Essential tremor is the most common movement disorder that causes rhythmic shaking. It affects the hands in most cases, but I also can affect the voice, arms, legs, and head. The tremor happens when the person is trying to perform a simple task like buttoning a shirt, putting on makeup or shaving for example.
This disorder is a chronic condition, meaning it could last for years or even be life-long.
Is the tremor caused by something more dangerous?
In most cases no. The tremor can have no known cause and is benign. In order to diagnose essential tremor, your doctor will have to rule out other conditions first.
A condition that is commonly confused with essential tremor is Parkinson’s disease. A defining characteristic of Parkinson’s is the tremor will occur while the person is at rest. With an essential tremor, the trembling occurs only when the person is attempting a task.
Essential tremor isn’t associated with secondary health complications/conditions. There are some people with an essential tremor that can develop neurological symptoms.
What is the likelihood of someone getting essential tremor?
There are two factors known that increase the likelihood of developing an essential tremor. One of which is a genetic mutation that is inherited, known as a familial tremor. The defective gene can be passed from just one parent. If your parent has the mutation you have a 50% percent chance of having essential tremor.
The other factor is age-related. It is more commonly found in people over 40 years old.
It is important to note that only half of the people with essential tremor have it as a result of the genetic mutation. It is not yet known what causes the tremor in those without this mutation.
It can occur in anyone, of any age.
What are the symptoms?
- Trembling that worsens with movement.
- Yes and no motions of the head not made intentionally.
- It starts gradually and can start on one side of the body.
- Hands are normally affected first.
- Stress, fatigue, caffeine and other environmental factors tend to make it worse.
If you have these symptoms, speak with your doctor.
How is it diagnosed?
There may be many steps to a final diagnosis of essential tremor. The first of which is a neurological exam and performance test that your doctor will do in your appointment.
They will check your posture, muscle strength, coordination, gait, and reflexes. They may ask you to hold your arms out, write, drink from a cup and draw a spiral.
Drawing a spiral can help the doctor gauge the frequency and intensity of your tremor.
Lab tests can be done to check if there are any underlying causes like metabolic problems, drug side-effects, thyroid disease and many others.
If the doctor is unsure you may be tested for Parkinson’s disease with a DAT scan. Ruling out Parkinson’s is an important step.
Can it be treated?
There are a few options for treatment of an essential tremor.
Medications are often used as a first step. Your doctor will determine what is best for you. The first medication, and most commonly used for essential tremor are beta blockers. They are normally used to treat high blood pressure but are known to relieve tremors.
Anti-seizure medications are used for those who don’t respond to the beta-blockers.
Benzodiazapines like Xanax or Klonopin can be used to treat those who are more affected by stress. They help to relax the person and releive the symptoms of stress. These medications can be habit forming and are only used with caution.
Botox injections can also be used in treating the tremors that affect the head and voice. If used for the voice, a side effect of hoarsness and difficulty swallowing can happen. It can be used to treat tremors in the hands, but it can cause weakness in the fingers.
If medications are not enough, occipatonal therapy is an option your doctor might suggest. It involves physical therapy that works to help you adapt to life with essential tremor. There are adaptive devices that they can suggest to use that diminish the effect of the tremor in an activity. Objects can be used like heavier glasses, wrist weights and wide writing tools to assist with grip.
If the tremor is severe, and doesn’t respond to medications or occupational therapies surgery is another option.
Deep brain stimulation invloves the doctor inserting an electrial probe into the protion of the brain that causes the tremors. The wire from the probe is run under the skin and into a pacemaker type device that is implanted just under the skin of the chest. The device will send painless signals that interupt the signals that cause the tremors. This does come with risks and side-effects such as, weakness, speech and balance issues, headaches and equipment malfunctions. They can go away with time as you adjust to the device.
What can I expect?
Essential tremor effects everyone differenly. It can be difficult to cope with and change the way others see you. It is a visible illness, and that alone can have a huge impact on your mental health. Support groups, counseling and social engagement can be helpful because you can find others to relate to.
Remember, the severity of essential tremor is different for everyone. Discuss all of your options with your doctor.
Resources:
Epileptea 