Computer stethoscope med

Southern Cross Medical Library

Southern Cross Medical Library information is necessarily of a general nature. Always seek specific medical advice for treatment appropriate to you. For more articles go to the Medical Library index page.

Essential tremor - symptoms, diagnosis, treatment

 
Essential tremor is a condition of the nervous system that involves involuntary shaking of parts of the body, usually without any other symptoms.  It’s a relatively common disorder that may affect between 1% and 5% of the adult population in New Zealand. It is sometimes referred to as familial tremor because in some cases it runs in families.

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.

General information

Essential tremor is an involuntary rhythmic shaking of a part of the body. It most commonly affects the arms, hands and head, and can also affect the jaw, face and vocal cords.  Rarely, it affects the trunk and legs.

Essential tremor is the most common type of movement disorder. 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 35-45 years.  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

Tremors are usually the only symptom of essential tremor. In the early stages of the condition tremors may only be noticed periodically and may be very mild. However, the condition can progressively worsen over time. It is possible for symptoms to plateau – where the condition remains stable without worsening for many years.

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 daily activities such as writing, eating and dressing.

Three distinct types of tremor can be observed in the condition:

Postural tremor
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 arms. It may be a relatively fine and rapid tremor.
 
Kinetic 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.
 
Internal tremor
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

Diagnosis of essential tremor is based on medical history, family history, physical examination and assessment of symptoms. Due to similarities between essential tremor and Parkinson’s disease, they are often mistaken for one another. For this reason a referral to a neurologist (a doctor who specialises in brain and nervous system disorders) is usually required before an accurate diagnosis can be made.

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:

Lifestyle changes

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 to reduce fatigue.
Alternative therapies
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.
 
Physical or occupational therapy
Physical or occupational therapy may be recommended.  Physical therapists can teach people with essential tremor exercises to improve their muscle strength, control, and coordination.  Occupational therapists can help people to adapt to living with essential tremor.
 
Medications
If further treatment is required, a type of medication called a beta-blocker - most commonly propranolol - may be prescribed.  Beta-blockers inhibitthe action of adrenaline and reduce the severity of tremors. They tend to work best for hand tremors.  Anti-seizure medications - most commonly primidone - may be effective in people who do not respond to beta blockers.  Sedative medications may be beneficial in people for whom anxiety worsens their tremors.

Surgery
This is only considered in very severe, disabling cases, where all other forms of treatment have been unsuccessful. Surgery involves operating on (thalamotomy) or electrical stimulation of (deep brain stimulation) 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.  

Further information and support

For further information and support about essential tremor, contact you doctor, or the New Zealand Essential Tremor Support Group. Their details are as follows:
 
New Zealand Essential Tremor Support Group Inc.
Freephone: 0508 TREMOR (873 667)
E-mail: nzetsg@gmail.com
Web: www.essentialtremor.org.nz 

References

Burke, D.A. (2016). Essential tremor (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/1150290-overview [Accessed: 12/07/17]
Mayo Clinic (2016). Essential tremor (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/essential-tremor/home/ovc-20177826 [Accessed: 12/07/17]
O’Toole, M.T. (Ed.) (2013). Essential tremor. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.
 
Last reviewed – July 2017
 
Go to our Medical Library Index Page to find information on other medical conditions.