At a glance
What it is
A neurological disorder that causes involuntary and rhythmic shaking. It can affect almost any part of the body, but trembling occurs most often in the hands during simple tasks such as drinking from a glass or tying shoelaces.
Symptoms
Gradual onset, usually more prominent on one side, worsens with movement, may include a yes-yes or no-no head motion, aggravated by emotional stress, fatigue, caffeine or temperature extremes.
Approach
Medications and therapy for mild cases. Nerve stimulation devices and surgery — radiofrequency thalamotomy, deep brain stimulation, focused ultrasound thalamotomy — for severe, disabling tremor.
What essential tremor is
Essential tremor is a nervous system (neurological) disorder that causes involuntary and rhythmic shaking. It can affect almost any part of your body, but the trembling occurs most often in your hands — especially when you do simple tasks, such as drinking from a glass or tying shoelaces. Essential tremor is usually not a dangerous condition, but it typically worsens over time and can be severe in some people. Other conditions don't cause essential tremor, although essential tremor is sometimes confused with Parkinson's disease. Essential tremor can occur at any age but is most common in people age 40 and older. **Symptoms** Essential tremor signs and symptoms: - Begin gradually, usually more prominently on one side of the body - Worsen with movement - Usually occur in the hands first, affecting one hand or both hands - Can include a "yes-yes" or "no-no" motion of the head - May be aggravated by emotional stress, fatigue, caffeine or temperature extremes **Essential tremor vs. Parkinson's disease** Many people associate tremors with Parkinson's disease, but the two conditions differ in key ways: - **Timing of tremors.** Essential tremor of the hands usually occurs when you use your hands. Tremors from Parkinson's disease are most prominent when your hands are at your sides or resting in your lap. - **Associated conditions.** Essential tremor doesn't cause other health problems, but Parkinson's disease is associated with stooped posture, slow movement and dragging the feet when walking. However, people with essential tremor sometimes develop other neurological signs and symptoms, such as an unsteady walk. - **Parts of the body affected.** Essential tremor mainly involves your hands, head and voice. Parkinson's disease tremors usually start in your hands, and can affect your legs, chin and other parts of your body.
Causes and risk factors
**Causes** About half of essential tremor cases appear to result from altered DNA. This form is referred to as familial tremor. It isn't clear what causes essential tremor in people who don't have familial tremor. **Risk factors** Known risk factors for essential tremor include: - **Altered gene.** The inherited variety of essential tremor (familial tremor) is an autosomal dominant disorder. An altered gene from just one parent is needed to pass on the condition.
If you have a parent with an altered gene for essential tremor, you have a 50% chance of developing the disorder yourself.
- **Age.** Essential tremor is more common in people age 40 and older.
Complications
Essential tremor isn't life-threatening, but symptoms often worsen over time. If the tremors become severe, you might find it difficult to: - Hold a cup or glass without spilling - Eat without shaking - Put on makeup or shave - Talk, if your voice box or tongue is affected - Write legibly
Treatment
Some people with essential tremor don't require treatment if their symptoms are mild. But if your essential tremor is making it difficult to work or perform daily activities, discuss treatment options with your doctor.
Medications
- Beta blockers
- Anti-seizure medications
- Tranquilizers
- OnabotulinumtoxinA (Botox) injections
Therapy
- Physical therapy to improve muscle strength, control and coordination
- Occupational therapy with adaptive devices — heavier glasses and utensils, wrist weights, wider writing tools
Nerve stimulation devices
- Cala Trio wearable wristband used for 40 minutes twice a day
- Stimulates peripheral nerves and muscles to create a response that reduces tremors
Surgery
- Radiofrequency brain lesions (stereotactic thalamotomy) — approximately 80% of patients experience long-lasting and near complete relief
- Deep brain stimulation — electrodes in the thalamus with a pacemaker-like neurostimulator implanted in the chest
- Focused ultrasound thalamotomy — noninvasive surgery using focused sound waves to destroy tissue in a specific area of the thalamus
Book a consultation
The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.
This page provides general information about essential tremor and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.