Essential Tremor

Overview, Causes, & Risk Factors

Essential tremor, also called ET, is uncontrollable shaking of thehands or head. It can also affect other parts of the body, but hands are mostcommon. ET usually affects both hands. Other areas that may be involved include:

  • voice
  • tongue
  • legs
  • trunk
  • The shaking is most often a back-and-forth movement.

    What is going on in the body?

    No one knows exactly what happens in the body to cause thesevisible tremors. They are not life threatening, but they can make it hard for aperson to function in daily life.

    What are the causes and risks of the condition?

    Heredity is the only known cause or risk for ET. Fifty to sixty percentof people with ET have a family history. When there is a family history of a similartremor, the condition is called familial tremor. The trembling can get worse withthe following:

  • stress, or emotion
  • hunger
  • fatigue
  • caffeine
  • temperature extremes
  • ET affects men and women equally. It is more likely to strike peopleas they age.

    Symptoms & Signs

    What are the signs and symptoms of the condition?

    The symptoms of ET include patterned trembling in one orboth hands and sometimes the head. The voice may also be shaky. The tremorsare mostly mild and only happen once in awhile at first. But they slowly worsen withage.

    The tremors are more obvious when the hands are in use. Restrelieves them in most cases.

    Diagnosis & Tests

    How is the condition diagnosed?

    The doctor will diagnose ET by seeing a person have tremors. Thedoctor will sometimes use an electromyography test, called EMG, to confirm thediagnosis. This kind of test checks the electrical activity in a set of muscles. Anoveractive thyroid gland, called hyperthyroidism, can mimic essential tremor.Blood tests can help rule out this condition.

    A person who comes to a doctor with ET is often concerned aboutParkinson disease. A doctor can usually tell these two types of tremors apart.

    Prevention & Expectations

    What can be done to prevent the condition?

    At this time, there is no known way to prevent ET.

    What are the long-term effects of the condition?

    Over time, the tremor can become severe enough to make it hard to doanything that calls for fine motor skills, such as:

  • writing
  • eating
  • drinking
  • dressing
  • The loss of function and embarrassment often affect quality of life.Over time, ET gets worse. This means that either the tremors become morepronounced, or they come more often.

    Treatment & Monitoring

    What are the treatments for the condition?

    First-choice medicines used to treat this condition include:

  • propranolol, a beta-blocker
  • primidone, an anticonvulsant
  • Propanolol is used more often in younger people, while primidone isoften the first choice for the older person. At times, these medicines may even beused together. When neither of those medicines helps,clonazepam may be used. Early treatment is key, because it will often preventdisability.

    Other medicines sometimes used to treat ET include:

  • benzodiazepines, such as lorazepam, alprazolam, or diazepam
  • nadolol, a heart medicine
  • methazolamide
  • gabapentin
  • Doctors can also do a surgery that stimulates the thalamus,which is the part of the brain that relays sensory information. But this treatment isonly used in severe cases, which do not respond to medicine.

    Physical therapy can help a person adapt to the tremors.One- to two-pound weights strapped to the wrists may help make hands moresteady.

    What are the side effects of the treatments?

    Potential side effects of the medicines used include:

  • fatigue
  • light-headedness
  • sleepiness
  • Potential risks of surgery include infection and bleeding in the brain.

    What happens after treatment for the condition?

    The tremors will often improve with medicine or surgery. But theycan rarely be completely stopped. A person may find that symptoms growworse with time, but this varies.

    How is the condition monitored?

    Any new or worsening symptoms should be reported to the doctor.

    Article type: xmedgeneral