Essential Tremor (ET)

What is essential tremor?

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

ET is the most common trembling disorder that people have. Everyone has some ET. But the movements usually can't be seen or felt. When tremors are noticeable, the condition is classified as ET.

ET is most common among people older than age 65. But it can affect people at any age. 

What causes ET?

ET can occur in different people for different reasons:

• Familial essential tremor. In most people, the condition seems to be passed down from a parent to a child. If your parent has ET, there is a 50% chance that you or your children will inherit the gene responsible for the condition.

• Essential tremor related to another disorder. Sometimes, a tremor is a symptom of another neurological disorder, such as Parkinson 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.

The cause of ET isn’t known. But one theory suggests that 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.

What are the symptoms of ET?

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 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

How is ET diagnosed?

Your rapid, uncontrollable trembling, as well as questions about your medical and family history, can help your healthcare provider determine if you have familial 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.

How is ET treated?

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

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

For ET in your hands, botulinum toxin (Botox) injections have shown some promise in easing the trembling. They work by weakening the surrounding muscles around your hands. For severe tremors, a stimulating device (deep brain stimulator) surgically put in your brain may help.

What can I do to help prevent ET?

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

Living with ET

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.

When should I call my healthcare provider?

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.

Key points about essential tremors

• ET is a neurological disorder. It causes your hands, head, trunk, voice, or legs to shake rhythmically. The cause is not known. But it is often passed down from a parent to a child.

• ET is sometimes confused with other types of tremor, so getting the right diagnosis is important.

• Tremors tend to be worse during movement than when at rest. The tremors are usually not dangerous. But they can get worse over time.

• Staying away from things that might make tremors worse, such as stress, caffeine, and certain medicines, may be helpful.

• Medicines can also help control or limit tremors in some people. Severe tremors can sometimes be treated with surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.