Every day, you do countless tasks and activities that depend on having steady hands: cooking and feeding yourself; applying makeup or shaving; buttoning your clothes and putting on shoes. Even texting, writing a grocery list or pushing the buttons on a remote control requires steadiness.
Developing a tremor, in which your hands shake or tremble uncontrollably, can affect those activities of daily living and the hobbies you enjoy. For 1 percent of the population, a condition known as essential tremor makes those activities much more difficult.
“Essential tremor is the most common movement disorder in adults,” says UNC Health neurosurgeon Vibhor Krishna, MD. “It’s important to know that there are safe and effective treatments so you can overcome limitations and still do what you enjoy.”
You may associate tremors with Parkinson’s disease, but essential tremor is its own distinct disorder. It’s not caused by other conditions, and it isn’t life-threatening.
Here’s what else you need to know about essential tremor.
Symptoms of Essential Tremor
Most commonly, essential tremor is characterized by tremors of the hands and arms, though it can also affect your head, voice and legs.
“It’s an action tremor, meaning that it will happen when people are moving and using their hands and arms,” Dr. Krishna says. “That makes it distinct from a Parkinsonian tremor, which is a rest tremor and happens when you’re not doing anything.”
Essential tremor typically affects both sides of the body, but it may start on one side and progress to both sides. Progression is typically slow, but the condition worsens noticeably in about three to five years, Dr. Krishna says.
If you have essential tremor, you may try to adapt your activities around the tremor, but this will get more difficult with time.
“People will start to avoid activities like going out to eat, so the challenges can lead to social isolation,” Dr. Krishna says. “The difficulties can come slowly, but it’s important to get treatment before someone struggles with eating or enjoying hobbies.”
The tremors are typically the main symptom, but you may also struggle with balance, leading to increased risk of falls. If the tremor affects your voice and swallowing muscles, you could have problems with speech and swallowing. Some people can have an increased risk of choking.
Essential Tremor Causes and Diagnosis
Many conditions and some medications can cause tremors, so getting a diagnosis of essential tremor involves eliminating those other causes. If you have a tremor, your doctor will ask about how and when you experience tremors, review your medical history, evaluate your movement and order tests that might indicate another issue, such as problems with your liver function or thyroid.
“The word ‘essential’—that means that other reasons, like thyroid issues, head injuries, stroke, alcohol dependence, to name a few, have been ruled out,” Dr. Krishna says. “The only risk factor is a family history, but plenty of people without a family history have essential tremor.”
It’s important to know the cause of the tremor and get the right diagnosis because essential tremor requires different treatment than tremors associated with other conditions.
Essential tremor can occur at any age but generally presents early during adolescence or between the ages of 40 and 50, Dr. Krishna says.
Essential Tremor Treatment Options
If the tremor is mild and not yet causing issues, Dr. Krishna says it’s reasonable to wait and observe before pursuing other options.
An occupational therapist can help to assess specific challenges and recommend solutions. For some, using heavier utensils to eat can help compensate for the tremor, allowing for more control; special keyboards or voice recognition software can help with typing or texting. If your voice is affected, speech and language therapy can help, and if you’re having balance difficulties, physical therapy can improve function.
If you’re diagnosed with essential tremor, your doctor will likely prescribe one of two medications: propranolol, a beta blocker typically used to treat high blood pressure that has been shown to reduce tremor symptoms, or primidone, an anti-seizure medication. Your doctor will work to find the dose of these medications that’s right for you.
“In general, these medications work better at higher dosages, but the dose that reduces the tremor can be limited by side effects,” he says, noting that propranolol can worsen conditions such as asthma or chronic obstructive pulmonary disease (COPD) and cause fatigue, while primidone can cause drowsiness and brain fog.
As the tremor progresses, it may be difficult to find a dose that addresses the symptom without significant side effects.
“If someone is having significant side effects or continuing to have significant tremors, it’s reasonable to think about surgery,” Dr. Krishna says. “There are two very safe, very effective surgical options for reducing tremors: deep brain stimulation and focused ultrasound ablation.”
Surgery for Essential Tremor
Tremors take a path in the brain from the cerebellum, where they originate, to the motor cortex, which controls movement. Deep brain stimulation uses electrical stimulation of the thalamus, a structure along this pathway that processes movement signals, to reduce tremors. Focused ultrasound ablation burns this same area to reduce them.
With deep brain stimulation, electrodes are implanted in the brain through small holes in the skull, and a stimulator about the size of a pacemaker is inserted below the collarbone. The stimulator automatically sends electrical signals to regulate brain activity and reduce tremors.
“Deep brain stimulation can reduce tremors by 70 percent or more, and with this method, if the tremor worsens, your doctor can dial up the electrical dose to control the tremor over time,” Dr. Krishna says.
Focused ultrasound ablation is an outpatient procedure that doesn’t require incisions, implanted hardware or general anesthesia. You’ll put on a helmet-like device and your doctor will use ultrasound beams at low levels to heat and inactivate brain tissue that causes tremors; this tissue is not otherwise needed for daily living.
Dr. Krishna was one of 15 researchers who demonstrated this treatment’s effectiveness for essential tremor in a clinical trial and notes that it can reduce tremors by 60 to 70 percent.
If you only have a slight tremor right now, brain surgery might seem daunting, but Dr. Krishna urges you to continue to see your doctor about the condition.
“The tremor creeps in and creates difficulty for what you enjoy doing, and you might slowly recede without realizing the effect on your quality of life,” Dr. Krishna says. “I’ve had patients who were musicians or painters where loss of hand function is a major issue because they can’t do what they enjoy doing most. We can help you figure out what works best for you and your lifestyle and form a treatment plan that improves your quality of life.”
If you notice a tremor, talk to your doctor. If you need a doctor, find one near you.