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Essential tremor (ET) is a type of involuntary shaking movement. It has no identified cause. Involuntary means you shake without trying to do so and are not able to stop the shaking at will.
Tremor - essential; Familial tremor; Tremor - familial; Benign essential tremor; Shaking - essential tremor
ET is the most common type of tremor. Everyone has some tremor, but the movements are often so small that they can't be seen. ET affects both men and women. It is most common in people older than 65 years.
The exact cause of ET is unknown. Research suggests that the part of the brain that controls muscle movements does not work correctly in people with ET.
If an ET occurs in more than one member of a family, it is called a familial tremor. This type of ET is passed down through families (inherited). This suggests that genes play a role in its cause.
Familial tremor is usually a dominant trait. This means that you only need to get the gene from one parent to develop the tremor. It often starts in early middle age, but may be seen in people who are older or younger, or even in children.
The tremor is more likely to be noticed in the forearm and hands. The arms, head, eyelids, or other muscles may also be affected. The tremor rarely occurs in the legs or feet. A person with ET may have trouble holding or using small objects such as silverware or a pen.
The shaking most often involves small, rapid movements occurring 4 to 12 times a second.
Specific symptoms may include:
The tremors may:
Your health care provider can make the diagnosis by performing a physical exam and asking about your medical and personal history.
Tests may be needed to rule out other reasons for the tremors such as:
Treatment may not be needed unless the tremors interfere with your daily activities or cause embarrassment.
For tremors made worse by stress, try techniques that help you relax. For tremors of any cause, avoid caffeine and get enough sleep.
For tremors caused or made worse by a medicine, talk to your provider about stopping the medicine, reducing the dosage, or switching. Do not change or stop any medicine on your own.
Severe tremors make it harder to do daily activities. You may need help with these activities. Things that can help include:
MEDICINES FOR TREMOR
Medicines may help relieve symptoms. The most commonly used drugs include:
These drugs can have side effects.
Other medicines that may reduce tremors include:
Botox injections given in the hand may be tried to reduce tremors.
In severe cases, surgery may be tried. This may include:
An ET is not a dangerous problem. But some people find the tremors annoying and embarrassing. In some cases, it may be dramatic enough to interfere with work, writing, eating, or drinking.
Sometimes, the tremors affect the vocal cords, which may lead to speech problems.
Call your provider if:
Alcoholic beverages in small quantities may decrease tremors. But alcohol use disorder may develop, especially if you have a family history of such problems.
Jankovic J. Parkinson disease and other movement disorders. In: Daroff RB, Jankovic J, Maziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 96.
Lang AE. Other movement disorders. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 410.
Zesiewicz TA, Elble RJ, Louis ED, et al. Evidence-based guideline update: treatment of essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2011;77(19):1752-1755. PMID: 22013182 www.ncbi.nlm.nih.gov/pubmed/22013182.