What to Know About Essential Tremor

Essential tremor, sometimes called benign essential tremor, is a common condition that causes uncontrollable shaking in different parts and sides of the body, especially the hands, arms, head, chin, and voice box. The lower part of the body is rarely affected, and the tremors aren’t associated with other symptoms or changes in consciousness.

Essential tremor is often hereditary, but sometimes there’s no known cause. This condition isn’t life-threatening, and most people with essential tremor can live normal lives. However, the tremors can make it difficult to do everyday things like eating, drinking, writing, and dressing.

If you’re wondering why you have shaky hands or why your body is shaking for no reason, here’s what you need to know about essential tremor symptoms, why it’s happening, and essential tremor treatment. 

What Are the Symptoms of Essential Tremor?

The only symptom of essential tremor is shaking tremors. You can see and feel the trembling of your arms, head, chin, voice, or torso. Normally, the shaking of essential tremor affects one or more of these areas of the body, and it affects both sides about equally and symmetrically.

The tremors occur at a rhythmic, rapid rate and may be more prominent with action than at rest. Anxiety or fatigue can worsen the shaking.

Symptoms of essential tremor include:

• Shaking of your head that may appear like constant nodding
• Speaking with a shaky, tremulous voice
• Erratic changes in the tone or volume of your voice
• Shaking hands when trying to eat, cook, write, or take care of personal hygiene (such as putting on makeup or shaving)
• Shaking of the shoulders
• Chin tremors, especially when speaking

What Causes Essential Tremor?

There is not an identified and consistent cause of essential tremor. Experts agree that there is likely a genetic component, and it sometimes runs in families. However, there is no identified single gene that is known to cause essential tremor.

This type of tremor is caused by a disruption in the regions in the brain that control and coordinate movement. Yet, there is no identified change in brain imaging or neurotransmitter levels that correlates with essential tremor.

Who Commonly Gets Essential Tremor?

Generally, essential tremor begins during adulthood, and it can be more common with advancing age. According to a review published in The BMJ, essential tremor affects approximately 1% of the population and 4% to 5% of people over age 65.

This condition can be hereditary, so you might have a higher risk of developing essential tremor if your parents or siblings have this problem.

Can Essential Tremor Increase the Risk for Other Conditions?

Essential tremor doesn’t cause other medical conditions and it doesn’t affect your health. It can be beneficial for you to get treatment for your essential tremor if it’s making you uncomfortable or self conscious. 

Many people who have essential tremor worry about the possibility of Parkinson’s disease or another movement disorder. While a tremor is a major symptom of Parkinson’s disease and some movement disorders, essential tremor doesn’t cause Parkinson’s disease or any other neurological disease. You can, however, have both essential tremor and Parkinson’s disease.

How Is Essential Tremor Diagnosed?

Essential tremor is diagnosed based on a medical history and physical examination. Your healthcare provider will discuss your symptoms with you and may ask how often they occur and about what makes them better or worse. 

A physical examination is a major part of the diagnostic process. With essential tremor, your healthcare provider may witness your tremors during your office visit because they tend to occur frequently. Additionally, you shouldn’t have any changes in muscle strength, reflexes, or muscle tone associated with essential tremor.

Since several other conditions can cause tremors, your healthcare providers may also consider other possible causes, such as Parkinson’s disease, anxiety, a medication side effect, or drug withdrawal.

Essential tremor is not diagnosed with tests, but if there’s a concern about other conditions, you might have some diagnostic tests.

Diagnostic procedures you might have include:

• Urine toxicology screen: Many drugs and medications have the potential to cause tremors, and sometimes these can be detected in the urine.
• Brain imaging tests: A brain magnetic resonance imaging (MRI) test or brain computed tomography (CT) test can identify certain neurological problems that can cause tremors—such as a brain tumor or an aneurysm (blood vessel outpouching) in the brain. If a structural problem that is causing the tremors is identified, this would mean that the condition is not essential tremor.
• Electroencephalogram (EEG): While seizures often cause symptoms that are different from essential tremor, sometimes the symptoms may be difficult to distinguish. An EEG can identify seizures or a predisposition to seizures, which would be treated very differently than essential tremor.

How Is Essential Tremor Treated?

Usually, essential tremors are treated with prescription medication or lifestyle measures. Some people choose to take medication, and others opt for lifestyle measures. Generally, lifestyle measures do not completely control essential tremor, but may help to a moderate degree.

Medications

The medications that are effective for treating essential tremor are not helpful in treating seizures or Parkinson's disease. And the medications that are used for treating seizures or Parkinson's disease are not helpful for preventing or treating essential tremor.

The most commonly prescribed medications for managing essential tremor are:

• Propranolol 
• Primidone

Sometimes other pharmacologic therapies are used for controlling essential tremor, which may include Neurontin (gabapentin), Topamax (topiramate), or muscle relaxants.

Therapies

Other interventions have been used to treat essential tremor, the most common of which is botulinum toxin injection. This type of injection paralyzes the muscle and can potentially prevent tremors in the affected muscles.

Surgery

Certain surgical procedures can help treat essential tremor. These procedures use different methods to control muscle movements by directly mediating action in the motor regions of the brain.

Examples include:

• Thalamotomy, with incision into the thalamus
• Ultrasound thalamotomy, with a nonsurgical procedure targeting the thalamus
• Deep brain stimulation, with an implanted device that sends electrical stimulation to the thalamus

These procedures are used to subdue involuntary movements. Extensive presurgical testing can help identify specific targets in the brain and minimize the risk of adverse neurological effects (such as weakness or sensory loss) that could result from surgery.

What’s the Outlook for People With Essential Tremor?

It's hard to predict the outcome of essential tremor. Many people with this condition can expect to experience progressively worsening symptoms after the tremor first begins, and then the symptoms may eventually stabilize.

However, some people living with essential tremor may also incidentally have other neurological problems, such as multiple sclerosis, dementia, or a movement disorder. Living with essential tremor and another neurological disorder would compound the physical disability and distress.

Can Essential Tremor Be Prevented or Cured?

There is no definitive cure for essential tremor, but it can be treated medically or surgically. No known strategies can help prevent essential tremor from developing. Lifestyle measures may help minimize the symptoms for some people.

Lifestyle strategies that can help reduce your tremors include:

• Getting enough rest
• Avoiding caffeine
• Relaxation techniques
• Managing anxiety

You can try all of these to see whether they are beneficial for helping control your tremors. Some people feel temporary improvement with alcohol, but drinking alcohol is not recommended as a therapeutic approach because alcohol can have adverse effects on your health.

Summary 

Essential tremor is a neurological disorder that causes a shaking of the chin, voice, head, or arms. This is the most common cause of tremors, but people who have essential tremor usually require an evaluation to ensure that there is no other medical cause.

Essential tremor can often be worse if you’re feeling anxiety, if you’ve had a lack of sleep, or after consuming caffeine. Medications can be used to help treat essential tremor. The most common are propranolol and primidone, which can be taken every day to control the condition. For some people who do not improve with medication, surgical intervention may be helpful.