Essential Tremor: Symptoms, Causes, And Diagnosis

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Medical News TodaySubscribeWhat to know about essential tremor

Medically reviewed by Seunggu Han, M.D. — Written by Adam Felman — Updated on April 16, 2021

Symptoms
Causes
Diagnosis
Treatment
Takeaway

Essential tremor is a neurological condition and movement disorder that causes involuntary shaking or trembling of part of the body, such as the hands, head, or jaw.

Essential tremor is the most common movement disorder, and around 10 million people in the United States experience it.

Essential tremor usually occurs alone, without other neurological symptoms, though some people may also have trouble with balance, for example.

Many people with Parkinson’s disease experience tremors, but essential tremor and Parkinson’s disease are different. Experts are still investigating possible links between the two.

In this article, we describe the symptoms, causes, diagnosis, and treatment of essential tremor.

Symptoms

Woman holding her face, looking sad — fizkes/Getty Images

The main symptom of essential tremor is trembling, particularly of the hands. The person cannot control this movement, which tends to have a rhythmic pattern. It may be an up-and-down or side-to-side motion.

Essential tremor usually affects both sides of the body, but it may be more noticeable on one side. A person may have the tremor in their:

face
head
neck
hands
arms
trunk
voice
legs and feet, less commonly

Essential tremor does not usually happen at rest. It can happen during activities such as eating and drinking, shaving, applying makeup, or writing. A person may also notice it when they hold out their hands.

The tremor is progressive, which means that it tends to become more severe over time. It can make daily activities, such as drinking from a glass, tying up shoelaces, or writing difficult.

A person with essential tremor may also experience:

changes in the way they walk
changes in thinking
depression
anxiety
personality changes
ataxia, a reduced ability to coordinate voluntary movements
a loss of hearing and the sense of smell, in some people

Causes

Essential tremor is a neurological condition and a movement disorder. Tremors happen when there is faulty signaling between the nerves and the muscles they connect with, but the exact cause remains unclear.

There may be genetic factors involving specific chromosomes or the nervous system, but research has not yet confirmed this. According to the National Organization for Rare Disorders (NORD), 17–50% of essential tremor cases may be hereditary.

The risk of developing essential tremor increases with age, but anyone can have it, including children.

There may be links between essential tremor and:

the use of some medications
exposure to toxins such as lead and mercury
an overactive thyroid
Parkinson’s disease
dystonia

Some experts have suggested that people with essential tremor may have a higher risk of developing other neurological conditions, such as Parkinson’s disease and hearing loss, especially if the tremor starts after the age of 65 years.

There may also be a higher risk of developing Alzheimer’s disease, according to NORD.

Learn more about the causes of hand tremors.

Triggers

Some factors can make essential tremor more pronounced. These include:

fatigue
stress and anxiety
hunger or low blood sugar
caffeine consumption
hot or cold temperatures
tobacco use

Alcohol consumption can worsen tremor during a hangover, in the short term, and if a dependency develops, in the long term. While a small study in 10 people found that tremor improved 45 minutes after consuming alcohol — drinking is not a treatment for essential tremor, and it can increase the risk of many severe health problems.

Diagnosis

There is no test for essential tremor. Instead, a doctor tends to:

look at the person’s symptoms
ask about their personal and family medical histories
ask about any medications
perform a physical examination
do some tests, if appropriate, to rule out other conditions

To evaluate the tremor, the doctor may ask the individual to:

pour and drink water
touch their fingers to their nose
hold their hands out in front of them
write
draw a spiral

They will also assess the person’s:

muscle strength and tone
tendon reflexes
gait
posture and coordination
ability to feel certain sensations

Tests to rule out other conditions might include a blood test to check levels of thyroid hormones and an MRI scan of the brain.

Treatment

If essential tremor is mild, it may not need treatment. If it affects the quality of life or ability to do everyday tasks, a doctor may recommend one of the following approaches.

Medications for essential tremor

The following types of medication may reduce the tremor:

beta-blockers, such as propranolol (Inderal), atenolol (Tenormin), sotalol (Betapace), or nadolol (Corgard)
calcium channel blockers, such as nimodipine (Nimotop)
anticonvulsants, such as primidone (Mysoline), topiramate (Topamax), and gabapentin (Neurontin)
antianxiety medications, such as alprazolam (Xanax) and clonazepam (Klonopin)

Doctors most commonly prescribe propranolol or primidone, although 30–50% of people report having no benefit from these drugs.

