What is essential tremor?
Essential tremor is a common condition that causes shaking, most often in the hands and arms. It can also affect the head and the voice. Less often, it affects the legs.
Essential tremor is not the same as Parkinson’s disease, although the two are often confused. It usually gets worse slowly, over many years. It is not dangerous to your health, but it can make everyday tasks hard, such as eating, drinking from a cup, writing, or buttoning a shirt. Some people also feel embarrassed by the shaking.
Essential tremor often runs in families. If a parent has it, their children have a higher chance of having it too. It can start at any age, but it becomes more common as people get older.
Common symptoms
Action tremor and rest tremor
Essential tremor is an action tremor. The shaking happens when you use your hands, such as when you hold a cup, write, or hold your arms out in front of you. It usually calms down when your hands are resting.
Parkinson’s disease more often causes a rest tremor. The shaking happens when the hand is relaxed, such as resting in your lap, and it often lessens when you use that hand.
People with essential tremor may notice:
- Shaking hands when eating, drinking, or writing
- A head tremor, which may be easier for others to see than for you to feel
- A shaky voice
- Tremor that gets worse with stress, tiredness, caffeine, or some medicines
Some people notice that their tremor eases for a short time after a small amount of alcohol. This can be a helpful clue for the diagnosis, but alcohol is not a treatment.
How we make the diagnosis
There is no blood test or scan that proves essential tremor. The diagnosis is made mainly through a careful exam by a movement disorder specialist.
At your visit, we will:
- Ask when the tremor started, what makes it better or worse, and whether family members shake
- Review your medicines and how much caffeine you have, since both can make tremor worse
- Watch your hands at rest, while you hold your arms out, and while you write or draw a spiral
- Look for signs of other conditions, such as Parkinson’s disease or dystonia
We may check blood tests, such as thyroid tests, because an overactive thyroid can cause tremor. When the diagnosis is not clear, a DaTscan can help tell essential tremor apart from Parkinson’s disease.
Treatment options
Not everyone with essential tremor needs treatment. If your tremor is mild and does not bother you, it is fine to simply watch it. When it gets in the way of daily life, several treatments can help.
Everyday tips
- Weighted silverware and weighted mugs can reduce tremor while you eat and drink. Many stores and websites sell them.
- Use cups with lids and straws
- Cut back on caffeine
- Rest your elbows on a table when eating or writing
- Ask about occupational therapy for tools and tips that make daily tasks easier
- Wearable devices and stabilizing spoons can also help. See Devices that can help with tremor.
Medications
The two most common medicines are propranolol, a blood pressure medicine, and primidone, a seizure medicine. Propranolol is not right for everyone, such as some people with asthma or those with hypotension (low blood pressure). A daily blood pressure log is good to bring in with your initial visit to be sure your blood pressure is not too low to take propranolol. We start with a low dose and adjust slowly to find the right balance between benefit and side effects. Other medicines are available if these do not help or cause side effects.
Make sure you bring a typed list of medications used to treat essential tremor that failed or caused side effects. Use BPMedTracker to track your medications and print a list.
Head tremor and voice tremor
Some people with essential tremor also have cervical dystonia, which causes a dystonic head tremor. A dystonic head tremor is treated with botulinum toxin, not with the medicines used to treat essential tremor.
A shaky voice from essential tremor can be confused with spasmodic dysphonia, a different voice condition. Spasmodic dysphonia is diagnosed by an ear, nose, and throat (ENT) doctor and treated with botulinum toxin injections.
Deep brain stimulation (DBS)
When tremor makes daily life hard and medicines have not helped enough, deep brain stimulation (DBS) may be an option. DBS is a surgery that places a thin wire in a part of the brain that helps control tremor. The wire is connected to a small device under the skin of the chest, similar to a pacemaker.
DBS may be worth considering if:
- Your tremor keeps you from eating, drinking, writing, or working the way you want to
- You have tried medicines that did not help enough or caused side effects
- You are in good enough overall health for surgery
Before surgery, we do a careful pre-surgical screening. This includes a detailed exam of your tremor and a review of mood and overall health. When surgery is the right choice, we refer patients to experienced neurosurgeons in the Dallas–Fort Worth area and continue their care before and after surgery.
After surgery, we do the DBS programming in our office. Programming means adjusting the settings over several visits to control the tremor as well as possible with the fewest side effects.
Other procedures, such as focused ultrasound, are offered at some centers. We can talk about whether one of these may fit your needs.
When to see a specialist
Consider seeing a movement disorder specialist if you or a loved one has:
- A new tremor, or a tremor that is getting worse
- Tremor that makes it hard to eat, drink, write, or work
- A diagnosis that isn’t clear, or you are not sure whether it is Parkinson’s disease
- Medicines that no longer help or cause side effects
- Questions about deep brain stimulation
Call 940-828-MOVE (6683) to schedule a visit.
Devices that can help with tremor
These devices may help steady hand tremor and make daily tasks easier. Ask us which one may be right for you. We do not sell these products.
Steadiwear
Steadi-3 Plus tremor glove
A glove with a small magnetic unit on the back of the hand that steadies hand tremor, with no batteries and no charging. It is an FDA-registered Class I medical device.
Dr. Lisk is an advisor to Steadiwear.
Cala Health
Cala kIQ wrist therapy
A device worn on the wrist that gives gentle nerve stimulation to ease action hand tremor in essential tremor and Parkinson’s disease. It requires a prescription. Medicare covers it for people who qualify.
Fasikl
Felix NeuroAI wristband
A noninvasive wristband that uses artificial intelligence to ease essential tremor during the day.
GYENNO
Bravo Twist stabilizing spoon
A spoon with a small motor that senses hand tremor and keeps the spoon steady while you eat.
SteadiSpoon
Stabilizing spoon
A spoon designed to steady hand tremor in every direction. Coming soon: you can join the waitlist on their website.