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Essential tremor - symptoms, diagnosis, treatment

Essential tremor is a condition that involves involuntary shaking of parts of the body, usually without any other symptoms.  It’s a relatively common disorder affecting 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 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

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 activities such as writing, eating and dressing.

There are three different types of tremor that 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 hands. It is a relatively fine 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 and treatment

Diagnosis of essential tremor is based on medical 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 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 in order 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.

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.

Further information and support

For further information and support about essential tremor, contact you doctor, or the New Zealand Essential Tremor Support Group. There details are as follows:
New Zealand Essential Tremor Support Group Inc.
Ph: 0508 TREMOR (873 667)


Burke, DA. Essential Tremor (2012). Medscape Reference: Drugs, Diseases & Procedures. WEbMD LLC.
Venkatasubramanian, C. (2005) Essential Tremor. The Gale Encyclopedia of Genetic Disorders, Second Edition. Brigham Nairns, Editor. Farmington Hills, MI. Thomson Gale.
O'Toole, MT. (Ed) (2013) Mosby's Dictionary of Medical, Nursing & Allied Health Professions (9th ed). St.Louis: Elsevior Mosby.
Last reviewed – 10 May 2013
Go to our Medical Library Index Page to find information on other medical conditions.