Botox injections might also help. Muscle weakness is a possible side effect, but this is usually temporary.

Deep brain stimulation

A doctor may recommend deep brain stimulation (DBS). This involves using imaging techniques to locate the thalamus, a part of the brain that helps control movement.

A surgeon then inserts an electrode into the area and an implantable pulse generator under the skin of the chest. The two are connected with a small wire. The generator helps control the tremor by sending electric currents to the brain.

A study in 34 people with essential tremor found that DBS reduced the tremor by about 80% and improved handwriting by nearly 70%. A follow-up assessment of 12 participants 90.7 months after their surgery suggested that the improvement was lasting.

Complications of the procedure include:

headaches
pain after surgery
seizures
bleeding and swelling in the brain

DBS may help with tremor, but it will not cure nerve damage or stop it from getting worse. Also, it will not improve dementia or other types of cognitive decline.

Thalamotomy

Another surgical option is a thalamotomy. This involves making a small lesion in the thalamus to block the brain activity that is causing the tremor.

Making this incision on one side can help reduce the tremor on one side of the body. Operating on both sides is not possible, as it could lead to severe disability.

Newer techniques are less invasive and include using focused radiation or ultrasound to cause the same lesion as the surgery.

The risk of complications, however, outweighs the benefits for most people. For this reason, doctors do not often recommend the surgery and always recommend medication first.

Physical therapy

Physical therapy to boost physical awareness may improve the quality of life for people with essential tremor.

While little research supports this approach, a 2017 case study suggests that it might help.

A 61-year old male who had previously undergone DBS participated in training that focused on balance, functional movement, and stability. After 14 weeks, the participant saw improvements in walking speed, balance, and performance of daily tasks. The risk of falls also decreased.

Takeaway

Essential tremor is a neurological condition and movement disorder that leads to trembling. It often affects the hands and head, but it can affect other areas, such as the limbs and trunk. Experts do not know exactly why it develops, but genetics may play a role.

If symptoms are mild, treatment may not be necessary. If the tremor affects the quality of life, a doctor may suggest medication, physical therapy, surgery, or a combination.

Alcohol / Addiction / Illegal Drugs
Anxiety / Stress
Psychology / Psychiatry
Seniors / Aging

How we reviewed this article:

SourcesMedical News Today has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

AAN summary of evidence-based guideline for patients and their families: Treatment of essential tremor. (2011).https://www.academia.edu/28660873/AAN_Summary_of_Evidence_based_Guideline_for_PATIENTS_and_ThEIr_FAMILIES_TrEATMENT_OF_ESSENTIAL_TrEMOr
Alcohol. (n.d.).https://tremor.org.uk/alcohol
Deep brain stimulation for movement disorders information page. (2019).https://www.ninds.nih.gov/Disorders/All-Disorders/Deep-Brain-Stimulation-Movement-Disorders-Information-Page
Essential tremor. (2020).https://medlineplus.gov/genetics/condition/essential-tremor/
Essential tremor. (2015).https://rarediseases.org/rare-diseases/essential-tremor/
Louis, E. D., et al. (2014). How many people in the USA have essential tremor? Deriving a population estimate based on epidemiological data.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137360/
Shanker, V. (2019). Essential tremor: Diagnosis and management.https://www.bmj.com/content/366/bmj.l4485
Tarakad, A., et al. (2019). Essential tremor and Parkinson’s disease: Exploring the relationship.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329774/
Ulanowski, E. A., et al. (2017). Physical therapy for a patient with essential tremor and prolonged deep brain stimulation: A case report.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357321/
Zhang, K., et al. (2010). Long-term results of thalamic deep brain stimulation for essential tremor.https://pubmed.ncbi.nlm.nih.gov/19911883/

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Medically reviewed by Seunggu Han, M.D. — Written by Adam Felman — Updated on April 16, 2021

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Tag » Why Do I Shake When I Yawn

Essential Tremor: Symptoms, Causes, And Diagnosis

Symptoms

Causes

Triggers

Diagnosis

Treatment

Medications for essential tremor

Deep brain stimulation

Thalamotomy

Physical therapy

Takeaway

How we reviewed this article:

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