Essential tremor is often mild and non-progressive but for some can be severe and affect daily activities like writing, eating and getting dressed. The condition can be mistaken for Parkinson’s disease so referral to a neurologist can assist with diagnosis.
Essential tremor is the most common type of tremor. Other names given to essential tremor include idiopathic postural tremor, benign essential tremor, familial tremor or senile tremor. It is benign in the sense that it does not indicate a serious underlying disorder of the nervous system and does not alter life expectancy.
In most cases the condition is mild and non-progressive. However, in some cases the condition is slowly progressive and worsens over time. Essential tremor can be quite disabling if the tremors are severe, and can significantly affect a person’s quality of life.
While essential tremor can affect people of all ages, the average age of onset is the mid 40s. It is estimated that essential tremor affects between 1% and 5% of the adult population in New Zealand. It occurs equally in men and women, and occurs in all ethnic groups. It is a more common cause of tremor in all age groups than Parkinson’s disease.
Essential tremor occurs as the result of abnormal communication between certain areas of the brain. A genetic cause for essential tremor has been identified in 50-70% of cases and, as a result, it has a strong tendency to run in families. However, essential tremor can develop in people who have no family history of the condition.
Signs and symptoms
There is great individual variation as to the severity of the condition. Symptoms can differ from person to person and change from day to day. In more severe cases, essential tremor can interfere with activities such as writing, eating and dressing.
There are three different types of tremor that can be observed in the condition.
This is the most common type of tremor experienced in essential tremor. It is seen when a person is voluntarily maintaining a fixed position eg: having outstretched hands. It is a relatively fine tremor.
This type of tremor is obvious when performing tasks, such as writing, drinking from a cup, or buttoning a shirt. It is a more severe tremor and it is the tremor that can interfere most with daily activities.
This is a feeling of general shakiness, often accompanied by a sensation of vibration inside the body.
Factors that can increase the severity of tremors include fatigue, anxiety, foods containing caffeine (eg: chocolate, cola, coffee), excessive alcohol, and smoking.
Diagnosis and treatment
Treatment of essential tremor aims to relieve its symptoms. However, if the tremor does not interfere with daily living, treatment may not be necessary. Treatment options include:
The first step in treatment often involves lifestyle changes. These may include:
- Avoiding food and drinks containing caffeine
- Not smoking
- Avoiding excessive alcohol
- Managing stress
- Getting adequate amounts of rest in order to reduce fatigue
Alternative therapies such as yoga, acupuncture, biofeedback and tai-chi may be useful in relieving symptoms – especially in those whose symptoms worsen with stress and anxiety.
If further treatment is required, a type of medication called a beta-blocker - most commonly propranolol (Cardinolol or Apo-propranolol) may be prescribed. Beta-blockers prevent the action of adrenaline and reduce the severity of tremors. They tend to work best for hand tremors. Other forms of medications, such as certain anti-seizure and sedative medications, may also be used to relieve symptoms. They may be used in combination with the beta-blocker.
This is only considered in very severe, disabling cases, where all other forms of treatment have been unsuccessful. Surgery involves operating on an area of the brain called the thalamus. The thalamus is involved in the control of movement and surgery to this area can reduce the severity of tremors.