Definition
Benign essential tremor (ET) is a movement disorder most commonly noticed by shaking in the hands. It occurs in as much as 10% of people over the age of 60. It may also cause shaking of the head, voice, arms, and trunk. It occurs less often in the legs and feet. Two types of tremor are common with ET:
- Postural tremor—shaking in certain positions only, such as with arms outstretched
- Kinetic or action tremor—shaking that gets worse during activities, such as eating or shaving
ET can be socially isolating in some cases. It may interfere with normal daily activities such as writing or speaking. Contact your doctor for an evaluation if you think you have ET.
Causes
The cause of ET is unknown. It does run in families. It is often called familial tremor when it is inherited. Children of parents with ET have a 50% chance of inheriting the condition.
In cases where there is no family history of tremor, other factors, such as toxins, may play a role. The role is far from clear. It is thought that essential tremor starts from abnormalities of specific circuits in the brain. This is an area that researchers are studying.
Risk Factors
Family history of tremors is the only known risk factor for ET. The condition may occur at any age. It is more likely to occur in people older than 40 years old.
Symptoms
ET is generally not serious, but its severity may vary and worsen over time. Symptoms may include:
- Tremor that occurs when standing or moving the limbs, but not usually at rest
- Uncontrollable, rhythmic, up-and-down movement
- Shaking in hands, arms, head, voice, trunk, legs, or feet on both sides
- Shaking only in certain positions or during activity
- Trouble with fine motor skills, such as drawing, sewing, or playing an instrument
- Shaking that gets worse from caffeine, stress, fatigue, or heat
- Hearing loss (Some cases are associated with hearing loss.)
- Problems with social, functional, or job-related abilities (More severe cases interfere with these abilities.)
Tremors must not be related to other health conditions in order for someone to have the ET diagnosis.
Diagnosis
Your doctor will ask about your symptoms and your medical and family history. A physical exam will be done. Attention will be paid to the central nervous system. There are no special tests to diagnose ET. You may have blood, urine, or other tests (eg, MRI) to rule out other causes, like:
- Parkinson’s disease
- Elevated thyroid hormone
- Low blood sugar
- Stroke
- Medications
Treatment
Most people with ET do not require treatment. Mild tremors may be relieved or even eliminated by simple measures, including:
- Staying well-rested
- Avoiding caffeine
- Avoiding stimulants often found in over-the-counter medications, like cold remedies
- Avoiding temperature extremes
Talk to your doctor about any medications that you are taking. The following treatment options may be helpful:
Medication
- Beta-blocker, such as propranolol (a blood pressure medication)
- Anti-seizure medications, such as primidone (eg, Mysoline), gabapentin (eg, Neurontin), topiramate (eg, Topamax), zonisamide (Zonegran)
- Sedatives (benzodiazepines)
- Olanzapine (antipsychotic drug)
- Botulinum injections (used in rare situations)
Surgery
Surgery may be an option in rare cases where tremors are disabling and medications don’t help. Two approaches are possible.
- Deep brain stimulation (DBS)—sends painless electrical pulses to the brain, interrupting faulty signals.
- Thalamotomy—destroys a tiny part of the brain generating the tremors (less commonly performed than DBS)
Prevention
There is no known way to prevent ET.
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