Description

Essential tremor (ET) is the most common cause of action tremors worldwide with an estimated prevalence worldwide of 1% overall and 5% in adults over the age of 60 years.  While sometimes confused with Parkinson's disease by patients, it is distinct and does not lead to the disability that can be associated with Parkinson's disease. ET tends to progress over time and may impact daily activities including writing and eating.

ET is familial, or inherited, in at least 50% of cases. There are aggravating factors that can make the tremor worse, such as stress, nicotine, caffeine, withdrawal from alcohol, and some medications. There are other conditions that can be confused with ET, for example, hyperthyroidism.

Symptoms

Essential tremor causes a rhythmic shaking movement of different parts of the body, especially the hands, head, and voice. The hand tremors in general do not occur at rest, but are increased with purposeful hand or arm movement in performing a specific activity, for example, holding a plate, drinking from a glass, and writing.  Alcohol consumption may decrease the tremor for a short period of time which may be followed by a rebound increase of tremor after the effects of alcohol wear off.

Diagnosis

Essential tremor is a clinical diagnosis which is made based on a comprehensive history and physical examination.  Additional evaluation may include blood work to exclude metabolic factors (thyroid dysfunction) and MRI (magnetic resonance imaging) to exclude structural abnormalities that can cause a tremor.  Absent any other treatable conditions which may cause tremor, appropriate medications can be prescribed to treat essential tremor.

Treatment

The following first line treatments may be considered (side effects listed in parentheses):

• Propranolol (dizziness, lightheadedness, nightmares, low blood pressure, slow heart rate, hair loss)
• Primidone (unsteadiness, dizziness, nausea, sedation).

Second line treatments include:

• Benzodiazepines (i.e. clonazepam, alprazolam) (sedation, dizziness, possibly addictive)
• Gabapentin (dizziness, sedation, swelling, weight gain)
• Topiramate (tingling in the extremities, word finding difficulty, reduced sweating, kidney stones)  

Botulinum toxin treatment with injections every 3 months is used to dampen the tremor in some patients who cannot tolerate medications or do not respond well to them.

Also available, a device called Cala Trio which is FDA approved to treat Essential Tremor. It is a wrist bracelet that is worn daily for 40 minutes to provide stimulation to the radial and median nerves in the wrist.  This treatment may provide up to an hour of relief from tremor.

There are also surgical options for treatment including deep brain stimulation and focused ultrasound. Your neurologist will be able to guide you as to which treatment plan is the best to suit your needs.