Essential Tremor

Essential tremor (ET) is a common condition that causes uncontrollable shaking in various parts of your body. This shaking can affect your hands, arms, head, voice box, tongue, and chin. The good news is that ET isn’t life-threatening, and most people can live normal lives with it. However, severe tremors can make daily activities like eating, dressing, or writing challenging.

Causes

Doctors aren’t entirely sure what causes ET, but they believe unusual electrical activity in the brain, particularly the thalamus (which coordinates muscle movement), is involved. Genetics play a role in about half of ET cases, with a 50% chance of passing the responsible gene to a child (who may not develop symptoms). While ET is more common in older adults and worsens with age, it’s not a natural part of aging.

Who is at risk?

ET is the most prevalent movement disorder, affecting up to 10 million people in the U.S. It can appear at any age, but adolescence or midlife (40–50 years) are the most common times for symptoms to arise. It’s important to note that ET is not a natural part of aging.

Symptoms of Essential Tremor

The primary symptoms associated with essential tremor encompass:

• Involuntary shaking episodes often occur briefly and uncontrollably.
• Quavering voice.
• Repetitive nodding of the head.
• Tremors exacerbate during periods of emotional strain.
• Increased tremors with intentional movement.
• Tremors are alleviated with rest.
• In rare instances, difficulties with balance may also arise.

It’s important to note that various factors or ailments can also trigger tremors, including Parkinson’s disease, multiple sclerosis, post-exercise fatigue, intense emotional distress, brain tumors, certain medications, metabolic disorders, and withdrawal from alcohol or drugs.

Possible Links to Other Health Issues

Essential tremor has been associated with various other conditions. Some reports suggest a connection between essential tremor and other movement disorders like Parkinson’s disease. Additionally, there are indications linking essential tremor to migraine headaches, and individuals with essential tremor may have an elevated risk of developing dementia, particularly Alzheimer’s disease.

It’s worth noting that medications used to manage essential tremors might potentially heighten the likelihood of experiencing depression.

While some experts suggest no increased risk of Parkinson’s disease for individuals with essential tremor, it’s possible that some people initially diagnosed with essential tremor might later be found to have Parkinson’s disease.

Diagnosing Essential Tremor

Typically, a neurologist or a specialist in movement disorders can diagnose essential tremor by assessing your symptoms and conducting a thorough neurological examination. Unlike some conditions, there isn’t a specific blood, urine, or other diagnostic test for essential tremor.

During the examination, your doctor may explore other potential causes of tremors, such as thyroid disorders, excessive caffeine consumption, or side effects from medications.

Treatment Options for Essential Tremor

In cases where the essential tremor is mild and doesn’t significantly impact daily life or social interactions, treatment may not be necessary. However, if essential tremor poses challenges in everyday activities or is socially burdensome, various treatments can help alleviate symptoms, including medications or surgical interventions.

Medications:

Oral medications can effectively reduce the severity of essential tremors. Some commonly prescribed drugs include gabapentin (Neurontin), primidone (Mysoline), propranolol (Hemangeol, Inderal, Inderal XL, InnoPran XL), and topiramate (Topamax). Benzodiazepines like alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan) may also be used. Additionally, Botox injections have shown effectiveness in treating vocal and head tremors.

Adaptive Devices:

External devices can help manage tremors by altering or controlling their severity. While they may benefit anyone with essential tremors, individuals with disabling tremors might not be ideal candidates. These devices include neuromodulation devices that are worn and controlled by the individual and tremor cancellation devices that help control hand tremors, facilitating activities like eating or writing.

Deep Brain Stimulation (DBS):

For individuals with severe tremors unresponsive to medication, DBS surgery can be an option. This procedure involves implanting an electrode into the thalamus, connected to a pacemaker-like device under the skin of the chest. The device emits gentle shocks that disrupt abnormal brain signals. DBS provides moderate relief for about 90% of recipients, and it can be adjusted or removed without damaging brain tissue, although it requires brain surgery and may cause symptoms during shock delivery.

MRI-Guided Focused High-Intensity Ultrasound:

This non-invasive procedure employs MRI technology to precisely target and destroy tissue in the thalamus using ultrasound waves. Although painless and conducted without cutting or drilling into the brain, it may not be effective for everyone, and any improvement in tremors could diminish over time.

Thalamotomy:

In some cases, surgery may involve selectively destroying part of the thalamus, usually on one side of the brain, to minimize risks. This can lead to improvements in tremors on the opposite side of the body.

Biomechanical Loading:

This therapy applies external force to a limb or muscle to control tremors. Research suggests that repeated sessions of this treatment can help alleviate tremors.

Prevention of Essential Tremor

Since the exact cause of essential tremor remains unknown, there are no preventive measures to avoid its onset. However, understanding the genetic predisposition associated with essential tremor provides researchers with valuable insights as they explore potential treatments and preventive strategies.

Living a Full Life with Essential Tremor

Unfortunately, there is currently no cure for essential tremor. However, various treatments exist to alleviate symptoms and enhance quality of life. These treatments may include medications and surgical interventions aimed at reducing tremors. It’s important to note that not every treatment or procedure is equally effective for every individual with essential tremor. Your doctor will devise a personalized treatment plan, which may include lifestyle adjustments that could help diminish tremors.

Sources

• Johns Hopkins Medicine Movement Disorders Center
• U.S. National Library of Medicine
• Clevland clinic
• American Academy of Neurology
• The Movement Disorder Society