reduce tremors, including: 

• Beta-blockers (like propranolol) to reduce tremors by calming the nervous system
• Anti-seizure medications (like primidone) to help control tremors
• Benzodiazepines (like alprazolam) to help if anxiety makes tremors worse
• Botulinum toxin (Botox) to relax overactive muscles

These medications can help but may cause side effects like dizziness, fatigue or an upset stomach. Talk to your provider to find the right medication and dosage for your symptoms.

Lifestyle changes

Certain lifestyle changes can help manage essential tremor:

• Stress management: Stress can worsen tremors, so practicing relaxation techniques like deep breathing, yoga, or meditation may help.
• Assistive devices: Special tools, like weighted utensils or pens, can make daily tasks like eating or writing easier to handle.
• Therapy: Working with a physical therapist can help you improve strength, coordination and control. Working with an occupational therapist can help you reduce the effect tremors have on your daily activities. 

Nerve and brain stimulation

In severe cases, when medication and lifestyle changes don’t help enough, advanced treatments may be considered:

• Peripheral nerve stimulation (PNS) is a non-invasive wrist device that sends gentle electrical pulses to the nerves. It is easy to use, helps reduce tremors and doesn’t require surgery.
• Deep brain stimulation (DBS) is a surgical procedure that involves implanting small electrodes in the brain to send electrical signals to the areas that control movement – like a pacemaker for the brain. DBS can be very effective and is recommended for people with severe tremors. 
• Focused ultrasound is a non-invasive treatment that uses sound waves to target and treat the part of the brain causing tremors. It can treat tremors without an incision, but isn’t the best option for everyone.

Living with essential tremor

Living with essential tremor can be challenging, but many people continue to lead full lives with treatment and support. Regular follow-up appointments with your health care provider can help monitor the condition and adjust the treatment plan as needed. 

How Banner Health can help

If you or a loved one is experiencing tremors, contact a Banner Health specialist. Our team is experienced in diagnosing and treating movement disorders like essential tremor. Whether you need medication, lifestyle advice or surgical options, we’ll work with you to create a treatment plan that fits your needs.