Essential Tremor

Overview

Essential tremor is a nervous system condition characterized by involuntary and rhythmic shaking. It can affect various parts of the body, most commonly the hands, causing trembling during simple tasks like drinking from a glass or tying shoelaces. The trembling usually starts gradually and worsens over time. Essential tremor is not a dangerous condition, but it can become severe in some individuals. It is often confused with Parkinson's disease, but the two conditions differ in terms of timing and associated conditions. Essential tremor is not life-threatening, but its symptoms may worsen over time, affecting daily activities such as holding a cup, eating, or writing.

Understanding the disease

Symptoms

The symptoms of essential tremor include:

• Gradual onset
• Rhythmic shaking or trembling, usually starting in the hands
• Worsening with movement
• One-sided symptoms that may spread to the other side
• Head motion resembling "yes-yes" or "no-no"
• Tremors aggravated by emotional stress, fatigue, caffeine, or temperature extremes.

Risk Factors

The risk factors for developing essential tremor include an altered gene and age. Essential tremor that runs in families, known as familial tremor, is associated with an inherited altered gene. If one parent has an altered gene, their child has a 50% chance of developing the condition. Essential tremor is more common in people over 40 years of age.

Development

Essential tremor develops due to a nervous system condition causing involuntary and rhythmic shaking. It usually affects the hands, causing trembling during simple tasks like drinking from a glass or tying shoelaces. The condition typically worsens over time, but it's not considered life-threatening. About half of the people with essential tremor have an altered gene, which is referred to as familial tremor. For others, the cause is not clear. Essential tremor is more common in people aged 40 and older, and it can be aggravated by emotional stress, fatigue, caffeine, or temperature extremes.

Assessment and Diagnosis

Diagnosis

To diagnose essential tremor, your healthcare provider will typically start with a review of your medical history, family history, and symptoms. There are no specific medical tests to diagnose essential tremor, so it often involves ruling out other conditions that could be causing the symptoms. A neurological examination will be conducted to test your nervous system functioning, including checking your tendon reflexes, muscle strength and tone, ability to feel certain sensations, posture and coordination, and gait. Blood and urine tests may be conducted to rule out other conditions such as thyroid disease, metabolic problems, or side effects from medications. Performance tests may also be conducted, such as asking you to drink from a glass, hold your arms outstretched, write, or draw a spiral to evaluate the tremor itself. If your healthcare provider is still unsure if your tremor is essential tremor or Parkinson's disease, they may order a dopamine transporter scan to help distinguish between the two.

Management and Treatment

Complications

Complications of essential tremor can include difficulties with daily activities such as holding a cup or glass without spilling, eating without shaking, putting on makeup or shaving, and talking if the voice box or tongue is affected. Additionally, writing legibly may be challenging. Essential tremor symptoms often worsen over time, which can impact the overall quality of life.

Treatment

There are several treatments for essential tremor, though the effectiveness of each treatment can vary from person to person. Some common treatment options are:

1. Medications: Doctors may prescribe medications like primidone, propranolol, or topiramate to help control the tremors. These drugs can help reduce the severity and frequency of the shaking.
2. Deep brain stimulation: In some cases, deep brain stimulation (DBS) might be recommended as a treatment option. DBS involves implanting a device that sends electrical impulses to targeted areas of the brain, helping to reduce the tremors.
3. Lifestyle changes: Avoiding caffeine, alcohol, and other stimulants can help reduce the severity of essential tremor. Additionally, maintaining a regular sleep schedule, managing stress, and avoiding overexposure to temperature extremes can help improve symptoms.
4. Physical therapy: A skilled physical therapist can help patients develop adaptive strategies to manage the tremors, such as using splints or changing the way they perform daily tasks. It's important to consult a healthcare professional for an accurate diagnosis and personalized treatment plan for essential tremor.

Preparing for medical consultation

To prepare for an appointment for essential tremor, you should:

1. Make a list of your symptoms, including any that seem unrelated to the reason for your appointment.
2. Gather information about your personal and family medical history.
3. Bring a list of all medications, vitamins, or other supplements you are taking, including doses.
4. Compile a list of questions to ask your healthcare provider during the appointment.
5. Consider bringing a family member or friend to the appointment for support. For essential tremor, some questions to ask your healthcare provider include:

• What's the most likely cause of my symptoms?
• Are there other possible causes?
• What tests do I need?
• How does essential tremor usually progress?
• What treatments are available, and which do you recommend?
• How can I best manage other health conditions I have alongside essential tremor?
• Are there any restrictions I need to follow?
• Should I see a specialist? If so, whom do you recommend?
• Are there brochures or other printed materials I can have? What websites do you recommend?