Essential tremor is a type of involuntary shaking movement in which no cause can be identified. Involuntary means you shake without trying to do so.
Essential tremor is the most common type of tremor. Everyone has some tremor present, but the movements are often so small that they can't be seen. Essential tremors are most common in people older than 65.
The exact cause for essential tremor is unknown. Tremors occur when there is a problem with the nerves that supply certain muscles. Some research suggests that the part of the brain that controls muscles movements does not work correctly in patients with essential tremor.
Essential tremor can also occur with other brain and nervous system problems, such as dystonia, parkinsonism, and certain nerve conditions passed down through families.
If an essential tremor occurs in more than one member of a family, it is called a familial tremor. This type of essential tremor is passed down through families (inherited), which suggests that genes play a role in its cause.
Familial tremor is usually a dominant trait, which means that you only need to get the gene from one parent to develop the tremor. It often starts in early middle age, but may be seen in people who are older or younger.
The tremor is more likely to be noticed in the hands, but may affect the arms, head, eyelids, or other muscles. The tremor rarely affects the legs or feet. People with essential tremor may have trouble holding or using small objects such as silverware or a pen.
The shaking most often involves small, rapid movements -- more than 5 times a second.
Specific symptoms may include:
The tremors may:
Your doctor can make the diagnosis by performing a physical exam and asking questions about your medical and personal history.
A physical exam will show shaking with movement, usually small movements that are faster than 5 times per second. There are usually no problems with coordination or mental function.
Further tests may be needed to rule out other reasons for the tremors. Other causes of tremors may include:
Blood tests and imaging studies (such as a CT scan of the head, brain MRI, and x-rays) are usually normal.
Treatment may not be needed unless the tremors interfere with your daily activities or cause embarrassment.
For tremors made worse by stress, try techniques that help you relax. For tremors of any cause, avoid caffeine and get enough sleep.
For tremors caused or made worse by a medication, talk to your doctor about stopping the drug, reducing the dosage, or switching. Do NOT change or stop medications on your own.
Severe tremors may make it harder to do daily activities. You may need help with these activities. Devices may help with everyday activities, such as:
Buying clothes with Velcro fasteners, using button hooks
Cooking or eating with utensils that have a larger handle
Using straws to drink
Wearing slip-on shoes and using shoehorns
MEDICINES FOR TREMOR
Medicines may help relieve symptoms. The most commonly used drugs include:
The drugs can have side effects.
Other medications that may reduce tremors include:
Botox injections, given in the hand, have been used to reduce tremors by weakening local muscles.
In severe cases, surgery may be tried. This may include:
An essential tremor is not a dangerous problem, but some patients find the tremors annoying and embarrassing. In some cases, it may be dramatic enough to interfere with work, writing, eating, or drinking.
Sometimes the tremors affect the voice box, which occasionally leads to speech problems.
Call for your health care provider if
Alcoholic beverages in small quantities may decrease tremors but can lead to alcohol dependence and alcohol abuse, especially if you have a family history of such problems. How alcohol helps relieve tremors is unknown.
Tremor - essential; Familial tremor; Tremor - familial
Deuschl G, Raethjen J, Hellriegel H, Elble R. Treatment of patients with essential tremor. Lancet Neurol. 2011 Feb;10(2):148-61.
Updated by: Kevin Sheth, MD, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine;David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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