Benign essential tremor (ET) is a movement disorder most commonly noticed by shaking in the hands. It occurs in about 5% of older adults. 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.
What is tremor?
A tremor is a repetitive movement of a part of the body. It is involuntary. This means that it is generally not controllable and happens without you deciding to move that body part. It is often felt as a trembling or shaking sensation.
A slight tremor is present in all people. That is called physiological tremor. It may not be noticeable. Certain things will make a physiological tremor more noticeable such as caffeine (in coffee, tea and cola), anxiety or tiredness.
What is essential tremor?
Essential tremor is also called familial essential tremor. It is different from physiological tremor described above. It usually starts in the hands and arms. It can sometimes become quite severe so that everyday activities like holding a cup can be difficult. The tremor is usually not there at rest but becomes noticeable when the affected body part is held in a position, or with movement.
The term ‘essential’ means that there is no associated disease that causes the tremor.
For some people, ET is caused by a genetic mutation. For others, the cause is not clear.
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 teens and people older than 50 years old.
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 movement
- Shaking most common in hands, arms, head, or voice
- 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
- Shaking that may decrease when using alcohol
- Hearing loss
- Problems with social, functional, or job-related abilities in more severe cases
Tremors must not be related to other health conditions in order for someone to have the ET diagnosis.
You will be asked 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.
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
The following treatment options may be helpful:
You may be prescribed:
- Anti-seizure medications
- Botulinum injections
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 (less commonly performed than DBS)
There is no known way to prevent ET.