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Essential tremor

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.

Alternative Names

Tremor - essential; Familial tremor; Tremor - familial

Causes

Essential tremor is the most common type of tremor. Everyone has some tremor present, but the movements are often so small that they cannot be seen. Essential tremor affects men and women and is most common in people older than 65.

The exact cause of essential tremor is unknown. Some research suggests that the part of the brain that controls muscle movements does not work correctly in patients with essential tremor.

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). This suggests that genes play a role in its cause.

Familial tremor is usually a dominant trait. This 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.

Symptoms

The tremor is more likely to be noticed in the hands. The arms, head, eyelids, or other muscles may also be affected. The tremor rarely occurs in the legs or feet. A person 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 occurring more than 5 times a second.

Specific symptoms may include:

  • Head nodding
  • Shaking or quivering sound to the voice if the tremor affects the voice box
  • Problems with writing, drawing, drinking from a cup, or using tools if the tremor affects the hands

The tremors may:

  • Occur during movement (action-related tremor) and may be less noticeable with rest
  • Come and go, but often get worse with age
  • Worsen with stress, caffeine, and certain medications
  • Not affect both sides of the body the same way

Exams and Tests

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:

  • Smoking and smokeless tobacco
  • Overactive thyroid (hyperthyroidism )
  • Suddenly stopping alcohol after drinking a lot for a long time (alcohol withdrawal )
  • Too much caffeine
  • Use of certain medications
  • Nervousness or anxiety

Blood tests and imaging studies (such as a CT scan of the head, brain MRI , and x-rays) are usually normal.

Treatment

Treatment may not be needed unless the tremors interfere with your daily activities or cause embarrassment.

HOME CARE

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 make it harder to do daily activities. You may need help with these activities. Things that can help include:

  • Buying clothes with Velcro fasteners, or 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:

  • Propranolol, a beta blocker
  • Primidone, a drug used to treat seizures

These drugs can have side effects.

  • Propranolol may cause fatigue, stuffy nose, or slow heartbeat, and it may make asthma worse.
  • Primidone may cause drowsiness, problems concentrating, nausea, and problems with walking, balance, and coordination.

Other medications that may reduce tremors include:

  • Antiseizure drugs
  • Mild tranquilizers
  • Blood pressure drugs called calcium-channel blockers

Botox injections given in the hand may be tried to reduce tremors.

SURGERY

In severe cases, surgery may be tried. This may include:

  • Focusing high-powered x-rays on a small area of the brain (stereotactic radiosurgery )
  • Implanting a stimulating device in the brain to signal the area that controls movement

Outlook (Prognosis)

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.

Possible Complications

Sometimes the tremors affect the vocal cords, which may lead to speech problems.

When to Contact a Medical Professional

Call your health care provider if:

  • You have a new tremor
  • Your tremor makes it hard to perform daily activities
  • You have side effects from the medicines used to treat your tremor

Prevention

Alcoholic beverages in small quantities may decrease tremors. But alcohol abuse may develop, especially if you have a family history of such problems.

References

Deuschl G, Raethjen J, Hellriegel H, Elble R. Treatment of patients with essential tremor. Lancet Neurol. 2011;10:148-161.

Jankovic J. Movement disorers. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 71.

Updated: 5/20/2014

Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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